Fertility care

How doulas can help improve birth outcomes

Doulas are trained professionals who provide physical, emotional, and informational support throughout the pregnancy, birth, and postpartum experience. While they’re not medical professionals, doulas can help pregnant people navigate the birthing process, advocate for themselves during birth, and improve birth outcomes –– like reduced physical and psychological trauma, shorter labor times, fewer cesarean sections (C-sections), and increased parental satisfaction after labor.

As an Integrative Medicine Doctor, I respect the role doulas can play in improving the birth experience for women and birthing people, especially in those communities most at risk. In recent years, I’ve heard from more patients who plan to work with doulas either before, during, or after birth.

What are doulas?

A doula is an individual who provides non-medical support and care ––  typically through education, guidance, emotional support, and counseling –– for people during any part of a pregnancy journey.

In the U.S., doulas do not deliver babies. Instead, they support the birthing parent by sharing pain relief and relaxation techniques such as breathing exercises, massage, and laboring positions. They can also assist with communication between the birthing parent and their medical team and provide support after birth.

How can doulas impact birth outcomes?

Doulas have been around for centuries. In the early 1900s, when more births occurred in the home, doulas were especially critical players in birthing. With the development of modern medicine, there have been shifts away from this type of support. But in recent decades, a rising number of pregnant people have worked with doulas again.

One reason for the increase is that working with a doula is associated with better birth outcomes. Research found that doula-assisted parents were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breast/chestfeeding, which is also associated with health benefits.


The U.S. cesarean birth rate is much higher than necessary. While they are sometimes needed, the added risk of complications for the person carrying the pregnancy and the baby means they should be avoided when possible –– especially for low-risk pregnancies.

Studies have shown that the hospital where someone gives birth significantly impacts C-section rates. Doulas can provide education and support to help birthing people navigate hospital culture and advocate for themselves if they do not want a cesarean birth unless necessary. One study found that the odds of cesarean delivery were 40.9% lower for doula-supported births. Another found a 12% decrease in C-sections when a doula was present.

Whether planned or unplanned, C-sections happen, and doulas can be there for birthing people before or after the procedure to offer a calming presence during the surgery and guidance for whatever may happen after. For example, if the baby goes to the NICU, a doula can stay with the birthing person and help facilitate communication throughout different parts of the hospital.

Stress and pain management

Although doulas do not replace medical or mental health professionals, doulas can also have a positive impact on a person’s physical and psychological health. One study found that people who use a birth doula are 9% less likely to use medication for pain relief. Another study showed that anxiety levels were lowered when doulas were present during delivery. And with the rate of postpartum depression on the rise since COVID-19, doulas can help fill a gap in the need for emotional support through coaching and counseling.

Reduce racial disparities

In the U.S., people of color experience worse maternal health outcomes compared with their white counterparts. A history of racism and discrimination can create cycles of chronic stress and other illnesses that stem from it and make pregnancy and childbirth more dangerous. Black and Native American women are three to four times more likely than non-Hispanic white women to die from pregnancy-related causes during pregnancy, birth, and up to one year postpartum.

For BIPOC (Black, Indigenous, people of color) individuals, studies suggest that community-based doulas give patients autonomy over their journeys while educating providers on the harm they can inflict if they don’t unlearn biases. Black doulas and Indigenous doulas can add a cultural perspective to their support that can help create more culturally competent care from providers and help improve birth outcomes.

Resources for Carrot members

Doula services are often not covered under traditional insurance. Carrot members currently have unlimited access to chats with doulas for labor, birth plans, and postpartum questions.

Members can use their Carrot funds to pay for eligible doula services. To ensure members receive high-quality support that promotes healthy birth outcomes, doulas must meet specific criteria –– like obtaining accreditation from an approved organization, participating in an adequate training curriculum, and having an appropriate breadth of experience. If you’re a Carrot member, sign in to your account to learn more about your options.

This post was updated in January 2023.

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