Doula guide: Part 4 – What does the research say?

It sounds perfectly logical that continuous, one-on-one support during labour and birth (from someone other than your partner) is good thing, but what impact does it actually have on birth outcomes, and satisfaction with the overall birth experience? This article looks at one of the biggest reviews of research into continuous labour support, as well as some of the reasons why doula support is so effective.

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Doula guide - research
Photo by Nick Morrison on Unsplash

Largest review of research into continuous support

In 2017, a group from the world-renowned Cochrane medical research organisation carried out a systematic review of research into the continuous support of women during labour. They looked at 26 separate randomised control trials from 17 different countries, involving a total of 15,858 women.

The birthing women in the studies were randomised to receive either:

  • continuous, one-on-one support during labour and birth; or
  • ‘usual care’, which of course can involve considerable support at times, though not all the time.

Continuous support was provided by: a member of hospital staff, such as a midwife or nurse (9 studies); women who were not part of the birthing person’s social network and not part of hospital staff (doula, 8 studies; childbirth educators, 1 study; retired nurses, 1 study); or a companion from the birthing person’s social network such as a female relative or the woman’s partner (7 studies).

What does the review tell us about continuous support?

Although the strength of the evidence sometimes varied between studies, the overall results showed that women who had continuous support were:

  • more likely to have a spontaneous vaginal birth (i.e. without induction, caesarean or need for instruments)
  • more likely to be satisfied with their childbirth experience
  • less likely have an epidural
  • less likely to have a caesarean birth or need forceps or ventouse during vaginal birth

The results also showed two further benefits:

  • shorter labour
  • higher five-minute APGAR scores

Data from two trials included in the review also suggested that fewer women developed symptoms of depression if they had been supported in birth.

Is there anything special about doula support compared to other kinds of continuous support?

The review found that:

“continuous labour support appears to be more effective in achieving desirable clinical outcomes and fewer negative experiences when it is provided by someone in a doula role (e.g. caregivers who are not employees of an institution and thus have no obligation to anyone other than the labouring woman) and who have an exclusive focus on this task”.

The researchers also pointed out that while:

“support from a member of the woman’s social network is effective in reducing women’s negative birth experiences”, …”members of a woman’s social network may be less experienced with childbirth and have their own needs relating to the woman, baby and childbirth process, compared to someone in a doula role.”

Why are doulas so effective?

As well as the obvious benefit of being supported by a trusted and experienced woman whose ONLY purpose is to help you have the best possible experience, a doula also helps to:

  • Boost your self-esteem and decrease anxiety: With most of us birthing in hospital and faced with relatively harsh environments – bright lights, noises beyond our control, care providers we don’t know, feeling vulnerable and anonymous in a hospital gown – it can be easy to be overwhelmed, anxious and perhaps even fearful.

    These feelings are the last thing we need during labour, as they can dampen the naturally produced oxytocin needed for a swift and smooth birth. Worst case, they can even slow down labour, potentially leading to the need for interventions like syntocinon, breaking the waters or increased fetal monitoring.

    Having a known and trusted doula by your side – someone who is knowledgeable and also there for the sole purpose of helping you achieve the best possible experience – can help buffer you against that harsh environment, and help you keep self-esteem and confidence higher. With these raised, you are less likely to become discouraged, and better equipped to find your internal strength and resources to birth your baby.

    She can also be a calming influence on your partner, which in turn helps him/her support you better.
  • Encourage mobility and suggest/use comfort techniques: By helping to create a safe birthing space, the doula’s very presence increases the birthing woman’s feel-good hormones – endorphins – which in themselves act as a natural pain reliever. So having continuous support makes it easier to cope with the discomfort and intense sensations of labour.

    Doulas also typically have a broad knowledge and experience of pain relief and relaxation methods, should they be needed, including massage, using movement and positions, birth ball, sling, visualisations and vocalisations and more.

    The doulas can also support the woman’s partner in staying calm and practicing some of these techniques with the mother.

By increasing self-esteem, decreasing anxiety, and encouraging mobility and comfort techniques, continuous support from a doula helps keep the labouring woman’s oxytocin levels raised, which is ultimately the key to letting nature take its course.

Also, giving birth in a foreign country adds the extra complication of perhaps not speaking the language of the care providers. Having a doula who speaks a local language can help considerably with two-way communication when needed, and reduce the risk of frustration from misunderstanding.


Check back soon for the next in the series of our Ultimate guide to having a doula in Belgium! We’ll still be covering questions like: how can I find the right doula for ME? how much can I expect to pay for a doula’s services? I’ve discovered my calling: how can I become a doula in Belgium.