What Does a Doula Do and How Does Doula Support Improve Birth Outcomes?

By Vijay Kumar MalesuReviewed by Benedette Cuffari, M.Sc.

Introduction
What is a doula?
What does a doula do?
Health outcomes associated with doula support
Limitations and gaps in evidence
How do doulas complement clinical care?
Practical considerations
Conclusions
References
Further reading

Doulas are non-clinical professionals who provide continuous emotional, physical, and informational support throughout pregnancy, labor, and the postpartum period, helping address gaps in modern maternity care. Evidence suggests doula support is associated with improved maternal experiences and outcomes, including lower cesarean rates and better mental health, although findings vary across populations and study designs.

Image Credit: Pixel-Shot / Shutterstock.com

Introduction

Rising maternal mortality, persistent racial disparities, and limited continuous labor support in hospital settings have renewed interest in doulas as non-clinical professionals who provide physical, emotional, and informational support across pregnancy, birth, and the postpartum period. In hospital settings, continuous one-to-one labor support is often limited, with clinical staff such as nurses unable to provide sustained bedside support throughout labor.² Evidence from scoping reviews and cohort studies suggests that doula care is associated with lower cesarean rates, possible reduced preterm birth, decreased anxiety, lower odds of postpartum depression or anxiety,³ and improved breastfeeding initiation, particularly among socioeconomically vulnerable populations.^1,2,3

This article discusses the role of doulas, potential maternal and neonatal benefits, as well as the strengths and limitations of current evidence.

What is a doula?

Historically, childbirth support was provided by experienced women within communities. As births shifted from homes to hospitals in the twentieth century, continuous labor support declined until the modern doula movement emerged to restore that sustained presence.

A doula is a person who provides emotional, physical, and informational support during pregnancy, labor, and postpartum. Core functions of a doula include emotional reassurance, hands-on comfort measures, clear explanations of options and interventions, advocacy for patient preferences, and the promotion of continuity of care throughout the maternity experience.^1,2

Unlike a midwife, obstetrician, or nurse, a doula does not monitor fetal development, perform medical procedures, or make clinical decisions. Rather, the primary focus of the doula is to provide comfort and support to the mother during delivery, which may involve assisting with proper positioning due to the patient’s lack of mobility, teaching breathing techniques, and using alternative non-medical methods for pain relief. Postpartum doulas provide support after birth by helping with breastfeeding, newborn care education, and emotional adjustment.^1,2 Across the maternity continuum, doula roles may include prenatal, labor-and-birth, postpartum, antepartum, and community-based models, although the evidence discussed here is focused mainly on birth-related and postpartum support.²

What does a doula do?

Doulas provide support to clients before, during, and after birth to enhance maternal confidence and continuity of care. Before delivery, doulas offer prenatal visits to prepare expecting parents for labor through childbirth education and discussion of their birth plan.^1,2,3

Doulas provide continuous presence during labor and delivery, which is often limited in hospital settings. These non-clinical support professionals also use non-medical pain management strategies, including positioning, ambulation, massage, breathing techniques, and verbal reassurance. Doulas often facilitate communication between patients and healthcare teams to promote patient autonomy and emotional security.^1,2,3 They may also help patients interpret clinical information, ask questions, and advocate for their preferences, which can improve communication and shared decision-making.^2,3

After birth, doulas may conduct postpartum visits to support recovery, breastfeeding initiation, and newborn care education. Emotional reassurance and practical guidance during this transition period can reduce stress and enhance maternal adjustment.^1,2,3 Some programs also include referral to community resources and support for navigating maternity services.^2,3

Health outcomes associated with doula support

Doula support is associated with measurable improvements in maternal and newborn outcomes. For example, a multi-state Medicaid study reported that women who received doula care had 52.9% lower odds of cesarean delivery and 57.5% lower odds of postpartum depression or anxiety³. Scoping reviews similarly found associations between doula support and reduced cesarean rates, shorter labor duration, and decreased use of epidural or other pain medications.^1,2,3

Neonatal outcomes appear favorable, with several studies observing improved breastfeeding initiation and continuation, earlier lactogenesis in low-income populations, and inconsistent or non-significant reductions in preterm birth in some cohorts.^1,2,3 Emotional and psychological outcomes consistently indicate reduced maternal anxiety and stress, greater confidence in coping with labor, and higher satisfaction with the birth experience when continuous doula support is present.^1,2,3 However, findings are not uniform across all outcomes or populations, and some studies reported no significant differences for outcomes such as birthweight, preterm birth, cesarean delivery, or maternal depression in certain settings.^1,2

One scoping review also noted a study showing that community-based bilingual doula support was associated with longer hospital stays among some migrant women, underscoring that observed effects can vary by context and population.²

Limitations and gaps in evidence

Many studies evaluating the benefits of doula care have been observational or retrospective in their design, with relatively few randomized controlled trials and mixed findings even among higher-quality studies, thereby increasing the risk of selection bias and confounding.

Variations in study design, population studied, and definitions of doula support, including timing, intensity, and type of integration with clinical teams, further limit the generalizability of existing findings. Doula roles and training models also vary widely from community-based volunteers to formally reimbursed professionals, further complicating direct comparisons across studies.^1,2

Many of the outcomes assessed in these studies are heterogeneous and range from cesarean delivery to breastfeeding, mental health, and health care utilization, similarly preventing direct comparison across studies.^1,2 Evidence is strongest for associations with reduced cesarean delivery and improved maternal experience, particularly among socioeconomically vulnerable populations, while evidence for some neonatal outcomes and longer-term postpartum outcomes remains more limited or mixed.^1,2,3

There remains a lack of data on the association between doula care and Apgar scores, low birth weight, and long-term postpartum outcomes. Further research is needed to clarify causal pathways and optimal models of integration.^1,2

How do doulas complement clinical care?

Doulas function as complementary members of the maternity care team by providing continuous non-clinical support alongside obstetricians, midwives, and nurses. Doulas do not replace medical providers or perform clinical tasks; rather, they provide emotional reassurance, physical comfort, and communication support that may be difficult to sustain in busy hospital settings.^2,3 Doulas often act as intermediaries to help patients understand medical information, articulate concerns, and navigate hospital systems.^2,3

A multi-state Medicaid study found that the integration of doula services with clinical teams, including midwives, resulted in the most consistent decreases in both cesarean delivery and postpartum depression or anxiety. Medicaid-based pilot programs in several states have successfully implemented structured models in which doulas provide prenatal visits, continuous labor support, and postpartum follow-up while coordinating with healthcare providers.

These benefits are thought to arise from continuous support, improved communication, reduced stress, and increased use of non-medical coping strategies during labor, rather than from direct clinical intervention.^1,2,3

By strengthening continuity of care without substituting medical expertise, doulas serve as an added layer of support within interdisciplinary maternity care models.^2,3

Image Credit: New Africa / Shutterstock.com

Practical considerations

Choosing a doula often involves reviewing training background, certification, and experience across the pregnancy continuum. Although doulas are non-clinical providers, structured programs, such as those integrated into Medicaid pilots, require standardized training, defined scopes of prenatal and postpartum visits, and coordination with healthcare teams. Compatibility, trust, and communication style are also critical, as doulas provide continuous emotional and informational support and may serve as intermediaries between patients and clinicians.^2,3

Historically, doula services have been underutilized, partly due to financial barriers. However, emerging Medicaid reimbursement programs in several U.S. states demonstrate that emerging models can expand access for socioeconomically vulnerable populations.^2,3 Access remains uneven, and several studies note that Black women, publicly insured women, and other marginalized groups are often more likely to want doula care than to receive it.^2,3

Community-based doulas frequently serve marginalized groups, including Black and Latina women, to address communication barriers, implicit bias, and health disparities. Culturally congruent support may further enhance trust, empowerment, and equity in maternity care.^2,3

Conclusions

Doulas provide continuous, emotional, physical, and informational support across pregnancy, labor, and the postpartum period. Current evidence suggests that doula support is associated with lower odds of cesarean delivery, potential but not consistently demonstrated reductions in preterm birth and maternal anxiety, and improved breastfeeding initiation, while the strength of evidence varies by outcome and study design.^1,2,3

References

1. Sobczak, A., Taylor, L., Solomon, S., et al. (2023). The effect of doulas on maternal and birth outcomes: A scoping review. Cureus 15(5). DOI: 10.7759/cureus.39451. https://www.cureus.com/articles/154723-the-effect-of-doulas-on-maternal-and-birth-outcomes-a-scoping-review
2. Chaudhary, P., Rech, J. P., Kumar, G., et al. (2025). Role of doulas across the pregnancy care continuum on maternal and child health: a scoping review. npj Womens Health 3. DOI: 10.1038/s44294-025-00109-4. https://www.nature.com/articles/s44294-025-00109-4
3. Falconi, A. M., Bromfield, S. G., Tang, T., et al. (2022). Doula care across the maternity care continuum and impact on maternal health: Evaluation of doula programs across three states using propensity score matching. EClinicalMedicine 50. DOI: 10.1016/j.eclinm.2022.101531. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00261-9/fulltext

Further Reading

• All Pregnancy Content
• Is “Mom Brain” Real? The Science Behind Memory, Mood, and Motherhood
• Early Signs of Pregnancy
• Is it Safe to Exercise During Pregnancy?
• Pregnancy: 0-8 weeks

Last Updated: Mar 19, 2026