As doulas, it is important we help empower our families to have positive birth experiences whenever possible. Using evidence-based strategies to improve birth outcomes is important. We can help educate families about these things so they can make informed decisions about their pregnancy and birth.
With growing research confirming what doulas have known for generations, the effectiveness of non-clinical interventions in improving birth outcomes, it’s important that we use these strategies to support the families we serve.
Here are evidence-based strategies you need to know:
Encourage Comprehensive Childbirth Education: Knowledge Is Power
Parents can only choose from the options they know exist. Childbirth education equips birthing people with an understanding of the physiological process. With that as the basis of understanding, more knowledge about pain relief options, interventions, and informed decision-making can help parents be active participants in their birth.
Evidence shows that people who take childbirth education classes are more likely to have vaginal births, use fewer interventions, and feel more satisfied with their birth experiences. As a doula, encourage attendance at quality, evidence-based classes and help interpret what’s learned for each family’s unique context.
As a doula, you might also consider becoming a Certified Childbirth Educator to help your families experience more continuity of care.
Advocacy: Teach the B.R.A.I.N. Tool
One of the most powerful tools for advocacy is the B.R.A.I.N. acronym:
- Benefits – for me? For baby?
- Risks – for me? For baby?
- Alternatives – What other options do we have?
- Intuition – What’s my gut feeling?
- Nothing – What happens if we do nothing?
Teaching families how to use this method helps them communicate with their providers to better make informed decisions. Even when a client agrees with their provider’s recommendation, it can help them process why an intervention is recommended.
During birth, a doula can use this to remind families it is okay to ask questions and make informed decisions. Being an active participant in birth can improve birth outcomes for families.
Know the Red Flags of Pregnancy Complications
While doulas are non-clinical, we play a crucial role in helping families recognize when something might be outside the norm. Understanding warning signs like preterm labor, preeclampsia symptoms (e.g., severe headaches, swelling, high blood pressure), or abnormal bleeding allows you to encourage clients to seek timely medical care. Staying current on these red flags helps doulas be proactive, not reactive.
It is important we educate families and encourage them to practice self-advocacy whenever they have concerns about their health.
Continuous Labor Support: The Doula Advantage
The evidence is clear: continuous support during labor—especially from a trained doula—leads to shorter labors, lower rates of cesarean birth, reduced need for pain medication, and higher satisfaction.
Being a calm, consistent presence in the birth space can make a profound difference in both physical outcomes and emotional well-being. The families you serve likely know this and that is why they’ve opted to work with you. However, it is important you educate families about your role and why it can lead to improved outcomes – while emphasizing you cannot guarantee any specific outcomes. You guarantee a continuous presence and support, not specific outcomes.
Encourage Families to Always Attend Prenatal Appointments
When someone has an uncomplicated pregnancy, the frequent appointments towards the end can feel unnecessary. However, these appointments are vital for confirming mom’s blood pressure is in a safe range and baby’s heart tones are appropriately responsive. Yes, most mother baby pairs progress through pregnancy just fine. However, for the few who do not, early detection of concerns is lifesaving.
Proper prenatal care improves birth outcomes.
Overall Nutrition and Activity Level Impacts Birth Outcomes
A well-nourished, hydrated, and physically active pregnant person is more likely to have a smoother labor. Good nutrition supports fetal development, stabilizes energy levels, and reduces the risk of complications.
Gentle, regular movement—like walking, yoga, or swimming—can help align the baby, build stamina, and improve mental well-being. Doulas can provide resources and encouragement to help clients build sustainable, healthy habits.
But what about people who are unable to eat well during pregnancy? Education about the importance of nutrition can help families advocate for better care if they are struggling with prolonged pregnancy sickness. Families navigating complications, such as hyperemesis, need appropriate support to help improve their nutrition intake.
For pregnant people on modified rest, such as someone needing an emergency cerclage, working with a physical therapist can help. Finding ways to get modified and safe movement can be helpful when navigating a high-risk pregnancy.
Improve Birth By Being Upright and Moving: Gravity Is Your Friend
Encouraging upright positions and movement during labor (walking, swaying, lunging, using the birth ball) helps labor progress by using gravity and promoting optimal fetal positioning. It also allows birthing people to respond intuitively to their bodies. Research supports that upright labor leads to shorter labors and fewer interventions. Doulas can suggest and assist with different positions based on what stage of labor the client is in.
Practicing different positions towards the end of labor also allows parents to feel the benefit of positioning. For example, if a client is experiencing back pain but finds relief in an all fours position, it helps them understand how positioning can improve the labor experience.
As doulas, our role goes beyond emotional support—we are educators, encouragers of advocacy, and guides. When we center evidence-based practices like childbirth education, red flag awareness, continuous support, and movement during labor, we empower families to have safer, more satisfying births. The more tools and knowledge we bring to the table, the more we help shift birth outcomes for the better.
Let’s keep leading with knowledge, compassion, and a fierce dedication to informed, supported birth.
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Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...