DOULA FACTS
Evidence based information highlighting
the positive effect of doulas.
What is a doula?
According to DONA International, a doula is a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible. Dr. Christine Morton, author of the book Birth Ambassadors, describes a doula as a supporting companion throughout and after the moments of birth.
How many women use doulas?
The answer may surprise you! In a survey published in 2013, 6 percent of the 2,400 women who participated reported they used a doula. That’s up from 3 percent in 2005! According to the CDC, there were 3,747,540 births in America during 2019. That means at 6 percent, 224,852 births would have been supported by doulas.
Does doula support actually help?
In 2017, Meghan Bohren, along with other colleagues, published a Cochrane study researching the continuous support for women during childbirth. More than 15,000 women out of 26 trials were included. The pregnant women were randomly assigned to either receive one-on-one, continuous support during labor and delivery or “usual care”.
Overall, the women who received continuous, one-on-one support were more likely to have natural vaginal births and less likely to have medical interventions, such as pain medications, epidurals, vacuum or forceps-assisted births, and Cesareans (c-sections). They were also less likely to have negative feelings about their childbirth experience. In addition, their time in labor was shorter and their babies were less likely to have low Apgar scores at birth. Two separate trials also reported that mothers were less likely to developed postpartum depression if they received continuous doula support during labor.
This study ultimately proves that if women have continuous support during labor and birth, they are statistically much more likely to have greater, more positive outcomes!
How do doulas compare to other types of support?
In the Cochrane review, the researchers also explored if the type of continuous support affected the results. They sought to answer the question, “does it matter if women choose a midwife, doula, or partner for continuous support?” The results showed that those who chose a doula as their support during childbirth experienced a:
15% increase in the likelihood of a natural vaginal birth
39% decrease in the risk of Cesarean (c-section)
The study also found that with continuous, one-on-one support during childbirth, women saw a:
10% decrease in the use of any pain medications
Decrease of their time in labor with an average of 41 minutes
31% decrease in the risk of being dissatisfied with or having negative feelings toward their birth experience
38% decrease in the baby’s risk of receiving a low Apgar score
It is clear that doulas provide a level of support that it not easily replicated by partners, midwives, or hospital staff.
What does history teach us?
Up until the early 1900s, women were exclusively giving birth at home assisted by a midwife. In 1914, the first maternity hospital was created and Twilight Sleep - a method which involved dosing the mother with morphine and scopolamine - became popular. This medical intervention put mothers asleep for the entire delivery making it completely pain free! The only downside is both babies and mothers were more likely to die (yikes!).
Over time, more and more women began having their births in hospitals under the care of doctors. By the end of the 1930s, 75 percent of all women were having hospital births due to them being perceived as “safer”. During this time, unfortunately, there was a 40-50 percent increase in infant deaths from birth injuries due to all of the medical interventions being used.
With Twilight Sleep still being used and harming mothers and babies, Dr. Grantly Dick-Read published a book in 1942 highlighting the benefits of natural childbirth. This gave new scientific support for less invasive methods previously deemed out dated. By the 1970s Twilight Sleep was no longer used. This is around the time epidurals became a popular method for pain relief during childbirth, however it was quickly noticed to slow down contractions in nearly half of deliveries. As a result, another medical intervention was developed in order to reverse the negative effects of the other: pitocin.
As time went on, women increasingly expressed they deserved more choices when it came to childbirth. By the 1980s, women were able to choose going to a birthing center or embrace their roots and have a midwife attend their birth at home. Momentum for women’s birthing rights increased and the 1990s saw the release of the Ten Steps for a Mother-Friendly Childbirth Initiative, which encouraged a more natural approach to childbirth with a focus on the mothers wellbeing. This emphasized the belief that if the mother is doing well, the more likely her baby will do well also.
In the 2000s, the rate of maternal deaths increased for the first time in decades. Researchers believed one of the main reasons were the rise in c-sections. By this time, over 30 percent of all deliveries resulted in a Cesarean birth. As more and more research came out, more and more mothers began choosing not to have a hospital birth. Today, birthing center and homebirth popularity has soared due to the increasing research showing less medical interventions during childbirth produce more positive outcomes.
Why are doulas so effective?
There are various reason why doulas are so effective. The first reason is hospitals expose laboring women to very harsh environments. Childbirth used to take place in the comfort and calm of one’s own home. They were completely in control of their surroundings. However, ever since birth moved to hospitals, women lost control of their environments and were now subject to things such as bright lighting, being on display in front of strangers, unnecessary medical interventions, hospital routines, and more.
These conditions have shown to slow down a woman’s labor and increase risk for more serious medical interventions, such as c-sections. A doula, however, becomes a buffer between the harsh environment and the laboring mother. The idea is that any harsh circumstance women are exposed to, their doula will mitigate it through continuous support as well as advocating for the mother’s wishes. An example of this would be a doula encouraging hospital staff to speak softly and keep the lights dim. This support will promote self esteem in the mother and keep labor progressing in the right direction.
The second reason why doulas are so effective is because they are a form of pain relief themselves. Women who have doula support during their labor are significantly less likely to ask for epidurals or pain medications. This is because women often feel less pain when receiving continuous, one-on-one support throughout labor.
The third reason why doulas are so effective is because their support helps laboring women release the oxytocin hormone, which decreases stress, fear and anxiety. It also increases and promotes contraction strength and their effectiveness. In addition, the doula’s calming presence increases the mother’s own natural pain coping hormones (beta-endorphins), making labor feel less painful.