A 2023 meta-analysis showed how doula support improves maternal health and birth outcomes. As doulas this is no surprise as we see the benefits of our support firsthand. We see families empowered and using their voice. We see families making evidence-based decisions that feel right for them. Most importantly, we see our clients having positive birth experiences, even when things must pivot, because they’ve got continuous support.
But our anecdotal evidence is not always enough to convince the world of the value of doula support. Plus, as doulas, we value evidence. A meta-analysis provides a clearer picture of benefits by looking at multiple studies.
A comprehensive review of data from 16 peer-reviewed studies confirmed what many of us have long observed: doula support matters and it is associated with improved maternal and infant health outcomes.
What Was The Purpose of The Meta-Analysis?
There have been several studies of varying sizes looking at the potential benefits of doula support. When it comes to evidence, a study gains more validity when similar outcomes are seen in additional studies.
A meta-analysis compiles the data from multiple studies to get a better picture of the date. This review was looking at what impact doulas might have on birth outcomes. They were evaluating how continues labor support influences both maternal and infant health metrics.
Only studies conducted in economically developed countries and focusing on healthy, non-high-risk populations were included. By focusing on this, they can look at a baseline of doula support. Future studies can then assess the impact on varying risk levels.
How Doula Support Improves Maternal Health and Birth Outcomes
Reduced Cesarean and Premature Birth Rates
Across multiple studies, doula support was associated with lower cesarean delivery rates and fewer premature births. In one large cohort, the presence of doulas corresponded with a significant drop in cesarean deliveries compared to national statistics.
This matters because cesarean surgery, while lifesaving when necessary, carries increased risks and recovery burdens compared to vaginal birth. Reduced cesarean rates align with broader goals of improving maternal safety and experiences.
More Positive Lactation Outcomes
Doulas were linked with earlier onset of lactogenesis (mature milk production) and higher breastfeeding initiation and continuation rates. For many birthing people, especially first-time parents, this early support can influence neonatal nutrition and maternal confidence during the transition to parenthood.
Shorter Labor and Less Pain Medication Use
Multiple studies reported that doula care correlated with reduced length of labor and lower use of epidurals or pain medications. These outcomes align with the benefits of continuous, individualized physical and emotional support.
Doulas support all births, including births with planned, needed, or desired pain medication use. However, doula support can ensure pain relief is used when truly needed or desired and not because someone feels unsupported.
Some parents hope to birth without an epidural but choose one when they are unable to find ways to cope with the intensity of birth. Continuous support can help parents find positions, utilize comfort techniques, and feel supported.
Improved Emotional Well-Being
One of the most consistent findings was that doulas help reduce anxiety and stress during labor. Emerging evidence suggests that this support may also lower postpartum mental health concerns such as acute stress and symptoms of post-traumatic stress.
Participants in several studies reported increased confidence and autonomy during labor when accompanied by a doula. This is an important psychological benefit with implications for long-term maternal well-being.
As doulas, we are familiar with the hormones involved with labor. We know that oxytocin is best released when people feel safe, cared about, etc. We know that adrenaline and stress hormones are released when people feel uncomfortable, scared, stressed, and anxious. The positive association between reduced anxiety and stress could be why births with doulas in attendance might help reduce the length of labor.
Addressing Health Equity: Doula Care as a Tool for Reducing Disparities
One of the most compelling elements of this review is its insight into how doula support mitigates disparities rooted in socioeconomic and racial inequalities.
For women from lower-income communities or those on public insurance plans like Medicaid, doula support was associated with:
- Near-universal rates of breastfeeding initiation in historically underserved populations
- Lower odds of non-medically indicated cesarean deliveries compared with those who desired but could not access doula care.
- Higher gestational age and reduced low birth weight in community-based pregnancy support programs.
In a healthcare landscape where systemic disparities contribute to poorer outcomes for birthing people of color and those with limited resources, these findings highlight doulas as a potential equity-enhancing intervention.
Why This Evidence Matters for Doulas
This review brings together research that validates the unique role doula care plays in improving outcomes, even when medical care is otherwise standard. Several key takeaways for IDI doulas and the broader community include:
- Doula care isn’t just “nice.” Doula support is evidence-based care associated with better health and emotional outcomes.
- Continuous, individualized support fills gaps that traditional medical systems cannot always address due to staffing, time constraints, or systemic barriers.
- Access to doulas is a matter of public health equity, not solely personal preference.
It is also important to note this review said, “Doulas can ease this process in a multifactorial capacity, but it is important first to properly define their role. With a clear definition, the responsibilities of the doula can be filled adequately by thoroughly trained individuals.”
Continuous labor support by a trained individual is what this study looked at. A trained doula is one with evidence-based knowledge about birth physiology, options for birth, interventions, supporting families in making decisions, and how to provide empathetic and non-judgmental support. This study did not look at healthcare professionals or family members providing this support.
The evidence is clear: doula support has a measurable, positive impact on maternal and birth outcomes.
Not a trained doula? Get started today and you can be part of improving birth outcomes in your community.
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...