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In the late 1970′s, when Drs. John Kennell and Marshall Klaus investigated ways to enhance maternal-infant bonding they found, almost accidentally, that introducing a doula into the labour room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications. Since their original studies, published in the 1980s, numerous scientific trials have been conducted in many countries, comparing and analyzing how the type of person providing care appears to make a difference.

Researchers today are continuing to spend a considerable amount of energy into the perinatal period and an increasing amount into labour support provided by doulas. Labour support is looked into from a number of angles; in hospitals, in penitentiaries, multicultural settings, low-income families, single parents, etc. Whatever the angle, results have been showing that labour support provided by caregivers who come to the labour setting expressly to provide this care appears to offer women more benefits than labour support provided by medical caregivers from that setting. You will find below a number of peer-reviewed studies.

Because of copyright obligations, we can only post bibliographic references. If you desire to see abstracts of most of the studies listed below you can go to PubMed or to the Cochrane Database and insert the bibliographic information. The abstracts will give you the conclusions of authors. Do use the results with a grain of salt as any information must be also assessed and weighed individually by reviewing the study parameters and methodologies used.

For more resources on the latest research see also DONA International‘s website and Childbirth Connection‘s resources for health professionals. If you sign-up with Childbirth Connection you will have access to a review updated by the Cochrane Database in 2007 on “Continuous support for women during childbirth” which was conducted by Hodnett, Gates, Hofmeyr, and Sakala. The latest research on doulas was written by McGrath and Kennell “A randomized controlled trial of continuous labor support for middle-class couples: Effect on cesarean delivery rates” in Birth published in 2008 (volume 35, pages 92-97).

Ballen LE, Fulcher AJ. Nurses and doulas: complementary roles to provide optimal maternity care. Journal Obstetrics Gynecoly Neonatal Nursing. 2006 Mar-Apr. 35(2): 304-11.

Bartley C. Making a difference: you can be an agent of change. Midwifery Today Int Midwife. 2007 Autumn. (83): 15, 64.

Breedlove G. Perceptions of social support from pregnant and parenting teens using community-based doulas. Journal Perinaal Education. 2005 Summer. 14(3): 15-22.

Brill J. The Cambridge Doula program: helping women access their deepest courage. Midwifery Today International Midwife. 2005 Autumn. (75): 22-4.

Buck L. On labor support and doulas. AWHONN Lifelines. 2006 Aug-Sep. 10(4): 279; author reply 279-80.

Campbell D, Scott KD, Klaus MH, Falk M. Female relatives or friends trained as labor doulas: outcomes at 6 to 8 weeks postpartum. Birth. 2007 Sep. 34(3): 220-227.

Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. Journal of Obstetrics Gynecology Neonatal Nursing. 2006 Jul-Aug. 35(4): 456-64.

Campero L, García C, Díaz C, Ortiz O, Reynoso S, Langer A. “Alone, I wouldn’t have known what to do”: a qualitative study on social support during labor and delivery in Mexico. Social Science Medicine. 1998 Aug. 47(3): 395-403.
Cargill YM, MacKinnon CJ, Arsenault MY, Bartellas E, Daniels S, Gleason T, Iglesias S, Klein MC, Lane CA, Martel MJ, Sprague AE, Roggensack A, Wilson AK; Clinical Practice Obstetrics Committee. Guidelines for operative vaginal birth. Journal Obstetrics & Gynaecoly Canada. 2004 Aug. 26(8): 747-761.

Curl M, Davies R, Lothian S, Pascali-Bonaro D, Scaer RM, Walsh A. Childbirth Educators, Doulas, Nurses, and Women Respond to the Six Care Practices for Normal Birth. Journal Perinatal Education. 2004 Spring. 13(2): 42-50.

Gilliland AL. Beyond holding hands: the modern role of the professional doula.

Journal Obstetrics Gynecology Neonatal Nursing. 2002 Nov-Dec. 31(6): 762-769.

Guzikowski W. Doula–a new model of delivery (continuous, nonprofessional care during the delivery). Ceska Gynekol. 2006 Mar. 71(2): 103-5.

Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth. (View PDF)

The Cochrane Database of Systematic Reviews 2003 (updated in 2007), Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.

Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. American Journal of Obstetrics and Gynecology. 186,5 (2002): S160-72.

Hodnett ED, Fredericks S. Support during pregnancy for women at increased risk of low birthweight babies. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD000198. DOI: 10.1002/14651858.CD000198.

Hotelling B, Amis D, Green J, Sakala C. Continuous Labor Support. Journal Perinatal Educations. 2004 Spring. 13(2): 16-22.

Kane Low L, Moffat A, Brennan P. Doulas as Community Health Workers: Lessons Learned from a Volunteer Program. Journal Perinatal Education. 2006 Summer. 15(3): 25-33.

Keenan P. Benefits of massage therapy and use of a doula during labor and childbirth. Alternative Therapy Health Medicine. 2000 Jan. 6(1): 66-74.

Kennell JH, and McGrath SK. A randomized controlled trial of continuous labor support for middle-class couples: Effect on cesarean delivery rates. Birth. 2008. 35: 92-97.

Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA. 1991 May 1. 265(17): 2197-2201.

Kennell JH, Klaus MH. Bonding: recent observations that alter perinatal care.

Pediatric Review. 1998 Jan. 19(1): 4-12.

Anisfeld E, Curry MA, Hales DJ, Kennell JH, Klaus MH, Lipper E, O’Connor S, Siegel E, Sosa R. Maternal-infant bonding: a joint rebuttal. Pediatrics. 1983 Oct. 72(4): 569-572.

Klaus M, Kennell J. Parent to infant bonding: setting the record straight. Journal Pediatrics. 1983 Apr. 102(4): 575-576.

Klaus MH, Kennell JH. The doula: an essential ingredient of childbirth rediscovered. Acta Paediatrics. 1997 Oct. 86(10): 1034-1036.

Koumouitzes-Douvia J, Carr CA. Women’s Perceptions of Their Doula Support. Journal of Perinatal Education. 2006 Fall. 15(4): 34-40.

Lantz PM, Low LK, Varkey S, Watson RL. Doulas as childbirth paraprofessionals: results from a national survey. Womens Health Issues. 2005 May-Jun. 15(3): 109-116.

Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part I. Nonpharmacologic pain relief. American Family Physician. 2003 Sep 15. 68(6): 1109-1112.

Manning-Orenstein G. A birth intervention: the therapeutic effects of Doula support versus Lamaze preparation on first-time mothers’ working models of caregiving. Alternative Therapy Health Medicine. 1998 Jul. 4(4): 73-81.

Morhason-Bello IO, Olayemi O, Ojengbede OA, Adedokun BO, Okuyemi OO, Orji B. Attitude and preferences of Nigerian antenatal women to social support during labour. Journal Biosocial Science. 2007 (Nov 8):1-10.

Mottl-Santiago J, Walker C, Ewan J, Vragovic O, Winder S, Stubblefield P.

Nolan M. Supporting women in labour: the doula’s role. Modern Midwife.1995 Mar. 5(3): 12-15.

Mottl-Santiago J, Walker C, Ewan J, Vragovic O, Winder S, Stubblefield P. A Hospital-Based Doula Program and Childbirth Outcomes in an Urban, Multicultural Setting. Maternal Child Health Journal. 2007 (Jul 3).

Papagni K, Buckner E. Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient’s Perspective. Jourrnal of Perinatal Education. 2006 Winter. 15(1): 11-8.

Pascali-Bonaro D, Kroeger M. Continuous female companionship during childbirth: a crucial resource in times of stress or calm. Journal of Midwifery Womens Health. 2004 Jul-Aug. 49(4 Suppl 1): 19-27.

Pascali-Bonaro D. Childbirth Education and Doula Care During Times of Stress, Trauma, and Grieving. Journal Perinatal Education. 2003 Fall. 12(4): 1-7.

Perez PG, Herrick LM. Doulas: exploring their roles with parents, hospitals, & nurses. AWHONN Lifelines. 1998 Apr. 2(2): 54-5.

Punger D. Importance of continuous doula support during labor. American Family Physician. 2004 (Aug 1). 70(3): 448.

Ruhl C, Adams ED, Besuner P, Bianchi A, Lowe NK, Ravin CR, Reed ML, Simkin P. Labor support. Exploring its role in modern and high-tech birthing practices. AWHONN Lifelines. 2006 Feb-Mar. 10(1): 58-65.

Ridiman KM. Doula for the bereaved. Supporting a mother whose pregnancy has ended. Midwifery Today Childbirth Education. 1997 Spring. (41): 26-28.

Rosen MG. Doula at the bedside of the patient in labor. JAMA. 1991 (May 1). 265(17): 2236.
Schroeder C, Bell J. Doula birth support for incarcerated pregnant women. Public Health Nursing. 2005 Jan-Feb. 22(1): 53-8.

Scott KD, Berkowitz G, and Klaus M. A comparison of intermittent and continuous support during labor: a meta-analysis. American Journal of Obstetrics and Gynecology. 180,5 (1999): 1054-1059.

Scott KD, Klaus PH, Klaus MH. The obstetrical and postpartum benefits of continuous support during childbirth. Journal Womens Health Gender Based Medicine. 1999 Dec. 8(10): 1257-1264.

Shalev J. Having a doula during labor and delivery. Midwifery Today Childbirth Education. 1992-1993 Winter. (24): 8-9.

Simkin PP and O’Hara MA. Nonpharmacologic relief of pain during labor: systematic reviews of five methods. American Journal of Obstetrics and Gynecology. 186,5 (2002): S131-159.

Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003521. DOI: 10.1002/14651858.CD003521.pub2.

Stein MT, Kennell JH, Fulcher A. Benefits of a doula present at the birth of a child. Journal of Dev Behav Pediatr. 2004 Oct. 25(5 Suppl): S89-92.

Styrcula L. Every mother deserves a doula. Nurs Spectr (Wash D C). 1998 Aug 24. 8(17): 16, 19.

Thomassen P, Lundwall M, Wiger E, Wollin L, Uvnäs-Moberg K. Doula–a new concept in obstetrics [Article in Swedish]. Lakartidningen. 2003 Dec 18. 100(51-52): 4268-71.

Van Zandt SE, Edwards L, Jordan ET. Lower epidural anesthesia use associated with labor support by student nurse doulas: implications for intrapartal nursing practice. Complement Therapeutic Clinical Practice. 2005 Aug. 11(3): 153-60.

Waldenström U. Old-fashioned childbirth alternatives challenge modern obstetrics. Home childbirth and doula support controversial [Article in Swedish]. Lakartidningen. 2003 (Dec 18). 100(51-52): 4254-5.

Wang D, Mao X, Qian S. Clinical observation on Doula delivery[Article in Chinese] Zhonghua Fu Chan Ke Za Zhi. 1997 Nov. 32(11): 659-61.

Zhang J, Bernasko JW, Leybovich E, Fahs M, Hatch MC. Continuous labor support from labor attendant for primiparous women: a meta-analysis. Obstetrics & Gynecology. 1996 Oct. 88(4 Pt 2): 739-744.