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Continuous labor support by a doula

Alison Stuebe, MD, MSc
Robert L Barbieri, MD
Section Editor
Vincenzo Berghella, MD
Deputy Editor
Kristen Eckler, MD, FACOG


A woman's view of her childbirth experience is influenced by several factors and can change over time. Factors associated with a satisfactory childbirth experience include [1]:

Personal expectations that were realized

Quality of caregiver support and rapport with the caregiver

Ability to participate in decision making

These factors may be as important as the effects of pain, pain-relief measures, obstetrical interventions, labor characteristics, demographics, birth environment, and preparation.

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Literature review current through: Nov 2017. | This topic last updated: Aug 01, 2017.
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  1. Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002; 186:S160.
  2. Simkin PP, O'hara M. Nonpharmacologic relief of pain during labor: systematic reviews of five methods. Am J Obstet Gynecol 2002; 186:S131.
  3. Green J, Amis D, Hotelling BA. Care practice #3: continuous labor support. J Perinat Educ 2007; 16:25.
  4. Hodnett ED, Lowe NK, Hannah ME, et al. Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial. JAMA 2002; 288:1373.
  5. Gordon NP, Walton D, McAdam E, et al. Effects of providing hospital-based doulas in health maintenance organization hospitals. Obstet Gynecol 1999; 93:422.
  6. Hofmeyr GJ, Nikodem VC, Wolman WL, et al. Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding. Br J Obstet Gynaecol 1991; 98:756.
  7. Campero L, García C, Díaz C, et al. "Alone, I wouldn't have known what to do": a qualitative study on social support during labor and delivery in Mexico. Soc Sci Med 1998; 47:395.
  8. Lederman RP, Lederman E, Work B Jr, McCann DS. Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern. Am J Obstet Gynecol 1985; 153:870.
  9. Lederman RP, Lederman E, Work BA Jr, McCann DS. The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol 1978; 132:495.
  10. Bohren MA, Hofmeyr GJ, Sakala C, et al. Continuous support for women during childbirth. Cochrane Database Syst Rev 2017; 7:CD003766.
  11. Kennell J, Klaus M, McGrath S, et al. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991; 265:2197.
  12. Trueba G, Contreras C, Velazco MT, et al. Alternative strategy to decrease cesarean section: support by doulas during labor. J Perinat Educ 2000; 9:8.
  13. Gagnon AJ, Waghorn K, Covell C. A randomized trial of one-to-one nurse support of women in labor. Birth 1997; 24:71.
  14. Kozhimannil KB, Hardeman RR, Attanasio LB, et al. Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health 2013; 103:e113.
  15. Declercq E, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to Mothers III: Pregnancy and Birth. New York: Childbirth Connection; May 2013. http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf
  16. Chapple W, Gilliland A, Li D, et al. An economic model of the benefits of professional doula labor support in Wisconsin births. WMJ 2013; 112:58.
  17. Kozhimannil KB, Attanasio LB, Hardeman RR, O'Brien M. Doula care supports near-universal breastfeeding initiation among diverse, low-income women. J Midwifery Womens Health 2013; 58:378.
  18. http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery (Accessed on June 19, 2014).
  19. Hodnett ED, Osborn RW. Effects of continuous intrapartum professional support on childbirth outcomes. Res Nurs Health 1989; 12:289.
  20. Kayne MA, Greulich MB, Albers LL. Doulas: an alternative yet complementary addition to care during childbirth. Clin Obstet Gynecol 2001; 44:692.
  21. Wolman WL, Chalmers B, Hofmeyr GJ, Nikodem VC. Postpartum depression and companionship in the clinical birth environment: a randomized, controlled study. Am J Obstet Gynecol 1993; 168:1388.
  22. Payant L, Davies B, Graham ID, et al. Nurses' intentions to provide continuous labor support to women. J Obstet Gynecol Neonatal Nurs 2008; 37:405.
  23. Maher S, Crawford-Carr A, Neidigh K. The role of the interpreter/doula in the maternity setting. Nurs Womens Health 2012; 16:472.
  24. Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. J Obstet Gynecol Neonatal Nurs 2006; 35:456.
  25. Bertsch TD, Nagashima-Whalen L, Dykeman S, et al. Labor support by first-time fathers: direct observations with a comparison to experienced doulas. J Psychosom Obstet Gynaecol 1990; 11:251.
  26. Hodnett ED, Osborn RW. A randomized trial of the effects of monitrice support during labor: mothers' views two to four weeks postpartum. Birth 1989; 16:177.