Evaluation of a Shift Model Doula Program During Labor and Birth at a Large Volume, Safety-Net Teaching Hospital.
Phoebe Montgomery, Stefka Fabbri, Laura Podewils and 1 others
PMID 41427692WHAT IT FOUND
In-hospital doula support was associated with a 31% lower adjusted risk of cesarean birth.
NICU admissions were lower (2.8% vs 5.1%), but the study did not show a clear difference. Doulas were accepted 94.7% of times offered.
Key findings
01Doula support was associated with a 31% lower risk of cesarean birth after adjustment.
02NICU admissions were lower with doula support (2.8% vs 5.1%) but did not reach statistical significance.
03Most patients offered doula support accepted it; 355 accepted, or 94.7% of those offered.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was observational, so it cannot show that doula support caused the lower cesarean rate. Doulas were not universally offered, and availability depended on shift schedules and requests. Patients who accepted doula support differed from those who did not, including race, language, parity, and BMI. The analysis excluded scheduled or urgent cesarean births and fetal demise, so it does not cover all births. Several labor variables, such as type of vaginal birth, labor duration, severity of risk factors, and intravenous pain medication use, were not captured. The number of doulas per patient and continuity of support were not measured. Breastfeeding, postpartum depression, and postpartum follow-up were not available. Survey response rate was 31.8%, and patient, family, and staff responses were combined. The program was studied at one safety-net teaching hospital where most patients were insured by Medicaid.
The easy way to misread this
Do not read the 31% lower cesarean risk as proof that doulas cause fewer cesareans. Patients selected or were referred to doulas, doulas were not universally available, and the study did not randomise support.