The Statistical Benefits of Doula Support (and why they don’t always matter)
Megan supporting a laboring client
If you’re looking for a doula, you’ve probably seen these statistics listed on many birth workers’ websites:
According to a study (PDF download), people who had a doula were:
39% less likely to have a c-section
31% less likely to use pitocin to speed up labor
12% less likely to have an epidural
At face value, these numbers sound pretty good! After all, many of our clients have goals to avoid using an epidural and/or pitocin, and nearly all prefer to avoid cesarean birth if possible. So if hiring a doula can provide an advantage to achieving these goals, that’s pretty cool.
But boiling doula support down to these statistics leaves so much out!
In our practice, we work with clients experiencing high-risk pregnancies, clients who are pretty sure they will want an epidural (for a myriad of reasons), clients who are planning a c-section, and more. But the statistics above make it sound like only one version of birth is ideal - one with little to no medical support needed. And while there are some doulas who feel that way, that is definitely not how we practice!
There is so much variation among our clients and their paths to parenthood. The often-quoted doula statistics leave out so many of the people we’ve been privileged to work with over the years. So while it's wonderful to have research like this that demonstrates some of the impact birth doulas can have, it feels incomplete to us.
Rather than specific medical outcomes, we care much more about:
whether people felt that they had agency and decision-making power during their birth
whether people felt supported during their birth
whether people felt they were able to ask for and receive what they needed during their birth
whether people felt their birth was honored as an important life event, rather than just a medical event
To us, these facets of someone’s experience matter much more than whether they used any specific medical tool during their labor or not. Of course, minimizing unwanted and unnecessary medications and procedures is important! But the amount of medical care someone received doesn’t correlate with satisfaction about their birth experience. Rather, the answers to the questions above are MUCH more impactful, in our experience.
When someone has agency, feels supported, can get what they need (and aren’t made to feel like a burden!), and have their experience honored and respected by the people accompanying them during birth, they are much more likely to look back on their birth experience positively.
It turns out there is actually some data around these more personal and emotional topics.
Evidence Based Birth has an article all about the evidence for doula support, and there are some impactful findings shared there.
Here are some snippets:
There are four pillars of doula support:
Physical support
Emotional support
Informational support
Advocacy
Doulas are a form of pain relief in and of themselves. The calming effect of the doula’s presence can increase the birthing person’s own natural pain coping hormones, making labor feel less painful.
Doulas play an important role in “agency.” They facilitated communications with care providers, so that clients felt a sense of empowerment or ownership over their care.
Doula support may help disrupt negative impacts of racism and other social determinants of health on Black birthing people.
Research has shown that the most positive birth experiences for partners were ones where they had continuous support by a doula.
Partners have said that when they had labor support from a doula:
things were explained to them
their questions were answered
their labor support efforts were guided and effective
they could take breaks from the emotional intensity of the labor without abandoning their laboring partner
Doulas contribute to feelings of personal safety and security.
Doulas connect clients with resources and “translate” information received from care providers.
A doula’s presence has been shown to facilitate greater respect and autonomy in decision-making.
Marlee supporting clients during labor
As doulas, we are keenly aware of how much our presence, words, and actions can affect someone’s experience of their birth. This extends far beyond whether they had an epidural, pitocin, or a c-section. This is especially important since many people’s birth experience do include one or more of those medical factors for many different reasons - and that doesn’t mean that their birth was objectively substandard somehow!
But when we set so much store by the epidural/pitocin/c-section statistics that so many doulas publicize, we are leaving out so many other important facets of how doulas improve birth experiences.
Again, minimizing medications and procedures to situations where they are specifically needed or desired is a worthy goal, and an important part of what we do in our practice. But birth is about more than just what ends up on a medical chart when all is said and done.
Our work goes so much deeper than those statistics, in ways that often end up mattering much more to our clients than the specific medical events of their births.
In addition to improving health outcomes, having a doula by your side can drastically improve your overall experience during birth. You deserve support to help you have the most positive birth experience possible!
If you’re ready to take the next step in adding a doula to your birth team, we’d love to speak with you!
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