Why Doula Support May Improve Birth Outcomes
Doulas are entering the mainstream as awareness of their contributions to improve birth outcomes grows. Doula support has been found to reduce cesarean section frequency, low birth weight, and premature labor. To improve parental and infant health in the United States, twenty-six states have added doula services to Medicaid coverage.
Why does doula support work?
Doulas offer relationship-driven physical, emotional, and informational support to families during pregnancy, birth, and postpartum. Prenatal sessions are an essential part of the practice that are often used to create plans for birth and postpartum, learn about childbirth, discuss pain management, and advise on nutrition. In some cases, this is the only prenatal care families have access to and is a vital source for education. Preparation for birth helps parents feel more confident and relaxed when entering the birthing space, especially since a skilled support person will be present to help birth go smoothly.
“Failure to progress” is a common reason vaginal labor is escalated to cesarean birth. In order for a vaginal delivery to happen, the baby must be positioned and engaged in the pelvis and prepared for pushing. Doulas are trained in how to encourage fetal positioning using birth tools like the peanut ball and improve engagement by providing suggestions based on the metrics of fetal station, dilation, and effacement. With guided support, birthing people are often able to deliver vaginally.
Cesarean births are not bad, but are not always medically necessary.
Cesarean intervention can be a lifesaving procedure for parents and babies who need it. The World Health Organization has identified an ideal cesarean rate of 10-15%, defining it is a procedure that can effectively prevent maternal and perinatal mortality and morbidity. However, there was no evidence to support benefit for birthing people and infants who do not require the procedure.
Doula support does not replace lack of access to medical care.
Doulas are a wealth of experience, knowledge, and care who offer evidence-backed support for birthing people. While doula support may improves birth outcomes, it is not an appropriate solution for systemic outcomes created by lack of access to prenatal, birth, and labor care.
References
Hasan, Anoosha. 2024, April 16. State Medicaid Approaches to Doula Service Benefits. The National Academy for State Health Policy. https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/
Sobczak et al.. 2023, May 24. The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review, https://pmc.ncbi.nlm.nih.gov/articles/PMC10292163/
World Health Organization. 2015, April 14. WHO Statement on Caesarean Section Rates. https://iris.who.int/server/api/core/bitstreams/475b39fc-240b-462d-a5e1-429401c98a79/content
