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The 2017 Cochrane Review: What It Says About Birth Doulas
6/26/20262 min read
Understanding the Role of Birth Doulas
Birth doulas have become increasingly popular in recent years, and for good reason. They serve as emotional and physical support during pregnancy, labor, and the postpartum period. But what does the evidence say about their effectiveness? The 2017 Cochrane review offers valuable insights into this very question.
The Cochrane Review Findings
In 2017, Bohren et al. published an updated Cochrane review on continuous support in childbirth. They combined the results of 26 trials with more than 15,000 people across 17 countries including North America, South America, Europe, the Middle East, Africa, Asia, and Oceania, in both high-income and middle-income settings.
Benefits of Having a Birth Doula
Overall, birthing people who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesareans. In addition, their labors were shorter by about 40 minutes on average, and their babies were less likely to have low Apgar scores at birth (an Apgar score is a measure of a baby’s immediate health at birth).
For two of the health outcomes below (designated with asterisks*), the best results occurred when a birthing person had continuous labor support from a trained doula– someone who was NOT a staff member at the hospital and NOT part of their social network.
The researchers found that overall, continuous support during birth leads to a:
25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*
8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*
10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference
38% decrease in the baby’s risk of a low five-minute Apgar score; there is no data on if the type of person providing continuous support makes a difference
31% decrease in the risk of being dissatisfied with the birth experience; this risk was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff
The results of this study mean that continuous support, including support from a doula, is a safe and beneficial way to increase the likelihood of better outcomes for the birthing person and the baby.
For any expectant mother considering whether to hire a birth doula, the evidence presented in the review suggests that the benefits outweigh the drawbacks. Doulas are not there to take the place of medical professionals but to complement their efforts, ensuring that the mother's needs and preferences are respected throughout the process.
For more detailed insights on the 2017 Cochrane review findings, check out Evidence Based Birth, where you can go through an incredible library of articles on evidence backed perspectives around birth, pregnancy, recovery, and neonatal health.
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