Doula support linked to fewer preterm and caesarean births

Design

Systematic review and meta-analysis, GRADE-rated (US studies)

Population

12 randomised trials and 18 non-randomised studies of doula support vs standard care

Primary outcome

Maternal and infant outcomes

Effect

Moderate-certainty reductions in preterm birth and caesarean; many outcomes low-certainty

A US evidence synthesis graded the effect of doula support against standard maternity care across 12 randomised trials and 18 non-randomised studies, using GRADE. Most studies carried moderate or high risk of bias, which sets the ceiling on how firm the conclusions can be.

With moderate certainty, doula support was associated with lower preterm birth and caesarean rates, better birth experience and more postpartum visit attendance. With low certainty it was linked to better prenatal mood, more breastfeeding initiation, shorter labour and less epidural use. It showed no clear effect on hypertensive disorders, maternal readmission or neonatal intensive care admission.

Among studies made up entirely of women facing care disparities, four of five reported some benefit. Where doula support can be facilitated, it is reasonable to do so — while being honest that the size of most effects is uncertain, and that this US evidence may not transfer directly to Indian practice.

• US synthesis of 12 randomised trials and 18 non-randomised studies, GRADE-rated.
• Moderate certainty: lower preterm birth and caesarean rates, better birth experience, more postpartum visits.
• Low certainty: better prenatal mood, more breastfeeding initiation, shorter labour, less epidural use.
• No clear effect on hypertensive disorders, maternal readmission or neonatal intensive care admission.
• Four of five studies in disadvantaged populations reported some benefit.

Why it matters

Doula care is expanding and often publicly funded, so grading what it can and cannot be expected to change is overdue.

Don't overread it

Most outcomes are low-certainty, and the studies were US-based and heterogeneous, so benefits may not transfer directly to Indian settings.

The statistics, in plain English

Most estimates are low-certainty because many studies had high risk of bias and results varied; moderate certainty means the direction is reasonably secure but the exact size is not.

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