Evidence on Doulas
Reduced risk of Cesarean | Shorter Labors | Less use of pain medications
In 2017, Bohren et al. published an updated Cochrane review on continuous support in childbirth. They combined the results of 26 trials with more than 15,000 people across 17 countries including North America, South America, Europe, the Middle East, Africa, Asia, and Oceania, in both high-income and middle-income settings.
People in these studies were randomly assigned (like flipping a coin) to either receive continuous, one-on-one support during labor or “usual care.”
The Cochrane reviewers also looked to see if the type of support made a difference. They wanted to know—does it matter who provides continuous labor support? Does a midwife, doula, or partner, friend, or relative offer more benefit? The researchers were able to look at this question for six topics: use of any pain medication, use of Pitocin® during labor, spontaneous vaginal birth (a vaginal birth that happens on its own), Cesarean, admission to special care nursery after birth, and negative birth experiences.
For two of the health outcomes below (designated with asterisks*), the best results occurred when a birthing person had continuous labor support from a trained doula– someone who was NOT a staff member at the hospital and NOT part of their social network.
The researchers found that overall, continuous support during birth leads to a:
25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*
8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*
10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference
38% decrease in the baby’s risk of a low five-minute Apgar score; there is no data on if the type of person providing continuous support makes a difference
31% decrease in the risk of being dissatisfied with the birth experience; this risk was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff
For more information visit: EvidenceBasedBirth.com/Doulas