Multiple factors contribute to maternal/infant health outcomes, including presence of a birth doula.

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Doula care around pregnancy and childbirth was once considered to be something accessible only to those with substantial financial means, as hiring a private doula can cost thousands of dollars. But 26 states as well as the District of Columbia now cover doula care via Medicaid, with an additional seven states in the process of implementing this coverage, according to the National Health Law Program. And a study published this month in JAMA Network Open identified multiple objective measures of the benefits of perinatal doula care.

Birth doulas are trained professionals who work with pregnant individuals before, during and after delivery, assisting in providing both physical and emotional support throughout labor and delivery and often in the early newborn period. While not medically trained, there are various doula training certifications either through private or hospital-based entities. Most private insurers do not cover the cost, but Medicaid coverage continues to expand, from 10 states in 2023 to 26 currently and likely soon to 33.

Having a doula during the labor and delivery process has several benefits, according to a 2023 study published in Cureus, including reduced incidence of cesarean section, which is often considered to serve as a marker for improved birth outcomes, increased use of breastfeeding and better advocacy for child safety measures. The study did not measure mental health outcomes for the mother, but the recently published study did.

The recent study reviewed 22 previously published studies, most of which were randomized clinical trials, on the impact of doula care during labor, delivery and the early time period after birth. The most notable findings, after compiling all accessible data points from these studies, included reduced maternal anxiety, improved postpartum follow up and higher incidence of breastfeeding in the early newborn period. They did not find significant impact on frequency of cesarean section or pain reduction during labor and delivery.

While there was limited consistency on the presence of a doula on the impact of postpartum depression, the reduction in maternal anxiety was much more consistent. The impact of maternal anxiety both during labor and in the hours and days after delivery can play an important role on maternal bonding to the newborn as well as in interest in pursuing breastfeeding. While these factors are not direct links to postpartum depressive symptoms, reducing anxiety in particular may later be shown to reduce maternal depression in the newborn period.

Doula care can also span much wider than just the labor and delivery process, including prenatal support and support in the days or even weeks after delivery. As publicly funded insurance is addressing only hospital-based doula care, inequities in access to doula care for the weeks before and after delivery will likely remain for the foreseeable future. Studies that continue to highlight objective outcomes that benefit maternal and child health based on inclusion of a birth doula may lead to expanded coverage of care by both private and public insurers.