Evaluation of a Shift Model Doula Program During Labor and Birth at a Large Volume, Safety-Net Teaching Hospital

Despite documented benefits of doula support for patients and newborns, access remains limited. This evaluation examined patient and neonatal outcomes associated with a hospital-based, shift model of doula care.

This retrospective analysis was conducted on eligible births at a single, safety-net teaching hospital between January 1 and December 31, 2022. Patients who received doula care during labor and/or birth were compared with those who did not. Doulas were volunteers who self-scheduled shifts and provided support when available. Primary outcomes included cesarean birth and neonatal intensive care unit (NICU) admission. Adjusted odds ratios were calculated to assess the association between doula presence and outcomes of interest.

Among 3055 eligible patients, 375 (12.2%) were offered doula support, and 355 (11.6% of total; 94.7% of those offered) accepted. Most patients were 25 to 34 years old (53.6%), were multiparous (67.2%), identified as Hispanic (65.7%), and had public insurance (82.5%). Patients who received doula support were more likely to identify as Black non-Hispanic or multiracial (P = .005). Labor complications, including chorioamnionitis, shoulder dystocia, and arrest of labor, were more frequent among those with doula support (18.9% vs 14.6%; P = .034), as was oxytocin augmentation (54.9% vs 37.0%; P <.001), and induction of labor (55.2% vs 37.1%, P <.001). NICU admissions were lower among doula-supported births, although not statistically significant (2.8% vs. 5.1%, P = .058). Doula-supported patients had lower odds of cesarean birth (11.8% vs 16.5%; P = .024; adjusted odds ratio, 0.69; 95% CI, 0.48-0.97).

Doula care provided through a shift-based hospital model was associated with a decreased cesarean birth rate despite increased labor complications, induction of labor, and oxytocin use. These findings suggest that even intermittent doula support may improve outcomes. Additional studies are warranted to further evaluate the impact of shift-based doula care models on perinatal outcomes.