A systematic review published in JAMA Network Open examined recent clinical research on doula services. This nonmedical support intervention showed benefits for some perinatal outcomes, particularly reducing maternal anxiety and promoting breastfeeding, but consistent high-quality evidence is still lacking for key outcomes such as cesarean birth and preterm birth.
Reported by Dr. Liji Thomas, the review included 22 publications covering 21 studies, including randomized controlled trials and some controlled studies, and assessed effects on maternal and infant health during pregnancy, labor, and the postpartum period.
Doulas are community-based support professionals who do not make medical decisions or perform procedures. They provide emotional support, physical assistance, and health education throughout the perinatal period. Working in homes, communities, or hospitals, they help pregnant women understand childbirth, manage pain and anxiety, and receive guidance on breastfeeding and self-care after birth.
The model has grown partly in response to persistent inequities in maternal and infant health. In the United States, cesarean rates, preterm birth, and severe maternal complications differ markedly among racial and ethnic groups, particularly among American Indian, Alaska Native, and Black populations. These disparities involve structural inequity, social determinants, and systemic bias. Doula services may help bridge some of these care gaps.
The American College of Obstetricians and Gynecologists supports doula services, and expanded Medicaid coverage is increasing access.
Interventions varied substantially among studies: more than 80% used a single doula and about 20% used team support. Most focused on continuous support during labor, while a minority covered pregnancy through postpartum care. Services included guidance on birthing positions, breathing and relaxation, pain coping, emotional support, and maternal and infant care education.
The evidence showed a divided pattern.
Consistent benefits included lower anxiety during labor and higher rates of breastfeeding initiation. Some recent studies also suggested better adherence to postpartum follow-up. Nearly all of the 8 studies assessing implementation reported high patient satisfaction.
Findings were inconsistent for other key clinical measures. Doula services were associated with less epidural use, but effects on oxytocin use varied. Some studies found lower cesarean and preterm birth rates, while others found no significant difference.
Evidence on postpartum depression was also inconsistent. Some studies found lower risk with doula support, while others found higher rates. Researchers suggested reverse causation may play a role, because pregnant women at higher psychological risk may be more likely to seek doula support. Depression also tends to develop gradually after birth, while doula support is most intensive during labor.
Compared with randomized trials, several observational studies and earlier systematic reviews, including a 2017 Cochrane meta-analysis, were more likely to support effects on reducing cesarean birth, preterm birth, and induction. However, this evidence was generally low quality with wide confidence intervals.
Methodological limitations likely explain much of the inconsistency, including small samples, nonstandardized interventions, limited assessment of fidelity, and short follow-up. Underrepresentation of high-risk and vulnerable groups, such as incarcerated women, survivors of domestic violence, and families of infants with complex needs, also limits generalizability.
Overall, doula services have clearer value for improving experiences and behavioral outcomes, but their effect on hard outcomes such as cesarean and preterm birth requires stronger evidence.
The authors called for larger randomized trials with longer follow-up, greater inclusion of high-risk and marginalized populations, and systematic evaluation of costs, access, and integration with existing health systems.
As health systems increasingly emphasize patient-centered care, doulas may be most valuable not as a replacement for medical intervention but as support for emotional well-being, health education, and continuity of care.
News | Can doula services improve birth outcomes? Systematic review finds partial benefits
News | Can doula services improve birth outcomes? Systematic review finds partial benefits
A systematic review published in JAMA Network Open examined recent clinical research on doula services. This nonmedical support intervention showed benefits for some perinatal outcomes, particularly reducing maternal anxiety and promoting breastfeeding, but consistent high-quality evidence is still lacking for key outcomes such as cesarean birth and preterm birth.
Reported by Dr. Liji Thomas, the review included 22 publications covering 21 studies, including randomized controlled trials and some controlled studies, and assessed effects on maternal and infant health during pregnancy, labor, and the postpartum period.
Doulas are community-based support professionals who do not make medical decisions or perform procedures. They provide emotional support, physical assistance, and health education throughout the perinatal period. Working in homes, communities, or hospitals, they help pregnant women understand childbirth, manage pain and anxiety, and receive guidance on breastfeeding and self-care after birth.
The model has grown partly in response to persistent inequities in maternal and infant health. In the United States, cesarean rates, preterm birth, and severe maternal complications differ markedly among racial and ethnic groups, particularly among American Indian, Alaska Native, and Black populations. These disparities involve structural inequity, social determinants, and systemic bias. Doula services may help bridge some of these care gaps.
The American College of Obstetricians and Gynecologists supports doula services, and expanded Medicaid coverage is increasing access.
Interventions varied substantially among studies: more than 80% used a single doula and about 20% used team support. Most focused on continuous support during labor, while a minority covered pregnancy through postpartum care. Services included guidance on birthing positions, breathing and relaxation, pain coping, emotional support, and maternal and infant care education.
The evidence showed a divided pattern.
Consistent benefits included lower anxiety during labor and higher rates of breastfeeding initiation. Some recent studies also suggested better adherence to postpartum follow-up. Nearly all of the 8 studies assessing implementation reported high patient satisfaction.
Findings were inconsistent for other key clinical measures. Doula services were associated with less epidural use, but effects on oxytocin use varied. Some studies found lower cesarean and preterm birth rates, while others found no significant difference.
Evidence on postpartum depression was also inconsistent. Some studies found lower risk with doula support, while others found higher rates. Researchers suggested reverse causation may play a role, because pregnant women at higher psychological risk may be more likely to seek doula support. Depression also tends to develop gradually after birth, while doula support is most intensive during labor.
Compared with randomized trials, several observational studies and earlier systematic reviews, including a 2017 Cochrane meta-analysis, were more likely to support effects on reducing cesarean birth, preterm birth, and induction. However, this evidence was generally low quality with wide confidence intervals.
Methodological limitations likely explain much of the inconsistency, including small samples, nonstandardized interventions, limited assessment of fidelity, and short follow-up. Underrepresentation of high-risk and vulnerable groups, such as incarcerated women, survivors of domestic violence, and families of infants with complex needs, also limits generalizability.
Overall, doula services have clearer value for improving experiences and behavioral outcomes, but their effect on hard outcomes such as cesarean and preterm birth requires stronger evidence.
The authors called for larger randomized trials with longer follow-up, greater inclusion of high-risk and marginalized populations, and systematic evaluation of costs, access, and integration with existing health systems.
As health systems increasingly emphasize patient-centered care, doulas may be most valuable not as a replacement for medical intervention but as support for emotional well-being, health education, and continuity of care.
Source:
Compiled from online sources