Doula Support and Breastfeeding Outcomes: A Systematic Review

Introduction: Breastfeeding is considered the ideal source of infant nutrition and has been shown to enhance maternal-infant health, but most women do not achieve their breastfeeding goals. Significant racial, ethnic, and socioeconomic disparities exist in breastfeeding outcomes. While current literature indicates a positive association between doula support and breastfeeding, the specific breastfeeding outcomes impacted by doulas remain unclear. Our objective was to synthesize existing literature on breastfeeding outcomes when doulas are utilized. Methods: Electronic searches were conducted in February 2022 and updated in April 2024 to include primary studies that examined doula support and breastfeeding outcomes (intention, initiation, duration, exclusivity, support, knowledge, education). Studies were excluded if they were secondary research or outside the perinatal period (pregnancy, childbirth, and/or up to 1 year postpartum). Data were extracted and synthesized narratively, and risk of bias was assessed. Results: A total of 1,917 deduplicated studies were screened, and 32 were included. Twenty-two studies were quantitative, and 10 studies were qualitative or mixed methods. Most studies (n = 24) consisted of birthing populations that experience marginalization, such as adolescents, low-income status, and racially/ethnically minoritized groups. Although doula support was associated with improved breastfeeding outcomes overall, there were mixed findings regarding breastfeeding duration and exclusivity. Lactating clients found doulas to be an important source of breastfeeding support, education, and knowledge. However, doulas reported a need for increased breastfeeding education during their training. Health care providers had limited knowledge of doulas' role in promoting breastfeeding. Conclusion: Doulas are associated with improved breastfeeding outcomes. Increased breastfeeding education in doula training and greater inclusion and awareness of doulas among the health care team could maximize this benefit.