History of Doulas

Origins of Doulas

Doulas provide labor support to women undergoing childbirth. The term “doula” was developed in the 1960s to describe the comforting presence of a friend during labor. Historically, this type of labor support personnel has been used since the Greeks in ancient times, although they were servants and not professionals. In modern times, doulas have seen widespread usage not only in the U.S. but throughout the world. This recent popularity was brought on by clinical studies which showed that the presence of a doula reduced the need for medical intervention during labor as well as a higher success rate for breastfeeding during the first few days after birth.

Development of the role of a doula

Since the 1980s, doulas have been widely used to provide effective labor support. As their roles began to expand, the duties of a doula began to differentiate. Birth doulas, sometimes called labor doulas, provide support mainly during labor. They educate the mother on the most effective labor positions, main management techniques such as breathing exercises, and medical/non-medical options that can be used during delivery. They also offer a safe and comforting presence by providing companionship and emotional support. In contrast, the role of a postpartum doula is to provide the same warm and comforting presence to both the mother and newborn after her labor. She also provides newborn care and breastfeeding education in order to support the new mom.

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The history of doula training and certification

Initially, there were no requirements to become a doula. The first official doula certification program to be created was called Doulas of North America or DONA. DONA requires a trainee to attend in-person classes, a 3-day training workshop, complete a list of required readings and assist in childbirth to gain experience to receive a doula certification. As the success of DONA grew, many other doula certification organizations were founded.

How doulas have evolved in modern times

Historically, doulas have been a non-medical profession, meaning that they cannot perform medical tests or make medical diagnoses. Those roles are delegated to doctors, nurses, and midwives. However, doulas are trained to recognize symptoms, such as postpartum mood disorders, and to contact the appropriate medical authorities. The education that doulas provide to their clients originates from rigorous clinical studies which have been performed, peer-reviewed and published in esteemed medical journals.


Evidence on Doulas

There have been 26 randomized trials that tested the effects of continuous labor support on more than 15,000 people giving birth. Overall, people who receive continued support are more likely to have a normal vaginal birth and less likely to have pain medication, negative feelings about childbirth, and Cesareans. In addition, their labors are shorter, and their babies are less likely to have complications at birth or be admitted to a NICU. In these studies, the best results occurred when the continuous support was provided by a trained doula—someone who was not a staff member at the hospital and not part of the birthing person’s social network. - Evidence-Based Birth

Evidence-Based Birth has compiled the evidence for doulas and notes that people who have continuous support during childbirth experience a:

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    25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease) *

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    8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase) *

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    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

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    31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff

For two of these outcomes (designated with asterisks*), the best results occurred when a birthing person had continuous labor support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of their social network.

Learn More About Evidence Based Birth https://evidencebasedbirth.com/the-evidence-for-doulas/

Black Maternal Health

According to the Centers for Disease Control and Prevention (CDC), the rate of maternal mortality has continuously increased since data started being collected. The data reveals a dire picture of the racial disparities of the maternal mortality rate. According to the CDC, per 100,000 live births, there were 14.1 deaths among Asian women, 30.4 deaths among Indigenous women, and 42.4 deaths among black women, in comparison to 13.0 deaths among white women. It is important to note that Indigenous women have over twice the maternal mortality rate of white women and black women have over three times the maternal mortality rate of white women.


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Black doulas combat the maternal mortality crisis

Read more on Black Maternal Health:

❖ Black Maternal Health Caucus: https://blackmaternalhealthcaucusunderwood.house.gov/about-blackmaternal-health
❖ Black Maternal Health in the United States: Fact Sheet https://www.nationalpartnership.org/our-work/resources/healthcare/maternity/maternity-snapshot-black-maternal-health.pdf
❖ Black Maternal and Infant Health: Historical Legacies of Slavery: https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305243
❖ Black Mothers Matter: Racism and Childbirth https://profiles.ucsf.edu/karen.scott#narrative
❖ Black Women's Perspectives on Structural Racism across the Reproductive Lifespan: A Conceptual Framework for Measurement Development https://pubmed.ncbi.nlm.nih.gov/33398713/
❖ SACRED Birth Study: Dr. Karen Scott https://sacredbirth.ucsf.edu/sacred-birthBlack
❖ DONA’s Open Letter To DONA Members Regarding Antiracism Efforts https://www.dona.org/antiracism/



Additional Research (Words underlined in red, link to studies)

  • Doula care can reduce anxiety in mothers.
  • Doulas empower clients and help them realize that their decisions and emotions are important. They also help with the initiation of breastfeeding.
  • Doulas keep clients informed about birth, especially for first-time mothers.
  • Doulas work adaptively with clients to maintain nonjudgmental support and inform them of their options, even when birth doesn’t progress according to the preference or plan of the family.
  • Doulas humanize mothers during labor and childbirth. They do not make decisions for their clients. Rather they help clients engage and make decisions while providing respectful support and attentiveness.
  • Doula care can decrease the risk of cesarean and preterm labor.
  • Doula care can decrease the rate of non-indicated cesareans for low-risk mothers. Further studies show the association between doula care and preterm and cesarean birth, insurance reimbursement for doula services would save state Medicaid programs money.
  • Doulas can provide trauma-informed care.