How doula care improves outcomes for mother and baby

Unfortunately many people, both in medical professions and in the general public, view doula care for pregnant, birthing, and postpartum parents as an expensive luxury.

But would people view doula care differently if they knew that the presence of a doula before, during, and after birth can act as preventative care against physical and mental health complications related to giving birth?

Viewed in this context, doula care can actually save money in the longer term, not to mention improve longer term health outcomes for mother and baby. Here are a few examples of how:

● When a doula is present during labor and delivery, there are fewer medical interventions in the birthing process - especially c-sections.

Although doulas can support all kinds of births, including c-sections, birthing parents who wish to avoid these interventions are significantly more likely to achieve this goal if a doula is present. Research has shown that those who receive doula support are 39% less likely to have a c-section delivery than those without a doula (Bohren et al., 2017). C-sections are major surgery, and are much more expensive than low-intervention births, as well as requiring longer hospitalizations. The cost of doula care is a fraction of the cost of surgical birth, whether that cost is covered by an individual, insurance, or government. Recovery time for non-surgical births are typically faster and have fewer complications.

● Doulas can positively affect mental health outcomes for mothers in two key ways:

1) Birthing parents who have a doula present when they give birth are more likely to report a positive experience of labor and delivery, and more positive memories of giving birth. This reduction in negative or traumatic associations with giving birth constitutes a mental health benefit in itself, as mothers are much more likely to have postpartum mental health complications if they have negative perceptions of the birth experience.

2) Doulas can help mothers and families to be aware of the signs of postpartum depression or anxiety, helping them to differentiate between typical mood fluctuations in the postpartum phase, and more serious mental health difficulties. They are then able to connect mothers with community resources to address complications, meaning mothers with doula care in the postpartum period can access mental health support sooner rather than later.

● Doula presence during labor and delivery can mean babies are less likely to have low APGAR scores.

APGAR tests check for skin color, heart rate, reflexes, muscle tone, and breathing rate at 1 minute and 5 minutes after birth. Research shows that the presence of continuous support, whether a partner, friend, relative, or doula, reduces the frequency of low APGAR scores by 38% (Bohren et al., 2017). Low APGAR scores increase the likelihood that baby will need interventions shortly after birth.

Doula Evonna of atlanta, georgia, usa offers support and encouragement as her client breastfeeds for the first time.

● Doula support during and after birth positively impacts a mother’s ability to establish breastfeeding with her baby.

As with maternal mental health, this is partly because it is easier to establish breastfeeding when there are fewer medical interventions during birth, and also because doulas can help mothers to find lactation support in their community if required. Some doulas may themselves be trained in providing lactation support, but even if not, the presence of a doula at the hospital or in the home following delivery can provide emotional support and encouragement for mothers in the early stages of breastfeeding.

● Although more research into the benefits of doula care before, during, and after birth is required, there is no evidence that the presence of a doula has any negative effect.

At worst, the presence of a doula is neutral, and at best, it can make a huge difference to a mother’s satisfaction with her birthing experience, her physical and mental health outcomes, the health of her baby, and her ability to reach her birthing and breastfeeding goals.

It is worth noting that some of the statistics around doula care can be understood as correlation rather than causation: for example, as per hospital policy, many women are more likely to be able to have a doula present during birth if their pregnancy is low risk, and so their likelihood of achieving a low-intervention birth is already higher. Likewise, a low risk pregnancy is less likely to result in a baby born with low APGAR scores. Nonetheless, the positive correlation between doula care and good health outcomes for mother and baby should be taken seriously as evidence that doula care can play a significant role in preventing costly health complications.

Gina Didaglo

Gina is a writer, editor, and mom of three young kids, living in Paris, France. She particularly enjoys writing on topics related to motherhood and parenting, justice and equity, and the ways that culture shapes beliefs and practices. Her hope is to use the power of the written word to tell stories that help people to see things in new ways.