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Doula Support During Pregnancy, Childbirth, and Postpartum: A Systematic Review and Meta-Analysis
Meera Viswanathan1, Jennifer Cook Middleton, Nila A Sathe
1RTI International, Research Triangle Park, the University of North Carolina at Chapel Hill, Chapel Hill, Birth Sisters Doula Services, Knightdale, and Kiota Doula, Zebulon, North Carolina.
Objective:
To systematically review the evidence on doula support in pregnancy, birth, and postpartum.
Data Sources:
PubMed, Cochrane Library (which includes clinical trials), CINAHL, PsycInfo.
Methods Of Study Selection:
Eligible studies were English-language randomized controlled trials (RCTs) and nonrandomized studies of interventions (NRSIs) based in the United States that evaluated doula support compared with standard care. Included studies reported maternal, infant, and partner outcomes from database inception through November 18, 2025. We used GRADE (Grading of Recommendations Assessment, Development and Evaluation) to assess the certainty of evidence.
Tabulation, Integration, And Results:
Twelve RCTs and 18 NRSIs reported on doula support compared with standard maternity care. One study had low risk of bias (ROB) (one RCT), 10 had moderate ROB (three RCTs, seven NRSIs), and 19 had high ROB (eight RCTs, 11 NRSIs). Doula support is likely to be associated with lower rates of preterm birth and cesarean delivery, improved birth experiences, and increased likelihood of postpartum visit attendance (moderate certainty of evidence). Doula support may be associated with improved prenatal mood, spontaneous vaginal birth, vaginal birth after cesarean, initiation of breastfeeding, childbirth education attendance, respectful care, satisfaction with care, self-efficacy, parenting confidence, postpartum adjustment to parenthood, and reduced epidural anesthesia use, length of labor, and infant mortality (low certainty of evidence). It may not be associated with reduced rates of hypertensive disorders of pregnancy, maternal readmissions, and neonatal intensive care admissions (low certainty of evidence). Among studies composed entirely of people at risk of disparities (specifically, those arising from race, carceral settings, low income, and having public insurance), four of five reported at least some benefit associated with doula support. There was insufficient information available on the effects of varying intensity or types of doula support. Heterogeneity was noted across many outcomes.
Conclusion:
Research suggests that doula support is associated with some improved maternal outcomes, although many studies were heterogeneous and rated as having high ROB. Research on type (including independent doulas), intensity, and timing of doula support could help to clarify settings in which doula care improves maternal and child outcomes and reduces health disparities.
Systematic Review Registration:
https://doi.org/10.17605/OSF.IO/P795C.