Why Might Doulas Make a Difference?

Why Might Doulas Make a Difference?


Last week, the Cochrane Library released an updated systematic review of continuous support during labor.

After examining 21 trials involving over 15,000 women, the review authors found that women who received continuous support during labor:

  • were more likely to have a spontaneous vaginal birth
  • were less likely to have intrapartum analgesia (i.e. an epidural)
  • were less likely to report dissatisfaction with their labors
  • had shorter labors
  • were more likely to give birth without cesarean, vacuum, or forceps
  • were less likely to have regional analgesia
  • were less likely to have babies with a low 5-minute Apgar score

In addition to these welcome and exciting findings–many of which appeared in the previous Cochrane Review of continuous support during labor–the new review adds the following information:

Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labor support, and has at least a modest amount of training, appears to be most beneficial.

What do I think we can infer from this statement?


In light of this news, I’ve been pondering why doula support in particular provides these unique benefits.

Why does it matter if a labor support person is not a member of the hospital staff?  Why does it make a difference if s/he is not a friend or family member of the woman in labor?

Here are a few of my sneaking suspicions:


Emotional Distance/Emotional Closeness

Promoting the unique benefits of doula support is not meant to detract from the support that friends, family, and caregivers can offer to a woman during labor.  In fact, the new Cochrane review found that women were often more satisfied with their birth experience when they received continuous support from a chosen family member of friend.

But doulas don’t typically have the same sort of emotional closeness that a woman’s friends and family have, and this difference can be beneficial during labor.

It’s not that doulas don’t care for their clients.  I care deeply for my clients and now consider many of them to be my friends!  But this care is different from the emotional investment that a woman’s  friends and family have, especially during labor.  A doula’s “emotional distance” can help a her to maintain a relatively objective standpoint so that she can continuously support her clients regardless of whether they and their other support people are confident or scared, sailing through an easy birth or facing a challenging labor, experiencing their ideal birth or encountering unexpected circumstances.  (And, for what it’s worth, providing continuous support can be difficult for a family member or friend to do during  scary, challenging, or unexpected circumstances.)

On the other hand, as much as some hospital staff members would love to provide continuous support during a woman’s labor, few are able to because of their other responsibilities and duties on the job.  In this respect, the emotional closeness and commitment that a doula does have with her client can help her to maintain a continuity of care throughout a woman’s labor.


Knowledge is Power

Good books and internet resources, a childbirth education class, and even past experience with birth can all help to prepare a woman’s friends and family to support her during her labor.  I would even go so far as to describe this sort of preparation as being “essential” for any person who wants to accompany a woman during her labor!

But despite all of this preparation, a trained or experienced doula probably has more in-depth knowledge or familiarity with:

  • hospital and/or care provider policies and protocols
  • non-pharmaceutical comfort measures (such as massage, heat and cold, position changes, aromatherapy, etc.)
  • position changes that help to enhance labor progress and/or relieve discomfort
  • questions that a woman can ask to help her make informed decisions before and/or during labor
  • understanding about the behavior that is “normal” during labor (even when it might not look or sound “normal”)
  • community resources related to prenatal care, childbirth preparation, breastfeeding, and infant care

On the one hand, by keeping this knowledge “in play” during labor, a doula can help a woman to navigate the hospital system more confidently, to avoid pain medication for as long as possible, and to generally avoid various medical interventions that are associated with additional complications or negative side effects.

On the other, a doula can also use this knowledge to help the rest of a woman’s support team to better support her.  In other words, any doula worth her salt (or worth her lavender oil!) won’t be out to replace a woman’s partner, or her mother, or her best friend, or whoever else is in the room.  A doula’s role is to “fill in the gaps”–and sometimes, this means helping everyone else in the room to become even better support people!


Confidence, Compassion, and Respect

The effect that confidence, compassion, and respect have on a woman’s labor is difficult, if not entirely impossible, to quantify.

But when a doula can help to bring each of these into the laboring woman’s space–when a doula is giving continuous encouragement to her client, when she is treating her with compassion, when she is modeling what it means to treat a laboring woman with respect–I think that it can do wonders for that woman’s birth.

I’ve seen it do wonders for women’s births.


Why do you think that doula support offers such unique benefits to laboring women?  Why does doula support seem to make such a difference?

And don’t forget to check out Childbirth Connection’s new (and fabulous) resource on Labor Support!

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  1. Jenn

    Great post! In regard to emotional distance/closeness, I totally agree that it is an important piece in the equation. There have been several times when a mom has said something to me in private when a spouse or loved one leaves the room for a moment. It’s usually some intense emotion/feeling/thought they are having, but that they don’t want to say it in front of their loved one in order not to “scare them”. A doula is a friend who cares about the mom, but not someone whom the mom has to protect emotionally – the mom can just let it all hang out, so to speak. I also had a mom tell me one time something that really sums up how I felt about my personal doula support during my own births, and what I try to provide to others…”You believed in me, even when I wasn’t able to believe in myself”.

    • BirthingBeautifulIdeas

      Absolutely! I hadn’t even thought about the emotional investment that the mother has in the friends and family supporting her. Sometimes it is so much easier to be open and honest and raw with someone who isn’t a part of this circle.

      And I just love what that mother told you. That IS the essence of doula support! :-)

  2. Ann Becker-Schutte
    Ann Becker-Schutte02-25-2011


    I loved this post for several reasons. First, I’m always thrilled with data that points out the value of women getting the support that they need. Second, I don’t think I had realized until I read this how closely related therapy and doula work are. It was the “emotional distance” comment that cemented the connection. Thank you for sharing.


  3. Farmer Lynda
    Farmer Lynda02-26-2011

    Great post! Question: do you think doula support is beneficial even in instances where there are 2 midwives present (at a homebirth or birthing center)? A homebirth midwife I interviewed for an article I wrote in our local newspaper said she didn’t think doulas were necessary (or as useful) at a homebirth with two midwives present… Just wondering your opinion.
    Farmer Lynda´s last blog post ..making raised beds or Junkyard Wars meets the vegetable farm

    • BirthingBeautifulIdeas

      That’s such a good question. I think that it often depends upon the way that particular midwives practice. If a mother wants more hands-on support during labor, but her midwives are very hands-off (which, admittedly, can be very appealing to many women during labor!), then I think that having a doula present would still be beneficial.

      For what it’s worth, I had hired a doula for what would have been my September home birth, even though I too would have had two midwives present at my birth.

      • Farmer Lynda
        Farmer Lynda02-28-2011

        It also seems to me (and maybe this is selfish, I don’t know?) that it would be nice to have an expert who is solely focused on you, and your comfort, and your emotional well-being… whereas midwives are responsible for the Big Stuff: the health and welfare of both you and the baby. Which is incredibly important, and it’s what they should do — but it seems like having someone to just support you & your partner would be valuable to reduce stress and thus pain.

        Just last night I delivered triplet baby goats who had the worst possible presentations (1st one’s head was bent back, then 2 trying to come out at once, one of whom was breech) — it required forearm-deep intervention and my focus was entirely on getting the kids out alive without damaging the mother. My husband was focused on supporting me and giving me confidence… which left no one to support the goat. I know this is a goat and not a human, but if you’ve ever met a goat you’d know that they have emotional needs too. :) I’m sure she would have appreciated having someone to stroke her head and rub her back while this whole thing was going on.

        Anyway, that’s a long way of saying, I think I would come to the same decision you did. We’re still trying, though, and at this rate who knows when I’ll get to make that decision… Sigh.
        Farmer Lynda´s last blog post ..making raised beds or Junkyard Wars meets the vegetable farm

        • BirthingBeautifulIdeas

          That’s another great distinction (between a doula’s focus and a midwife’s focus). Especially during more trying situations, even two midwives might not be able to focus on anything other than the health and safety of a mom and baby–and these experiences are where doula support is truly essential!

          And what an experience you just had last night! I love that you thought of the goat perhaps wanting her own emotional support during the birth. :-)

  4. Rachel

    I love how you are pushing theory forward here. :) Especially since the authors didn’t do much on that. As Ann’s comment suggests, I’d love to see a psychological theoretical angle on the ‘doula effect.’

    • BirthingBeautifulIdeas

      I think the authors would love this too! IIRC, they characterized the subgroup analyses (including this particular topic) as something that could generate some rich hypotheses and further research. If only I had all the time in the world to actually put together a study that could adequately address this issue!

  5. pam carswell
    pam carswell02-28-2011

    I think that doulas’ confidentiality agreement is a great thing! I might be terribly embarassed by things that happen in the labor room but I know my doula will never tell a soul, whereas my best freind’s mouth is not as predictable! i thnki it’s a plus for the doulas! never give birth without one!

  6. Birth Smart
    Birth Smart02-28-2011

    Recently, I was talking to a woman about her homebirth midwife experience – it was her first birth and she had a very experienced midwife, but it really seemed like the mom lost her voice in her experience. She trusted the mw (who certainly had a better model of care than many women get), but the mw seemed very controlling. I was kind of surprised by this, but it was a good reminder that all women need to learn to communicate well and be assertive. In my childbirth classes, I try to teach women to communicate well with their providers – not feeling that they need to ask permission for things, but ask for information and options so that they can make the best choice for themselves. Sometimes a doula really can help to remind a mom, “this is your choice, not your dr. or midwife’s”.

  7. Not My Story to Tell « Amy D. Lavelle, Ph.D Birth and Post Partum Doula
    Not My Story to Tell « Amy D. Lavelle, Ph.D Birth and Post Partum Doula05-02-2011

    […] torn from telling someone else’s birth story to telling my own “birth” story.  So for now, a wonderful post about the benefits of doulas. Filed under My Journey ← Clients LikeBe the first to like this […]

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