Doula Research | C-Sections Reduced By 60-80%

There are many reasons why women and their partners choose to hire a doula to support them during pregnancy, childbirth and the postpartum period.

For some women, a doula will play a crucial role if, for example, her partner is unable to attend the birth or if he or she works in the military or overseas.

For others, having a certified doula is an additional, amazing layer of support and comfort for both the mother and her partner.

Couples love that a doula can provide a trifecta of maternity care, unlike anyone else who will care for them during the birth process.

This trifecta of health care allows for the fantastic outcomes doulas have consistently produced in countless studies from around the world.

What is a doula and how can c-sections be reduced?

A doula provides a trifecta of maternity care, whether you have a vaginal or cesarean birth. Let’s look at what this means.

C-Sections Reduced #1. A doula provides continuous support

Doulas are present during the whole process of labor and birth, whether it takes 3 hours or 18 hours. Regardless of the kind of birth you have, whether it is a natural birth, a cesarean birth or even a preterm birth, your doula will be by your side for as long as you need her.

C-Sections Reduced #2. A doula is experienced

These days there are many comprehensive doula programs. Just use search terms such as ‘doula training’, ‘doula childbirth education’ or ‘doula training cesarean births’, and you will see the number of trainings available for those who want to become a doula.

In the basic doula program, doulas are trained in normal, physiological birth. There’s no need to be trained in complications; that’s what doctors are for – and thank goodness we have them, when there is a genuine medical need. Doulas do not start with the premise that childbirth is a complicated and scary event. They help to keep things normal without interfering in any medical decisions.

Women’s needs are so different that doulas are specifically trained to cater for all aspects of obstetric care. As a result, all women can have genuine support when they need it most.

C-Sections Reduced #3. A doula is well known to the woman

The doula is specifically chosen by the mother, who has built a relationship with her doula before the birth. Trust has been established.

It’s rare that anyone else supporting a laboring woman in a hospital setting can provide all three types of care. A woman’s partner is neither experienced nor trained in birth, and members of the hospital staff will not stay by her side without interruption (due to shift changes and other women to attend to). In most cases, they aren’t even known to the mother until the day of the birth.

Because they’re in tune with the women they look after, hospital-based doulas can help in significantly reducing unnecessary interventions. They have already discussed the woman’s wishes and the whole goal is to help the woman achieve the birth she wants.

It’s because of these huge benefits, a review of available doula studies, done a few years ago, concluded that doula support was more effective than that of hospital staff or the mother’s family and friends. It meant fewer interventions, lower dissatisfaction with the birth and fewer complications.

The review concluded: ‘Continuous support during labor has clinically meaningful benefits for women and infants and no known harm. All women should have doula support throughout labor and birth’.

Read more about doulas in our article What Is A Doula? 11 Important Facts About Doulas.

Research talks: c-sections reduced with a doula

Research has been consistent for over a decade. Systematic reviews, randomized controlled trials and even the occasional retrospective cohort study have given good reasons for hiring a doula.

Having a doula’s support during childbirth was linked to an almost 60% reduction in the likelihood of a woman giving birth by c-section. This figure rises to 80% for non-medically indicated cesarean births.

The researchers analyzed the results of pre-existing medical surveys, detailing singleton births that took place in a US teaching hospital between 2011 and 2012. This particular survey was used because it was the only survey that included information on doula care.

The survey not only asked whether a doula was present at the birth, but also whether the mother desired doula care. The survey also allowed participants to indicate whether or not they were aware of the role of doulas.

The study found that only 6% of the participants gave birth with the support of a doula but another 27% of participants would have liked to have a doula with them during the birth. Unfortunately, 40% of the participants were unaware of doula care.

This study was considered groundbreaking, however, because for the first time it offered a comparison between the outcomes for women who had doula support and those who would have liked to have it. The study showed that wanting a doula’s support does not produce the same benefits as actually having a doula present.

It’s time for the obstetric system to look at the evidence and start providing hospital-based doulas to offer continuous support and reduce what are, in some hospitals, outrageous numbers of cesarean births.

What doulas do?

Doulas are trained, non-medical birth professionals, who provide continuous support to both mother and baby.

Studies have identified that women who receive continuous support and care during labor have much better birth outcomes with higher rates of spontaneous vaginal birth, shorter labors, fewer pain relief requests and lower rates of medical intervention.

Hospital staff often juggle multiple laboring women at one time, leaving them unable to provide continuous care.

Doulas offer education, information and emotional support during pregnancy and birth, so that women can have the most satisfying possible experience when giving birth.

Doulas do not offer medical care but provide instead a service that helps women and their partners feel empowered, in control of their birth space and, therefore, fully able to relax. They might have additional skills, such as training in Calmbirth/Hypnobirth, massage, naturopathy and photography, to name just a few.

Can having a birth doula significantly reduce the chances of a cesarean section?

Research in the past few decades has been consistent: doula support during pregnancy and birth will reduce the chances of a laboring woman entering the operating room – even more so, if that operating room is in a US hospital.

Trained doulas support women’s health in all its diversity. Studies have also shown that doulas help with racial disparities. When a BIPOC (Black, Indigenous, and people of color) doula supports a woman of color, she becomes a bridge across the gap between the woman she looks after and the clinical team. BIPOC women are at higher risk of adverse birth outcomes.

The results speak volumes and these racial disparities are being addressed by the presence of a supportive doula, regardless of women’s socioeconomic status, or whether they are first-time mothers (nulliparous women). Most women, especially low-risk women, have better outcomes when they have doula support.

Choosing a doula

If you like the idea of having doula support at birth, you will be relieved to hear there are plenty of doulas available for you to choose from. You can even find your perfect doula in the BellyBelly Marketplace (in Australia and US only, with more coming soon).

Organize meetings with a number of doulas from your local area, so you can find out more about the unique skills and experience each one has to offer. Don’t select the first doula you meet; there are so many lovely doulas available and meeting several will give you the opportunity to see how comfortable you feel around different doulas.

It’s important for your partner to be comfortable with the doula, too, since they’ll be working together to support you.

Doula support (including prenatal visits, the birth and postnatal visits) usually starts at around $800-$1000+, depending on your location and the skills the doula offers. Part-payment plans are usually available for those who need to break up the cost.

Make sure you compare what’s included in the packages on offer, because they vary from doula to doula. The cost often reflects the value, experience and skills you’ll be getting. Some doulas are also massage therapists, naturopaths, nutritionists and other types of therapists; therefore, they put together packages to include these offerings.

Perhaps employing a doula is out of your budget. Some organizations offer funding to women in need. Speak to the doulas in your local area and find out about any local funding schemes. Students or newly qualified doulas sometimes offer low-cost care, as a way of gaining experience, so contact your local doula training center to see whether they can put you in touch with any students.

‘Doulas are useless’

I first heard about doulas after I became a qualified midwife. I have to admit that I didn’t understand the doula’s scope of practice, as everything I heard about what a doula did was about support: continuous labor support, emotional support and even social support. For me, that was the role of the midwife.

It took me some time to understand the role of the doula. These days – and especially in Western countries – birth has become a fast business where, once a woman is admitted to a hospital, the clock starts ticking. Just a few decades ago women gave birth supported by the women in their communities – such as elder women, family friends and sisters.

Once we moved birth out of the homes and into big hospitals, it was considered that community support was no longer necessary, as the birth was in the hands of childbirth professionals. After just a few years, women began to realize that something very important was missing: it was the sisterhood and care that women used to give during pregnancy, labor and the postpartum period.

That is the reason why doulas are not useless but quite the opposite. They are highly beneficial in achieving positive birth outcomes, reducing interventions and epidural usage and increasing women’s satisfaction.

What are the interventions for reducing cesarean section?

When talking about childbirth, the c-section is perceived as the highest level of intervention.

What should you do to avoid a c-section?

• Be informed. A hospital is a business and it’s run as a business. Staff look after their cost-effectiveness and that means the moment you go through the hospital door, the clock starts ticking. Get the right childbirth education and make sure you’re prepared and knowledgeable about birth physiology
• Look for the right support. You don’t get a degree in architecture when you want to build yourself a house. The same happens with childbirth. Hiring the right healthcare provider is key, whether it’s a doula or an independent midwife
• Change providers. If you don’t like what you’re hearing and the odds you’re given, then change providers. For them, it might be just another easy c-section but it sure doesn’t feel the same way when you’re the woman the c-section is performed on.

Doula care after c-section

A randomized controlled trial on primary care home visits to mothers in the USA concluded that doula care has a very positive impact on mother and child health.

A mother needs all the support she can get. After having a c-section, the support many women get from a trained doula is immeasurable. Postpartum doula care is very important but, after cesarean delivery, the woman has become a mother and has had major abdominal surgery, so the baby and the mother both need looking after.

C-section doula

In some countries, the number of cesarean sections is so high that there are c-section doulas. They get special training, to help and provide the right emotional support to women who have just had a c-section.

What is a VBAC doula?

VBAC stands for Vaginal Birth After C-section.

When the number of cesarean sections is high, the number of women who want to try for a vaginal birth after having had a cesarean birth is also quite high. A VBAC doula supports a woman who has already experienced a cesarean and wishes to avoid one next time around.

Read more in our articles Vaginal Birth After C-Section VBAC – What To Expect and VBAC Myths – 4 Common Myths Busted.

Is 3rd trimester too late for a doula?

It’s never too late to get doula support. You can still build up a good relationship with a doula at the end of your pregnancy. With doula care, outcomes are greatly improved, so it’s never too late to get the benefits the company of a doula can bring to you and your birth experience.

Is doula support covered by medical funds?

Doula care is not usually covered by medical insurance companies; however, private insurance companies are foreseeing the potential financial value of doulas. Cesarean sections cost a great deal more than vaginal births and rising rates of c-sections mean rising costs. If medical insurance covered the cost of doula care, it would significantly reduce the risks and costs involved with cesarean sections, by 60% or more.

According to the National Partnership for Women and Families, Minnesota and Oregon were the first states in the US to include reimbursed doula care for pregnancy, childbirth and the postpartum period. Virginia, Rhode Island, Washington DC and California followed in 2021.

In the Netherlands, the public health care system provides a pack of free-of-cost postnatal visits by a postpartum doula who will help the family during the first few weeks after the birth of the baby.

Like the sound of these doula benefits? Visit the BellyBelly Marketplace to find a doula in your area.