March 22, 2019


What is a doula and how do they help women giving birth?

File 20190319 60990 ex8umc.jpg?ixlib=rb 1.1

Doulas support women before, during and after childbirth. A new review explores the important role they play.
From shutterstock.com

Meghan A. Bohren, University of Melbourne

Women have traditionally been supported by a companion during childbirth, and there is good evidence this benefits both the woman and the baby.

The World Health Organisation recommends continuous support for women during childbirth. Yet across the world, initiatives promoting health facilities as the safest place to give birth have not necessarily respected this tradition.

But now we have new evidence on the ways women are supported during childbirth by a doula or other labour companion.

Our research has found labour companions (including doulas, partners, and family members) support women during childbirth by providing information, advocating for the woman’s needs, and providing practical and emotional support.

Importantly, our research also indicates pairing a woman with a doula from the same ethnic, linguistic or religious background as her may be an important way to improve equity and provide culturally responsive care.

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What is doula care?

The word “doula” comes from a Greek word meaning “woman’s servant”.

Doulas are trained, non-medical professionals who provide continuous physical, emotional, and informational support to women before, during and after childbirth, to facilitate the best possible birth experience.

Research has shown doula care is beneficial for both women and babies.
Peter Oslanec/Unsplash

Doulas typically meet with a woman (and sometimes her partner or family) during pregnancy to help her to prepare for childbirth, build rapport, manage expectations and provide evidence-based resources.

When a woman goes into labour, she alerts her doula. The doula supports the woman throughout labour and childbirth. This is typically at a birthing clinic or hospital (some doulas may also attend home births).

Four ways to support women during labour

Our Cochrane review, published this week, brings together data from 51 studies across 22 countries looking at support provided by labour companions, including doulas.

First, we found through providing information, labour companions bridge communication gaps between health workers, such as doctors and midwives, and the woman. They keep her informed about the process of childbirth and her progress through labour. They may also provide her with tips around effectively using non-pharmacological pain relief, such as meditation or relaxation.

Second, labour companions advocate for the woman, speaking up in support of her and her preferences.

Third, labour companions provide practical support, which could include encouraging the woman to move around, providing massage, and holding her hand.

And finally, labour companions offer emotional support, helping the woman to feel in control and confident by praising and reassuring her, and providing a continuous physical presence.

Improved outcomes for mums and babies

The benefits of continuous support during labour and birth were highlighted in an earlier Cochrane review, which analysed data from 26 studies across 17 countries involving more than 15,000 women.

Continuous support was provided by a woman’s partner, family member, or friend; hospital staff (student midwives); or a doula.

The review found continuous support could improve several health outcomes for both the woman and her baby. Women may be more likely to have a vaginal birth (without the need for caesarean, forceps or vacuum extraction).

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In addition, women who receive continuous support may be less likely to use pain medications, may have shorter labours, and may be more likely to be satisfied with their birth experience.

The babies of women who receive continuous support may be less likely to have low five-minute Apgar scores, which assess babies’ health and well-being at birth and shortly afterwards.

Who can benefit from doula care?

Recent media has highlighted that doulas are fit for royals. Meghan Markle, the Duchess of Sussex, has hired a doula to support her during her current pregnancy.

In Australia, doula care typically ranges from A$500-A$2,500, depending on the doula’s experience and the services they offer. This cost typically includes one to two visits during pregnancy, attendance at birth, and one visit after birth.

While the cost of doula care may sound prohibitive, our findings highlight that providing community-based doula care for migrant, refugee and other foreign-born women in high-income countries may be an important way to improve equity and culturally responsive care.

When migrant women receive care from community-based doulas (from the same ethnic, linguistic, and/or religious background as them), they may feel more confident and less like “outsiders” in their new communities.

In Sweden and the United States, research has shown that foreign-born women supported by community-based doulas were more satisfied with their birth experiences, and doulas themselves felt empowered.

Community-based doulas may also be particularly beneficial for Indigenous women, whose traditional birthing practices are strongly linked to their cultural identities. In Canada, the British Columbia Association of Aboriginal Friendship Centres provides scholarships to pregnant Indigenous women to hire a doula.

Read more:
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Doula services may be provided free of charge for low income people and families, as a way to improve equity. The Doula Project provides free doula services to low income women in New York City through volunteers.

Supporting women to have a labour companion or doula of her choice during childbirth is an effective way to improve health outcomes, and is an important component of respectful maternity care.

Labour companionship and doula support may increase equity directly through improved women’s empowerment and provision of culturally responsive care, and indirectly by reducing the over-medicalisation of childbirth.

Sarah Chapman, a knowledge broker at Cochrane UK, contributed to this article.The Conversation

Meghan A. Bohren, Lecturer in Gender and Women’s Health, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • Unless I knew her really well, I’m not sure I’d have found this helpful.


  • It seems to be routine that Mum and baby go home within 1 or 2 days of giving birth. A nurse is automatically arranged to visit and check Mum and Baby at least twice a few days apart after them going home from hospital. The nurse takes scales and weighs the baby as well as discussing any issues Mum may have herself or with her baby.


  • I know people who swear by it but it never interested me. I am a strong person and knew what I wanted and what my rights were so I just did it my way.


  • Doulas seem to be more and more common now.


  • I didn’t have a doula but had excellent support from my husband, doctor, and hospital staff.


  • This is interesting, I hadn’t heard about doulas before


  • Sounds like a good idea, particularly for women who may not have a good support network.


  • Having someone to advocate on your behalf whilst you are emotionally exhausted would be a great idea


  • I really like the idea of having someone who can act on your behalf when things get to the end stage and you can’t really communicate any more.


  • I sure think support before during and after child birth is essential, be it from a doula, a midwife, a partner, a friend. It’s very important the woman herself to verbalize her needs and desires in regrds to the whole process.


  • Isn’t that pretty much what a midwife does? Only they have the added benefit of medical training.

    • Unless you get a student the midwife isn’t there for a lot of the birth.


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