Continuous labor support by doulas and nurses and its impact on birth outcomes: a systematic review

Continuous labor support provided by doulas, nurses, or midwives is increasingly recognized as an important component of respectful, woman-centered maternity care. Evidence suggests that continuous support during labor may improve maternal and neonatal outcomes by enhancing emotional support, facilitating labor progress, and reducing unnecessary obstetric interventions. However, variations in intervention models and healthcare settings have resulted in inconsistent findings regarding the effectiveness of different support providers. This systematic review aimed to evaluate the impact of continuous labor support provided by doulas, nurses, or midwives on maternal and neonatal outcomes and to identify current evidence gaps to inform clinical practice and future research.

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic searches were performed in PubMed, CINAHL, and Web of Science to identify eligible studies published between January 2008 and December 2025. Only peer-reviewed primary empirical studies published in English were included. Eligible studies evaluated continuous labor support provided by doulas, nurses, midwives, or trained birth companions and reported maternal and/or neonatal outcomes. Sixteen studies met the inclusion criteria. Data were synthesized narratively according to study characteristics, intervention type, and reported outcomes.

Overall, continuous labor support was associated with improved maternal and selected neonatal outcomes across diverse healthcare settings. The most consistent maternal benefits included increased spontaneous vaginal birth, reduced cesarean delivery, shorter labor duration, lower use of obstetric interventions, improved maternal satisfaction, and enhanced breastfeeding initiation. Midwife-led continuous support demonstrated favorable effects on labor progression, whereas community-based doula programs showed particular benefits for socially disadvantaged and migrant women by improving access to culturally responsive maternity care. Evidence regarding nurse-led continuous labor support remained limited. Although neonatal outcomes generally showed positive trends, findings for Apgar scores and neonatal intensive care unit admission were less consistent across studies.

Continuous labor support appears to be an effective, woman-centered strategy for improving childbirth outcomes and maternal experiences. Integrating doulas, nurses, and midwives into models of continuous labor support may contribute to reducing unnecessary obstetric interventions and promoting respectful maternity care. However, heterogeneity among intervention models and outcome measures limits direct comparison between studies. Future research should prioritize high-quality comparative trials evaluating different support providers, particularly nurse-led models, and investigate long-term maternal and neonatal outcomes.