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Impact of Doulas on Healthy Birth Outcomes

Low income women may experience fewer instances of preterm birth and costly birth complications if they opt for a doula's services.

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There are numerous studies supporting the effectiveness of enrolling Doulas into the birthing process.

Compelling academic research around this topic has been carried out by a number of organizations, some of the research that has inspired me thus far are as follows:


Modern hospital maternity care practices have reduced the availability of an attending nurse to remain with a mother during labor. A result of this has been the loss of having someone at the bedside to offer continuous support throughout the birthing process (Papagni & Buckner, 2006). One study found that new mothers expected their nurse to spend 53% of her time offering support, but only 6%–10% of the nurse’s time was actually engaged in labor support activities (Tumblin & Simkin, 2001). Because many women during labor are comforted and encouraged by having someone with them throughout labor and birth, support persons known as doulas have become increasingly present. Doulas are trained to provide physical, emotional, and informational support to women during labor, birth, and in the immediate postpartum period. With the support of doulas, many women are able to forego epidurals, avoid cesarean births, and have less stressful births. A skilled doula empowers a woman to communicate her needs and perceptions and actualize her dream of a healthy, positive birth experience. The positive effects of doula care have been found to be greater for women who were socially disadvantaged, low income, unmarried, primiparous, giving birth in a hospital without a companion, or had experienced language/cultural barriers (Vonderheid, Kishi, Norr, & Klima, 2011).

A skilled doula empowers a woman to communicate her needs and perceptions and actualize her dream of a healthy, positive birth experience.


The role of a doula is to provide specific labor-support skills, techniques, and strategies, offer guidance and encouragement, build a team relationship with the nursing staff, encourage communication between the patient and medical caregivers, and assist the mother in covering the gaps in her care. According to DONA (n.d.), a doula's role can be summarized in seven objectives:

  1. To recognize birth as a key life experience that the mother will remember all of her life;

  2. To understand the physiology of birth and the emotional needs of a woman in labor;

  3. To assist the woman and her partner in preparing for and carrying out their plan for the birth;

  4. To stay by the side of the laboring woman throughout the entire labor;

  5. To provide emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions;

  6. To facilitate communication between the laboring woman, her partner, and clinical care providers; and

  7. To perceive the doula's role as one who nurtures and protects the woman's memory of her birth experience.

Doulas use techniques such as imagery, massage, acupressure, and patterned breathing to reduce a woman's pain. They suggest position changes to accelerate labor or aid in fetal positioning. They also provide guidance and encouragement to minimize fear and anxiety, and encourage touch and communication between the laboring woman and her partner.


Doulas can empower women to achieve the best birth outcomes possible, and all outcomes—for births, infants, and mothers—seem to be affected more positively if support is provided by a doula in addition to the medical personnel. The doula focuses on individualized support before, during, and after birth; whereas nurses often are attending to several women in labor and responsible for many clinical and administrative tasks besides direct labor support. Research indicates that the expectation of nurse support by expectant women may be far greater than what is actually provided. 

What is a provocation or insight that might inspire others during this challenge?

Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth. HMW ensure women have access to the resources and support they need, despite income level.

How does this research relate to our use cases and personas?

This post addresses "The Under Resourced Mom"

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