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If you are thinking about hiring a doula, you may wonder if doula care is evidence-based. Is there any proof that doulas are helpful in labor and birth? 

First, in case you are new to the term “evidence-based”, let’s do a quick review of what it means. Evidence-based refers to an approach that relies on the conscientious and explicit use of the best available evidence to inform decision-making, particularly in the fields of medicine, psychology, education, and policy. This practice emphasizes the integration of scientific research findings, empirical data, and expert consensus to guide the development and implementation of practices, interventions, or policies. 

The foundation of evidence-based decision-making lies in the systematic evaluation and synthesis of relevant research studies, clinical trials, and observational data, with the aim of identifying the most effective and reliable strategies for addressing specific challenges or achieving desired outcomes. By prioritizing empirical evidence over anecdotal experience or tradition, the evidence-based approach strives to enhance the credibility, objectivity, and overall quality of decision-making processes across diverse domains.

How Doulas Support the Non-Birthing Parent

Now, I also find it necessary to explain that evidence-based decision making is not the only way to approach learning and/or decision making. I actually believe it SHOULDN’T be the only thing consulted or the “end-all-be-all”.

Sometimes families choose to do something that isn’t evidence based. For example, some families have particular types of foods that they like to eat in the postpartum period.

The food may be something outside of the American definitions of “good” food, but it isn’t harmful or spoiled and they’re not allergic to it (times when we can maybe call a food “bad for you”, but there’s also nothing evidence based that says what they are consuming it is nutritious or the best option. In this case, this family is following their tradition and that is important too.

Also, it’s important to note that there are no requirements, food doesn’t have to be “good” to eat it. You have permission to eat without guilt. 

Ok, let’s get back to the topic, are doula’s evidence based? 

And the answer is both yes, and no. Let’s dive into that!

Doulas Are, In Fact Evidence-Based

Numerous studies(1, 2, 3) have indicated that the continuous support provided by doulas during labor is associated with reduced rates of interventions. This includes lower rates of cesarean sections, episiotomies, and the use of medical interventions such as forceps or vacuum extraction. The evidence suggests that the presence of a doula can positively impact the overall birthing experience by promoting natural processes and reducing unnecessary interventions.

Evidence-based doulas prioritize the emotional well-being of the birthing person. Studies (1, 2) have consistently shown that individuals supported by doulas report higher levels of satisfaction with their birthing experience. The emotional support provided by doulas contributes to a more positive perception of childbirth, fostering a sense of empowerment and control.

It might sound surprising, but research has indicated that having a doula present during labor is associated with shorter labor durations. The comforting presence and guidance of a doula can contribute to a more efficient labor process, potentially reducing the overall time spent in the birthing room.

The evidence also suggests that individuals who receive support from doulas are more likely to initiate breastfeeding successfully. Doulas play a crucial role in educating and assisting with breastfeeding techniques, contributing to a positive start in the crucial bonding between parent and newborn.

Some Will Say Doulas Do Not Qualify

Some individuals may argue that doulas are not evidence-based for several reasons:

  • Lack of Consistent Research: While there is research supporting the benefits of doula support during childbirth, some critics argue that the evidence is not robust or consistent across all studies. They may point to gaps in the research or conflicting findings as reasons to doubt the effectiveness of doula care.
  • Limited Scope of Studies: Critics may argue that many studies on doulas are observational or qualitative in nature, lacking randomized controlled trials (RCTs) or other rigorous experimental designs. Without high-quality evidence from RCTs, some may question the validity of claims about the impact of doula support on birth outcomes.
  • Variable Quality of Doula Training: Another concern is that the quality of doula training programs can vary widely. Critics may argue that without standardized training requirements or accreditation processes, there is no guarantee that all doulas possess the necessary skills and knowledge to provide effective support.
  • Confounding Factors: Skeptics may suggest that any observed benefits of doula support could be attributed to other factors, such as the presence of continuous labor support in general rather than specifically doula care. They may argue that it is challenging to isolate the effects of doula support from other aspects of childbirth care.
Postpartum Essentials - a line art drawing of a mother and father cradling each other and a newborn on the father's shoulder with a beige background with green water color circle and gold glitter accents

The question of whether doulas are evidence-based is nuanced and multifaceted. While research consistently demonstrates the positive impact of doula support on various aspects of the birthing experience, including reduced rates of interventions, increased satisfaction, shorter labor durations, and improved breastfeeding initiation, some critiques challenge the strength and consistency of the evidence.

It is essential to acknowledge that evidence-based decision-making, while valuable, is not the sole determinant of individual choices or practices. Families may prioritize cultural traditions, personal preferences, or other considerations alongside empirical evidence when making decisions about childbirth and postpartum care. 

Ultimately, the evidence supporting the benefits of doulas aligns with the principles of evidence-based practice, emphasizing the importance of informed decision-making guided by the best available evidence, clinical expertise, and individual preferences. As the field of maternity care continues to evolve, it is crucial to maintain a balanced perspective, recognizing both the strengths and limitations of doula support in promoting positive birth experiences and maternal outcomes.

References:

Arteaga, S., Hubbard, E., Arcara, J., Cuentos, A., Armstead, M., Jackson, A., Gomez, A. M., & Marshall, C. (2023). “They’re gonna be there to advocate for me so I’m not by myself”: A qualitative analysis of Black women’s motivations for seeking and experiences with community doula care. Women and birth : journal of the Australian College of Midwives, 36(3), 257–263. https://doi.org/10.1016/j.wombi.2022.08.007

Dillion, Twylla, and Zainab Sulaiman, ‘The Integral Role of Community-Based Doulas in Supporting Birth Equity’, in Dorothy Cilenti, and others (eds), The Practical Playbook III: Working Together to Improve Maternal Health (New York, 2024; online edn, Oxford Academic, 22 Feb. 2024), https://doi.org/10.1093/oso/9780197662984.003.0035, accessed 3 Apr. 2024.

Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of doulas on healthy birth outcomes. The Journal of perinatal education, 22(1), 49–58. https://doi.org/10.1891/1058-1243.22.1.49

Marudo, C., Nicotra, C., Fletcher, M., Lanning, R., Nelson, M., & Hancock, C. (2023). Bridging Health Disparities and Improving Reproductive Outcomes With Health Center-Affiliated Doula Programs. Obstetrics and gynecology, 142(4), 886–892. https://doi.org/10.1097/AOG.0000000000005337

Sobczak, A., Taylor, L., Solomon, S., Ho, J., Kemper, S., Phillips, B., Jacobson, K., Castellano, C., Ring, A., Castellano, B., & Jacobs, R. J. (2023). The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review. Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA. Retrieved from https://www.cureus.com/articles/154723-the-effect-of-doulas-on-maternal-and-birth-outcomes-a-scoping-review.pdf

Thomas, M.-P., Ammann, G., Onyebeke, C., Gomez, T. K., Lobis, S., Li, W., & Huynh, M. (2023). Birth equity on the front lines: Impact of a community-based doula program in Brooklyn, NY. Birth Issues In Perinatal Care. https://doi.org/10.1111/birt.12701 

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