Module 1: Introduction to Birth Doula Work — 8 Hours
IN THIS LESSON
Topics Covered:
How doulas support the body during labor and birth
Learn how doula support may help labor feel more manageable and may lead to better birth outcomes.How doulas provide emotional support
Learn how doulas help birthing families feel calmer, more confident, and less alone during labor.How doulas help families feel informed and prepared
Learn how doulas explain options, offer guidance, and help families feel more ready to make decisions.
Introduction
Bringing a baby into the world can feel exciting, emotional, and sometimes overwhelming. During pregnancy and birth, many families want extra support, reassurance, and guidance. That is where a doula can make a real difference. In this lesson, you will learn about the benefits of doula support, including how doulas help during labor, how they provide emotional support, and how they help families feel more prepared and empowered throughout the birth experience.
How doulas support the body during labor and birth
Unit 2 · Lesson 1
How doulas support the body during labor and birth
Learn how doula support can make labor feel more manageable, and may lead to better birth outcomes
Learning objectives
- Describe the hands-on comfort techniques doulas use in labor, and explain why each one works in the body.
- Understand how steady support changes the hormones of labor: oxytocin, endorphins, and cortisol.
- Connect physical comfort measures to birth results found in peer-reviewed research.
- Practice with a study deck, a flowchart for slow labor, a myth vs. fact game, a role-play script builder, and a reflective journal.
Labor is physical, and so is doula support
Many people picture a doula holding a hand and saying kind words. Emotional support matters a lot. But a doula's physical support matters just as much, and there is real biology behind it. What you do with your hands, how you help someone move, and the room you help create all affect the body's hormones during labor. (Hormones are chemical messengers. They tell the body what to do.)
Think about the last time you couldn't sleep because you were worried. You wanted to rest, but your body stayed tense and wide awake. Labor works a bit like that. A frightened body has a hard time doing its job. A calm, safe body has an easier time.
This lesson covers how physical support works and why. When you know the science behind what your hands are doing, you do it better. You can also explain it in plain words to clients, partners, and hospital staff.
The body knows what to do
Labor is a normal body process, not an emergency. The body already has a hormone system built to help a baby be born. Your job is not to run labor. Your job is to protect the conditions that let that system work: less stress, more safety, more movement, and less fear. Think of tending a campfire. You don't make the fire burn. You shield it from wind and rain so it can burn well.
The hormones of labor
Before the techniques, meet the three main hormones in labor. Almost everything a doula does with her hands is meant to support or protect them (Buckley, Journal of Perinatal Education, 2015; Uvnäs-Moberg et al., Frontiers in Endocrinology, 2021).
Oxytocin
Makes the uterus (womb) contract, helps parents bond with the baby, and lowers fear and pain. People often call it the "love hormone."
Doula link: a calm presence, kind words, and massage-like touch all help the body release oxytocin.
Beta-endorphins
The body's own pain relievers. They rise during labor, so pain is easier to handle and the mind feels focused and a little dreamy.
Doula link: a safe, low-stress room lets endorphins rise naturally, without being interrupted.
Cortisol (stress)
The body's main stress hormone. It is released when we feel afraid or anxious. Too much can slow labor, make pain feel stronger, and get in the way of oxytocin.
Doula link: easing fear and giving comfort lowers cortisol, which helps labor keep moving.
A review in Frontiers in Endocrinology (Uvnäs-Moberg et al., 2021) looked at the research on oxytocin and labor. It found that slow, rhythmic touch, like a gentle massage, raises oxytocin in the blood and lowers how much pain a person feels. The same review noted that stress and high cortisol can hold back the oxytocin system. In plain terms, fear doesn't only make labor feel harder. It can make labor go harder. So every comfort measure you give has a job inside the body: it helps lower cortisol and supports oxytocin.
To picture it
Imagine your client Maya is in transition. That is the intense stretch near the end of labor, just before pushing. She's scared. Her shoulders are up by her ears and her whole body is bracing. Her cortisol is climbing, and that gets in the way of the oxytocin driving her contractions. You move close and lower your voice. During the next contraction, you press steadily on her lower back and say, "Your body is doing exactly what it's supposed to do." Her shoulders drop. Her breathing slows. That isn't only comfort. It is her hormones shifting in real time.
Physical comfort techniques: the doula's toolkit
Research points to four kinds of physical support that doulas give in labor (Hodnett et al., 2013; Bohren et al., 2017; OpenStax Maternal Newborn Nursing, 2024). Each one works for its own reason.
Touch and massage
This includes back massage, firm pressure on the lower back (called counter-pressure), light stroking, hand-holding, and the double hip squeeze. A review of 10 studies (PubMed/Medline, 2019) found that back massage reliably lowers labor pain. It seems to work by lowering stress chemicals (cortisol and norepinephrine), raising serotonin (a feel-good chemical), and triggering endorphins. Counter-pressure on the sacrum, the flat bone at the base of the spine, is especially helpful for back labor. Back labor means strong pain felt mostly in the lower back.
Movement and positioning
Walking, rocking, lunging, hands-and-knees, squatting, lying on one side, and using birth balls or peanut balls (a peanut ball is an exercise ball shaped like a peanut). Upright and leaning-forward positions let gravity help the baby move down, and they can shorten the first stage of labor. Squatting widens the opening at the bottom of the pelvis. Moving also keeps labor from stalling, and it helps her feel active instead of stuck.
Heat, cold, and water
A warm compress on the lower back or perineum, a cool cloth if she's nauseated or too hot, and water such as a shower or tub. Heat relaxes tight muscles and improves blood flow. Cold works through the "gate control" idea. The spinal cord can only carry so many signals at once, so a new feeling like cold can "close the gate" on pain signals. Several studies link using water in labor with less epidural use.
Room and senses
Dim the lights, keep noise down, adjust the temperature, offer ice chips or sips of water, apply lip balm, play music, or use calming scents. What a person sees, hears, and smells affects the nervous system. OpenStax (2024) says a calm, welcoming room lowers anxiety and cortisol, which helps labor along. A doula often handles these small details when no one else can.
Watch
How can a doula help during labor? (BabyCenter)
Why this helps: The hormone names and the reason behind each technique are easy to mix up. Flipping cards and repeating the ones you miss helps you remember them when a real client is in front of you.
Remaining: 10Known: 0Review-again presses: 0
Deck complete
What the research shows: results linked to physical doula support
Births with a doula show some strong results. They come from some of the best research in birth care. The results add up from many small physical supports, given non-stop by a trusted, trained person (Bohren et al., 2017; Fortier & Godwin, Canadian Family Physician, 2015; PCORI, 2023).
↓ 39%Lower odds of cesarean birth with trained doula support (Fortier & Godwin, 2015 meta-analysis)
↓ 25%Shorter average labor in doula-supported births (Klaus & Kennell research, cited in Midwifery Today)
↓ PainLess need for pain medication and epidurals. This was a steady finding across 27 randomized trials (Bohren et al., Cochrane 2017)
What do these numbers mean? "39% lower odds" of a cesarean doesn't mean that 39 out of every 100 clients avoid one. It means that across the studies, having a doula made a cesarean noticeably less likely. A meta-analysis is a "study of studies." Researchers pool the results of many trials to get a clearer answer than any single trial can give. A randomized trial is one where people are put into groups by chance, so the groups can be compared fairly.
Why a doula helps more than other support
Cochrane is a group that reviews health research very carefully. Its 2017 review (Bohren et al.) found the best results when support came from someone in a dedicated doula role. It did not find the same results with hospital staff or family members. The researchers say a trained doula can give steady, skilled, non-clinical physical support, without the other demands that pull people away. A partner may be scared. A nurse has other patients. A doula has trained for exactly this, and stays for all of it.
Comfort vs. clinical: keep the lines clear
Physical support works best when you stay in your lane. You don't check how the baby is lying. You don't check dilation (how open the cervix is). You don't manage medical problems. You ease fear, support movement, and use skilled touch. When a medical question comes up, help your client ask her care team. Don't answer it yourself. Picture two tracks side by side. Comfort is your track. Medical care belongs to the care team.
Breath: the underrated physical tool
Slow breathing is one of the easiest comfort tools in labor, and research supports it. A doula often shows it, reminds the client, and keeps it going. When we're anxious, the body's "fight-or-flight" system (the sympathetic nervous system) switches on and releases cortisol. That can make labor longer and pain feel bigger (OpenStax Maternal Newborn Nursing, 2024). Slow, deliberate breathing switches on the body's calm-down system (the parasympathetic nervous system). That works against the stress response.
Here is how it looks in practice. Most people can breathe through a contraction when someone guides them. But if they're alone or scared, they forget how, and they start to brace. So breathe with her. Match a slow rhythm, keep eye contact, and ask her to focus on the breath out rather than on the pain. Try it right now: breathe in gently, then let out one long, slow breath. Notice your shoulders drop. That small change is the same effect you are helping her find. It is a real body change, not just a figure of speech.
"Anxiety stimulates the sympathetic nervous system to release stress hormones, namely cortisol. The resulting 'fight-or-flight' response causes longer labor and increases the perception of pain."— OpenStax Maternal Newborn Nursing, Chapter 17: Nonpharmacological Pain Management, 2024
Scenarios & tips
Scenario 1
Your client is 6 cm dilated (about 6 of 10 cm open) and has strong back labor. She tenses with every contraction and says it's too much.
"I'm right here with you. Let's try something. On the next one, I want you to breathe out slowly while I press on your lower back. Ready? Just breathe out... good. Tell me if that pressure helps, or if you want it different."
Tip: Counter-pressure during back labor, like a double hip squeeze or firm pressure on the lower back, is one of the quickest things you can do. Offer it, show her how, and adjust to what she tells you. Her body is the guide.
Scenario 2
Labor has stayed at 7 cm for over two hours. The nurse suggests Pitocin (a medicine that makes contractions stronger). Your client looks at you and asks, "What do you think I should do?"
"That's really a question for you and your care team. They can see the medical picture, and I can't. It might help to ask a few things first. What are my options right now? What happens if we wait another hour? What are the risks and benefits of Pitocin at this point? I'll stay right here with you while you talk with them."
Tip: Before the medical talk, think about the basics too. Has she eaten lately? Has she changed position in the last 30 minutes? Sometimes a walk or a few lunges gets things moving again. You can offer these comfort ideas while the team does its checks. Just don't present them as a replacement for medical advice.
Scenario 3
A partner wants to help but feels useless. They keep hovering, and your client is getting annoyed.
"Hey, I want to show you something really useful. During the next contraction, can you put your hands here on her hips and push in and down? I'll guide you. You're going to make a real difference."
Tip: Give the partner a job. It turns their worry into action, brings them closer to the person in labor, and doubles the hands helping. For example, a nervous partner who learns the hip squeeze often stops hovering, because they finally have something to do. Teach as you go.
Why this helps: Slow labor feels stressful for everyone in the room. This chart gives you a calm order of checks to follow, so you offer comfort first and send medical questions to the care team.
Why this helps: Writing about your own body and your own experience makes the science stick. It also helps you find words to explain your work to clients and hospital staff.
Your entries stay in this browser on this device. They are never sent to DNT Network. Copy or download them to keep a record or to share with your mentor.
🧠 Check your understanding
1
Why is easing a laboring person's fear more than emotional support? Explain step by step how fear connects to labor results through hormones.
2
A client wants to avoid an epidural but is struggling with pain at 5 cm. Describe at least four physical comfort measures you would offer, and say briefly why each one works in the body.
3
Why does the Cochrane review find better results when support comes from a trained doula than from a family member or hospital staff? What parts of the doula role explain the difference?
4
Labor has been slow. Your client has been lying in the same position for 90 minutes, she hasn't eaten in four hours, and bright lights glare overhead. What physical and room changes would you address first, and why?
Peer-reviewed references
- Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7, CD003766. https://doi.org/10.1002/14651858.CD003766.pub6
- Uvnäs-Moberg, K., Ekström-Bergström, A., Buckley, S., Massarotti, C., Nissen, E., Goberna-Tricas, J., & Olza, I. (2021). Maternal plasma levels of oxytocin during physiological childbirth — a systematic review with implications for uterine contractions and central actions of oxytocin. Frontiers in Endocrinology, 12, 742236. https://doi.org/10.3389/fendo.2021.742236
- Buckley, S. J. (2015). Executive summary of Hormonal Physiology of Childbearing: Evidence and implications for women, babies, and maternity care. Journal of Perinatal Education, 24(3), 145–153. https://doi.org/10.1891/1058-1243.24.3.145
- Fortier, J. H., & Godwin, M. (2015). Doula support compared with standard care: Meta-analysis of the effects on the rate of medical interventions during labour for low-risk women delivering at term. Canadian Family Physician, 61(6), e284–e292. [PMC4463913]
- Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7, CD003766. https://doi.org/10.1002/14651858.CD003766.pub5
- Patient-Centered Outcomes Research Institute. (2023). Impact of doula support during pregnancy, childbirth and beyond: A systematic review. https://www.pcori.org/research-results/2023/impact-doula-support-during-pregnancy-childbirth-and-beyond-systematic-review
- OpenStax. (2024). Maternal Newborn Nursing, Chapter 17.1: Nonpharmacological Pain Management. Rice University. https://openstax.org/books/maternal-newborn-nursing/pages/17-1-nonpharmacological-pain-management [Open access, CC BY 4.0]
- Lund, I., Yu, L. C., Uvnäs-Moberg, K., Wang, J., Yu, C., Kurosawa, M., & Lundeberg, T. (2002). Repeated massage-like stimulation induces long-term effects on nociception: Contribution of oxytocinergic mechanisms. European Journal of Neuroscience, 16(2), 330–338. https://doi.org/10.1046/j.1460-9568.2002.02087.x
What Doulas Do, What Doulas Don’t
Featured Study
Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews.
Reference (APA): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483123/
Summary
This large Cochrane systematic review analyzed data from over 15,000 birthing people across multiple countries. It found that continuous labor support significantly reduced the likelihood of cesarean birth, instrumental vaginal birth, and the use of pain medications. People who received continuous support were more likely to report positive birth experiences and shorter labors. Support was especially effective when provided by someone whose sole role was emotional and physical support, such as a doula. The benefits were consistent across hospital settings. No harms associated with continuous support were identified. The findings strongly support the presence of continuous labor support during childbirth.
What It Means to Birth Doulas
This review provides some of the strongest evidence supporting doula work worldwide. It confirms that continuous presence—not medical intervention—is a key factor in improving birth outcomes. Doulas offer a unique form of care that clinicians, who rotate shifts and manage multiple patients, cannot replicate. The findings reinforce that doulas are most effective when they are not part of the hospital staff and are dedicated solely to the birthing person. This research supports doulas advocating for uninterrupted support during labor. It also validates doula care as evidence-based, not anecdotal. Doulas can confidently reference this review when explaining their role to clients or healthcare teams.
Translating for Doula Clients
Suggested Script:
“Large studies across many countries show that having continuous support during labor lowers the chance of cesarean birth and helps people feel more positive about their experience.”
You can explain your role clearly:
“My job is to stay with you throughout labor—emotionally and physically—so you’re never navigating it alone.”
Help clients understand the value of presence:
“Research shows it’s not just what support is given, but the fact that someone is consistently there.”
Encourage questions and preferences to tailor support to their needs.
Hands-On Consultation
-
Context: A couple is weighing the cost of hiring a doula and asks, “Do doulas actually change birth outcomes?”
Suggested Doula Response:
“I completely understand your question. Research shows that families with doula support often have shorter labors, reduced need for interventions, and higher satisfaction with their birth experience. My role is to make sure you feel informed, supported, and cared for throughout your journey.” -
Context: A partner says, “If you’re here, will I still be important in the process?”
Suggested Doula Response:
“My role isn’t to replace you but to support both of you. Evidence shows that when doulas and partners work together, families report feeling more connected. I’ll guide you on ways to comfort your partner, so you remain central in this experience.” -
Context: A client shares, “My doctor said doulas aren’t necessary.”
Suggested Doula Response:
“I respect your doctor’s perspective. What research shows is that doulas work alongside medical teams to provide continuous non-medical support. I don’t make medical decisions, but I help you communicate with your provider, reduce stress, and keep your preferences front and center.”
2. How doulas provide emotional support
Unit 2 · Lesson 2
How doulas provide emotional support
Learn how doulas help birthing families feel calmer, more confident, and less alone during labor
Learning objectives
- Name the nine emotional support strategies that research has found birth doulas use in labor.
- Explain how emotional support connects to results you can measure, like less anxiety and lower rates of postpartum PTSD and depression.
- Tell the difference between support that builds her own strength and support that makes her depend on you. Practice words that point to her strength.
- Follow the emotional ups and downs of one birth, pick a strategy for a given moment, and watch how the stress-hormone chain responds when she feels safe.
Emotional support is not just being nice
Many people hear "emotional support" and picture hand-holding and kind words. That sounds warm, but it also sounds hard to measure. The research says it's more than that. Emotional support in labor is a set of skills you can learn. These skills affect how labor goes, how the birthing person feels about her birth, and how she feels weeks and months later.
Doulas are the only people in the birth room whose main job is emotional support. Nurses and midwives give some support too. But studies show nurses may spend as little as 6–10% of their time on labor support (Al-Adeli et al., 2025). Picture a busy nurse with several patients, charts to fill out, and monitors to check. She can't sit by one bed for hours. A doula can. And doing it well takes more skill than most people expect.
A useful difference
Being a caring person is one thing. Being skilled at emotional support is another. Both matter. You probably already have the first one, and that's likely why you're here. Training builds the second. Think of the friend everyone calls when they're upset, and then think of a trained counselor. This lesson helps you turn natural kindness into skills you can use again and again, with any client.
The nine emotional support strategies: what the research found
The best-known study of doula emotional support was written by researcher Amy Gilliland. It was published in the journal Midwifery in 2011. She interviewed 30 doulas from 10 U.S. states and two Canadian provinces. She also interviewed 10 mothers who had worked with a doula. Her goal was to find out exactly what doulas do to support people emotionally during labor. She used a method called grounded theory. That means she let the patterns come from what people told her, instead of starting with a guess.
She found nine strategies. Four are shared with nurses and midwives. Five are unique to doulas. Earlier studies had shown that doulas make a difference in birth outcomes, but no one could fully explain why. Gilliland thought these five strategies might be part of the answer. People call this the "doula effect."
Strategy 1 · SharedReassuranceLetting her know that what she feels is normal, she can handle it, and she is safe. "What you're feeling is exactly what labor feels like at this stage."Also used by: nurses, midwives
Strategy 2 · SharedEncouragementSpeaking up during and between contractions. Skip the generic "You've got this!" Say something specific about what she's doing right now. "You just got through that one. That was real work."Also used by: nurses, midwives
Strategy 3 · SharedPraisePointing out what she's doing well as it happens. Praise looks back at what she just did. Encouragement looks ahead. "You handled that last contraction beautifully."Also used by: nurses, midwives
Strategy 4 · SharedExplainingTelling her what's happening in calm, simple words, without scaring her. "Transition feels like the hardest part, and it's also the shortest." (Transition is the last stretch of active labor, just before pushing.)Also used by: nurses, midwives
Strategy 5 · Doula-uniqueMirroringMatching her pace, posture, and breathing so she feels you with her, without any words. You move into her rhythm. You don't ask her to match yours. If she sways, you sway slowly beside her. It helps most when words feel like too much.Unique to doulas in research
Strategy 6 · Doula-uniqueAcceptanceShowing that you accept whatever she feels or chooses, with no judgment. That includes asking for pain medicine, crying, yelling, or changing her birth plan. If she says "I want the epidural," you don't sigh or ask "Are you sure?" You stay fully with her.Unique to doulas in research
Strategy 7 · Doula-uniqueReinforcingShowing her own strengths back to her, especially when she doubts herself. "You told me at our prenatal visit that you've gotten through hard things before. This is one of those things."Unique to doulas in research
Strategy 8 · Doula-uniqueReframingOffering a new way to see a hard moment. You don't deny that it's hard. You change what it means. "This pain is doing something. Each contraction is opening your body, not just hurting." Therapists use reframing too.Unique to doulas in research
Strategy 9 · Doula-uniqueDebriefingTalking through the birth with her afterward, usually in the weeks after. It helps her make sense of what happened, name what was hard, and feel that the story is hers, whatever that story was.Unique to doulas in research
"Emotional support by professional birth doulas is more complex and sophisticated than previously surmised. Mothers experienced these strategies as extremely meaningful and significant with their ability to cope and influencing the course of their labour."— Gilliland, A.L., Midwifery, 2011 (PMID: 20850916)
In plain words: "surmised" means guessed. Doula support is more skilled than people thought. The mothers said these strategies helped them cope, and that they changed how their labor went.
Emotional support across the doula relationship
Emotional support doesn't start when labor starts. It builds over the whole time you work with a client. Each stage has its own job.
🌱 Prenatal visits
Build trust. Learn what she fears and hopes for. Let her know that worry is normal. Ask about past experiences that might shape labor. For example, a client who had a scary hospital stay years ago may tense up when she sees the monitors. This groundwork makes support in labor feel welcome instead of pushy. A client who trusts you can take in your reassurance. A client who just met you can't.
🕯️ During labor
Be with her, not just in the room. Change what you do as labor changes. Early on, you share more information. As contractions get stronger, you talk less and use more touch and quiet presence. You watch the room and your client at the same time.
🤝 Supporting the support person
Partners and family members feel afraid and helpless too. Research shows that when doulas help them, by giving them a job, keeping them calm, and helping them feel capable, it helps the person in labor too (Sobczak et al., 2023). Picture a nervous partner holding a cool cloth because you showed them how. They feel calmer, and so does she. Support spreads.
🌀 After the birth: debriefing
A visit or check-in where you gently go back over the birth. Postpartum PTSD is a stress reaction some people have after a frightening or painful event. Research on it shows that how people make sense of their birth, not just what happened during it, strongly predicts their mental health long-term (ScienceDirect, 2025). Debriefing may feel like a chat, but it matters a lot for her health.
Watch
What is a Doula and How Do Midwives Collaborate with Them? (Holland Hospital)
Why this helps: Seeing one birth as a path reminds you that support changes with each stage. You can picture what to do next before you are in the room.
Which strategies fit each stage is a teaching suggestion based on this lesson, not a rule from the research. Real labors don't follow a script, so read your client.
What emotional support does to outcomes
Emotional support isn't separate from physical results. It's one of the ways doula care works. Several studies link the emotional side of doula support to results you can measure (Bohren et al., 2017; Falconi et al., 2022; Sobczak et al., 2023).
↓ AnxietyIn randomized controlled trials (studies where people are placed in groups by chance), labor with doula support consistently shows lower anxiety (Sobczak et al., 2023; Gilliland, 2011)
↓ 57.5%Lower odds of postpartum depression or anxiety after births with a doula. "Lower odds" means it was less likely to happen (Falconi et al., eClinicalMedicine, 2022)
↓ PTSDDoula care was linked to lower risk of postpartum PTSD, even after other factors were accounted for, in a study of 437 women that used both numbers and interviews (ScienceDirect, 2025)
Why emotional support connects to physical results
The link between feelings and the body in labor isn't just a nice idea. It runs through hormones. Here is the chain. Feeling safe lowers cortisol, the body's main stress hormone. Lower cortisol helps protect oxytocin, the hormone that makes the uterus contract. Protected oxytocin helps contractions work well. Contractions that work well can mean a shorter labor and fewer interventions (medical steps to speed up or assist labor). So the emotional side and the physical side are one chain, seen from two angles.
Think about trying to fall asleep when you're scared someone is in the house. Your body won't relax. Labor works the same way. A frightened body tightens up. This is why Gilliland's research points to the doula-only strategies, mirroring, acceptance, and reframing in particular, as a possible reason doulas get results that simple encouragement can't explain.
Why this helps: Watching the stress-hormone chain move shows you why feeling safe matters for her body, not just her mood. It gives a reason behind every calm word you say.
This is a simple model of the chain described in this lesson. The bars show direction, not measured values. Real labors vary.
Emotional support vs. emotional dependency
A key skill for new doulas is knowing the difference between support and dependency. Every strategy you use should build up the client's own strength. You are not there to become her source of strength.
You'll see this most in the words you choose. Here are two ways to answer a client who says "I can't do this":
Two answers, two very different messages
Creates dependency: "You can do this because I'm right here with you. I've got you. You just need me."
Builds strength: "You are doing it. Look at what you've already gotten through. This feeling means you're almost there. Your body knows what to do."
The first answer makes you the reason she's coping. The second points to where her strength really is: in her. Your job is to hold up a mirror to that strength, not to hand it to her. Think of a friend learning to ride a bike. You can jog beside her, but she's the one pedaling.
The "rescuing" habit to watch for
Very caring doulas can slip into "rescuing." They try to take the client's pain away, in her body or her feelings. It comes from love, but it can backfire. If you try to remove every bit of discomfort, she may hear that her discomfort is a problem to fix, instead of a normal part of a powerful process. For example, if she groans and you keep asking "Is that better? How about now?", she may start to think something is wrong. Support her through it. Don't try to take it away.
Scenarios & tips
Scenario 1
Your client is in active labor. She says through tears: "I can't do this. I need the epidural. I'm not strong enough for this." (An epidural is pain medicine given through a small tube in the back.)
"I hear you. What you're feeling is real, and it's hard. This is also the point in labor where this feeling often shows up. It means your body is working really hard. Whatever you decide, I'm right here. And I want you to know you've already done something remarkable."
Tip: This answer uses acceptance (meeting her where she is, with no judgment), reframing (calling the intensity a sign of progress, not failure), and reinforcing (showing her own strength back to her). It doesn't push her toward or away from the epidural. It gives her room to choose from a calm place.
Scenario 2
The support partner is pacing and keeps asking, "Is she okay? Is this normal?" The person in labor is starting to pick up on their worry.
[To the partner, quietly, stepping a little aside:] "She's doing great. This is just what labor looks like at this stage. The best thing you can do right now is stay calm for her. She can feel your energy. Want me to show you something you can do with your hands?"
Tip: Anxious partners are one of the most common challenges in the birth room. A simple job, like pressing on her lower back or holding a cool cloth, does two things. It turns their worry into action, and it helps them feel useful instead of helpless. It's the same calming skill you use with your client, just aimed at the partner.
Scenario 3
You visit your client after the birth. She says it "didn't go the way I planned," and she seems sad and distant. She had an unplanned cesarean (a birth by surgery).
"I want to hear about it, all of it. What was the hardest part for you? And did anything surprise you, good or bad?"
Tip: This is debriefing. You aren't trying to fix the birth or put a bright spin on it. You are giving her room to tell the story in her own words. Research links trouble making sense of a birth story to higher rates of postpartum PTSD. Asking open questions and just listening can do more than it seems. It looks like a chat, but it matters.
Why this helps: It trains you to pick a strategy quickly when a client says something hard, and to check yourself for creating dependency before you speak.
🧠 Check your understanding
1
Gilliland (2011) found five strategies that only doulas use, not nurses or midwives. Name them. For each one, explain in your own words how it's different from simple reassurance or encouragement.
2
Why does emotional support in labor connect to physical results like labor length and cesarean rates? Trace the hormone chain from feeling safe to contractions that work well.
3
A client in transition keeps saying "Just tell me it's going to be okay." How would you answer using the reinforcing strategy without making her depend on you? Write the exact words you would use.
4
Research links doula care to lower rates of postpartum depression, anxiety, and PTSD. Which parts of the doula relationship, and which strategies in particular, do you think explain these longer-term effects?
Peer-reviewed references
- Gilliland, A. L. (2011). After praise and encouragement: Emotional support strategies used by birth doulas in the USA and Canada. Midwifery, 27(4), 525–531. https://doi.org/10.1016/j.midw.2010.04.006 [PMID: 20850916]
- Falconi, A. M., Bromfield, S. G., Tang, T., & Disciglio, R. (2022). Doula care across the maternity care continuum and impact on maternal health: Evaluation of doula programs across three states using propensity score matching. eClinicalMedicine (The Lancet), 50, 101531. https://doi.org/10.1016/j.eclinm.2022.101531
- Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7, CD003766. https://doi.org/10.1002/14651858.CD003766.pub6
- Sobczak, A., Taylor, L., Solomon, S., Ho, J., Kemper, S., Phillips, B., … & Jacobs, R. J. (2023). The effect of doulas on maternal and birth outcomes: A scoping review. Cureus, 15(5), e39451. https://doi.org/10.7759/cureus.39451 [PMC10292163]
- Association between doula care and postpartum post-traumatic stress disorder: A mixed-methods study. (2025). ScienceDirect. https://doi.org/10.1016/j.midw.2025.103731 [Study of 437 women; doula care independently associated with lower postpartum PTSD risk]
- Al-Adeli, N., et al. (2025). Role of doulas across the pregnancy care continuum on maternal and child health: A scoping review. npj Women's Health. https://doi.org/10.1038/s44294-025-00109-4
- Policy Center for Maternal Mental Health. (2025). The role of birth and postpartum doulas in improving maternal mental health. https://policycentermmh.org/the-role-of-birth-and-postpartum-doulas-in-improving-maternal-mental-health/
- Doula support for perinatal mental health needs: Perspectives on training and practice. (2024). ScienceDirect / Midwifery. https://doi.org/10.1016/j.midw.2024.103589 [Survey of 252 doulas; overwhelmingly desired more emotional support training]
Hands-On Consultation
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Context: The birthing person says, “I’m scared I’ll be left by myself when things get intense.”
Suggested Doula Response:
“You won’t be alone. My role is to provide consistent presence throughout labor, no matter how long it takes. That continuous support has been shown to help families feel calmer, more confident, and more in control.” -
Context: A client asks, “Won’t the nurses support me in the same way?”
Suggested Doula Response:
“Nurses are wonderful, but they often have multiple patients and medical responsibilities. I stay with you the entire time, focused only on your comfort, emotional support, and helping you communicate your needs.” -
Context: The partner says, “What if this takes 24 hours? I’m not sure I can last.”
Suggested Doula Response:
“That’s a very real concern. I’ll be there to share the load—encouraging you, guiding you both through rest breaks, and offering practical techniques like massage or position changes. My goal is to support both of you through the entire process.”
3. How doulas help families feel informed and prepared
Unit 2 · Lesson 3
How doulas help families feel informed and prepared
Learn how doulas explain options, share information, and help families feel ready to make their own decisions
Learning objectives
- Name the four ways doulas give information support: before the birth, during labor, and after.
- Use the BRAIN questions to help a client slow down and make her own decision in labor.
- Tell the difference between informing a client and telling her what to do. Learn why the first one respects her choices (this idea is called relational autonomy).
Information as support, not advice
One of the most helpful things a doula can do is also easy to misunderstand. You help your client feel truly informed.
That does not mean telling her what to do. It does not mean steering her toward your own beliefs about birth. It means she understands what's happening. She knows her options. She can ask good questions. And she feels sure enough to make her own choices.
This is harder than it sounds. Imagine your client Maria is 36 weeks pregnant. She texts you: "My doctor said something about being induced. Should I do it?" You want to help her. It's tempting to say what you'd do. But your job is to help her understand the choice, not to make it for her.
Researchers describe this as the difference between giving information and making the decision. The studies agree that the doula's role is only the first one (Meadow, Health Expectations, 2015; Jenkinson et al., Health Expectations, 2018).
A simple way to remember: lawyer, not judge
Think about a lawyer and a judge. A lawyer helps a person understand their options and the risks. The lawyer also helps them decide what to ask and how to say what they want. A judge makes the final ruling. In information support, you are always the lawyer. You are never the judge. Your client is the only decision-maker in the room. Your job is to make sure she has what she needs to decide well.
The four ways doulas give information support
Information support is not one single thing. It looks different at different times. Research across several studies points to four main parts (Bohren et al., 2017; Gruber et al., 2013; Women's Health Issues, 2024).
Prenatal education
This happens before labor starts, when your client can still think clearly. You explain the stages of labor and what they may feel in their body and emotions. You go over her birth preferences and help her partner know what to expect. You also explain common medical steps, like an induction, and what each one could mean. Example: at a visit, you walk Maria through what "early labor" usually feels like, so a 2 a.m. contraction doesn't scare her.
Birth plan support
You help your client figure out what matters most to her. Then you help her put her wishes into clear, friendly words. A birth plan is a way to talk with the care team. It is not a promise about how things will go. You also get her ready for the day plans change, and what she can do when they do.
Real-time translation during labor
In labor, medical words can sound like a foreign language. You put them into plain words. You can explain what a procedure is before it happens, or what a suggestion means. You never overrule the medical team. You also don't read clinical results, like a monitor strip, for your client. But you can help her ask the nurse, "Can you explain what that means?"
Question facilitation
You help your client find the questions she wants to ask. You encourage her to ask her providers directly. You also help her stay calm enough to think clearly. Research suggests this is one of the most meaningful things a doula does (Gruber et al., 2013). Example: before a prenatal appointment, you help her write three questions on her phone.
The BRAIN framework: a tool for informed decisions
One of the most useful tools you can share is called BRAIN. It is a short list of questions. It helps a client slow down and think about a medical suggestion, instead of saying yes or no right away.
You can teach it at a prenatal visit. Then you can gently bring it up in labor, when decisions feel rushed.
Each letter in BRAIN is a question your client can ask her care provider. You don't supply the answers. You help her feel steady enough to ask the questions herself.
| Letter | Question to ask the care team | How the doula helps |
|---|---|---|
| BBenefits | "What are the benefits of this recommendation for me and my baby?" | Encourage your client to ask this herself. If she feels too overwhelmed, offer to prompt her: "Do you want to ask about the benefits first?" |
| RRisks | "What are the risks if we go ahead, and the risks if we don't?" | Let her know she can ask about risks both ways. That includes the risks of the treatment itself. |
| AAlternatives | "Are there other options we haven't talked about yet?" | This is often the most powerful question. Many clients don't know they're allowed to ask it. You can say, "It might be worth asking if there are other options." |
| IIntuition | "What does my gut say? What feels right for me?" | This is the feelings part. Give her a quiet moment to check in with herself before she decides. You might ask, "How does that feel to you?" |
| NNothing / Not yet | "What happens if we wait, or do nothing right now?" | Help her see that "not yet" is sometimes an option. This is not true in an emergency. But in many non-urgent moments, there is time to wait and see. |
BRAIN in the moment
A midwife has just suggested breaking your client's water (this is called rupturing the membranes) to speed up labor. Your client looks at you. She seems overwhelmed. You lean in and say quietly, "You don't have to decide in 30 seconds. Would it help to ask a few questions first? What are the benefits? What are the risks? Could we wait and see what happens in the next hour?" You are not making the decision. You are reminding her that it's hers to make. That is information support.
Watch
Use the BRAIN: Informed Decision Making – Benefits, Risks, Alternatives, Intuition, Next steps (Centre CMI)
Why this helps: BRAIN only works if you can remember it when a client is stressed. Flipping the cards a few times helps the five questions stick, so they come to you without thinking.
Relational autonomy: the idea behind doula information support
Researchers use a term from medical ethics called relational autonomy. It appears in Health Expectations (Meadow, 2015; Jenkinson et al., 2018).
"Autonomy" means the ability to make your own choices. "Relational" means that choices don't happen alone. Your fear, your relationships, who holds power in the room, and what you know all shape what you choose.
Picture a woman in active labor. Her OB-GYN (a doctor who delivers babies) suddenly suggests something she didn't expect. She's in pain and tired. The room is unfamiliar. On paper, she's free to say yes or no. In reality, she may not feel able to think clearly or speak up.
The doula's information role is to bring those conditions back. You calm fear, give context, build confidence, and remind her that she has a voice.
"The doula's role is reframed as one of facilitating patient engagement and shared decision-making. A relational model emphasizes women's skills development, self-confidence, and recognition of the social context for decisions."— Meadow, S.L., Health Expectations, 2015 (PMID: 25327532)
In plain words: the doula helps a woman take part in her own care. She is not a source of facts that anyone can pull from. She is also not a fighter who argues with the staff. She is a helper who makes it possible for the client to understand and decide. The goal is always the client's strength, never the doula's.
Why this helps: Relational autonomy can sound abstract. This lets you see it: when fear drops and understanding rises, her ability to choose goes up. It also shows which of your tools to reach for first.
Your tool: lower the fear and give some context. For example, "You don't have to decide in 30 seconds."
Your tool: explain terms and procedures in plain words. Share the BRAIN questions, but don't recommend anything.
Your tool: remind her that asking questions is her right. Cheer on her confidence.
Conditions to make a real choice
This is a simple model of the idea in this lesson. The meter shows direction, not a measured score. At every setting, the doula never makes the decision.
What the research shows: information support and outcomes
A large study in Obstetrics & Gynecology (Karwa et al., 2024) looked at the records of 8,989 people who used a digital health platform. The researchers looked back at what had already happened, which is called a retrospective cohort study. They compared people by how many virtual doula visits they had. They found a "dose-response" pattern. That means more doula visits went along with better results on information and decision-making, like a stronger effect with a bigger "dose" of visits. Here are two of the findings:
3.67×Greater odds of feeling supported in deciding a birth preference, after 2+ doula visits (Karwa et al., Obstet Gynecol, 2024)
1.55×Greater odds of learning medically accurate information about pregnancy complications and warning signs (Karwa et al., 2024)
↑ Self-efficacyDoula-supported clients report greater locus of control, confidence, and empowerment in medical decision-making (Gruber et al., 2013; Women's Health Issues, 2024)
"Greater odds" means something was more likely to happen. For example, 3.67 times the odds is a big jump in how likely a person was to feel supported in her decision. A study like this shows a link. It can't prove the doula visits were the only cause.
Why information builds confidence
Another study looked at programs where doulas worked with clients before birth (Gruber et al., Journal of Perinatal Education, 2013). Doulas who gave information, not just comfort, helped clients feel more in control of their births. This feeling is called "locus of control." It simply means believing that your own actions can change what happens. Clients felt more sure that their choices and their active role in decisions mattered. That belief is called self-efficacy. It goes along with healthier habits in pregnancy, taking a more active part in your care, and a better experience of birth. So information is not just facts. It gives people power.
The bright line: informing vs. advising
The most important line in your work is the one between sharing information and giving advice. It's also the line doulas cross most often. Here is a simple map of it.
✓ Information support (inside your role)
- Explaining what a procedure usually involves
- Helping a client think of questions for her provider
- Teaching the BRAIN questions before a decision comes up
- Pointing to trustworthy, evidence-based resources on a topic
- Reading a birth plan with her and making the wording clearer
- Reminding her that asking questions is her right
- Explaining what a word means, like "augmentation" (helping labor along)
✗ Outside your role (directing, not informing)
- Recommending for or against a specific treatment
- Sharing your own opinion on epidurals, induction, and so on
- Telling a client what you would do in her place
- Reading medical results or assessments for her
- Arguing with or contradicting a provider's recommendation
- Presenting your own birth beliefs as facts
- Giving advice that works like medical guidance
The most common way doulas step over the line
It often sounds friendly. "I've seen a lot of births, and in my experience..." Or, "Most doulas would say..." Or, "Honestly, I think you should..." What you say may even be true. But now you are thinking for your client instead of helping her think. Watch for the moment you're about to share an opinion dressed up as information. When you feel it, try this question: "What feels most important to you right now?" That puts the decision back in her hands.
Scenarios & tips
Scenario 1
During a prenatal visit, your client says, "I don't really know what happens if they need to give me Pitocin. Should I be worried about it?"
"That's a great question to look at now. It's much easier to think about when you're not in the middle of contractions. Pitocin is a man-made form of oxytocin. It's used to start labor or make contractions stronger. Whether it's the right choice depends on what's happening at the time. It can help to know what to ask if it ever comes up. You could ask why it's being suggested, what the risks and benefits are, and if there are other options to try first. Want to practice those questions together now?"
Tip: This answer teaches without telling her what to do. It explains Pitocin in plain words. It moves her toward asking questions. And it uses the prenatal visit as practice for a real moment later. You never say whether Pitocin is good or bad.
Scenario 2
Your client is at 8 cm (almost fully open). The OB suggests an episiotomy, a small cut to make more room for the baby, to speed up pushing. Your client says right away, "I don't want one. Is that okay?" and looks at you.
"You absolutely have the right to ask questions and share what you prefer. This is a good time to ask the doctor why they're suggesting it right now, what happens if you don't, and if there's something else you could try first. I'll be right here while you talk with them."
Tip: She already knows what she wants. She needs help saying it to her provider. You aren't there to agree or disagree with the doctor. You're there to help her speak up for herself. Notice that you never say, "You don't have to have one."
Scenario 3
A client calls you at 37 weeks. She's panicking. Her provider just suggested an induction at 39 weeks. She asks, "What do you think I should do?"
"I can hear that this caught you off guard. That makes sense. I can't tell you what to do, because this is a medical decision that depends on your health and your values. What I can do is help you get ready for a good talk with your provider. Do you feel like you understand why they're suggesting it? Let's work out your questions: the benefits and risks, whether waiting is an option, and what worries you most. Then you'll be in a much better place to decide."
Tip: She is asking you to decide for her. That is the one thing you can't do. Notice her worry, say clearly that you aren't the decision-maker, and right away give her tools for talking to her provider. This is relational autonomy at work.
Why this helps: In the moment, it can be hard to tell if a reply is "informing" or "advising." Walking through the chart a few times gives you a quick check you can run in your head.
🧠 Check your understanding
1
Go through the BRAIN framework. In your own words, explain how a doula uses each letter. Think of it as a way to help a client find her own decision-making power, not a script to read aloud.
2
What is relational autonomy? How does it change the way we see the doula's information role? Why do researchers think it fits better than simply seeing the doula as an "information provider"?
3
The Karwa et al. (2024) study found a "dose-response" link between doula visits and clients' ability to decide on birth preferences. What does "dose-response" mean here, and why does this finding matter?
4
A client asks, "What do you think about epidurals? Do most doulas recommend them or advise against them?" Write how you would answer. Stay inside your role, and still be helpful and not evasive.
Peer-reviewed references
- Karwa, S., Jahnke, H., Brinson, A., Shah, N., Guille, C., & Henrich, N. (2024). Association between doula use on a digital health platform and birth outcomes. Obstetrics & Gynecology, 143(2), 175–183. https://doi.org/10.1097/AOG.0000000000005465 [PMID: 38052036]
- Meadow, S. L. (2015). Defining the doula's role: Fostering relational autonomy. Health Expectations, 18(6), 3057–3068. https://doi.org/10.1111/hex.12290 [PMID: 25327532]
- Jenkinson, B., Josey, N., & Flemmer, M. C. (2018). Defining the doula's role: Fostering relational autonomy. Health Expectations, 21(1), 130–139. https://doi.org/10.1111/hex.12604 [PMC5810740]
- Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of doulas on healthy birth outcomes. Journal of Perinatal Education, 22(1), 49–58. https://doi.org/10.1891/1058-1243.22.1.49 [PMC3647727]
- Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7, CD003766. https://doi.org/10.1002/14651858.CD003766.pub6
- Sobczak, A., Taylor, L., Solomon, S., Ho, J., Kemper, S., Phillips, B., … & Jacobs, R. J. (2023). The effect of doulas on maternal and birth outcomes: A scoping review. Cureus, 15(5), e39451. https://doi.org/10.7759/cureus.39451
- Women's Health Issues. (2024). United States doula programs and their outcomes: A scoping review to inform state-level policies. Women's Health Issues. https://doi.org/10.1016/j.whi.2024.03.004 [RAND Corporation / Jacobs Institute]
- American College of Obstetricians and Gynecologists. (2021). Informed consent and shared decision making in obstetrics and gynecology. ACOG Committee Opinion No. 819. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/informed-consent-and-shared-decision-making-in-obstetrics-and-gynecology
From a Doula: How Do You Know You're In Labor?
Hands-On Consultation
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Context: The birthing person says, “I really don’t want a C-section unless it’s necessary.”
Suggested Doula Response:
“I hear you. While no one can guarantee outcomes, research shows doula support is linked to lower cesarean rates. We’ll work together with your care team on comfort measures, positioning, and informed decision-making to help reduce unnecessary interventions.” -
Context: “If you’re with me, does that mean I won’t need interventions?”
Suggested Doula Response:
“My role isn’t to prevent medical care—it’s to help you understand your options, ask questions, and feel confident in your decisions. Sometimes interventions are necessary, but I can support you in knowing when and why, so you remain part of the decision-making process.” -
Context: The partner says, “Isn’t it better to just get the epidural right away?”
Suggested Doula Response:
“Pain relief options are always available, but sometimes families want to try comfort techniques first. Evidence shows doulas help reduce requests for pain medications, but I’ll support whatever decision you make. We can try natural strategies and reassess together as labor unfolds.” -
Context: A second-time parent says, “Last time, I felt ignored and helpless. I don’t want that again.”
Suggested Doula Response:
“Thank you for sharing that. Many parents with previous difficult experiences find having a doula makes a big difference. I’ll help ensure your voice is heard, remind you of your preferences, and provide steady support so you feel safe and cared for this time.”
Module 1: Introduction to Birth Doula Work
Lesson 1.2 Quiz: Benefits of Doula Support
Test your understanding of how doulas support the body during labor, provide emotional care, and help families feel informed and prepared. Select an answer for each question to see immediate feedback.
1. Which of the following is a physical benefit doulas may provide during labor?
✓ Correct! Doulas use non-medical comfort measures — position changes, counter-pressure, massage, breathing techniques — to help the body cope with labor.
✗ Not quite. Those are clinical tasks. Doulas support the body through non-medical comfort measures like positioning, counter-pressure, and hands-on techniques.
2. How can doula support potentially affect labor outcomes?
✓ Correct! Continuous doula support has been associated with labor feeling more manageable and may contribute to better birth outcomes — though it's never a guarantee.
✗ Not quite. Doula support doesn't guarantee specific outcomes, but it can help labor feel more manageable and may contribute to better experiences overall.
3. Which of the following best describes emotional support from a doula?
✓ Correct! Emotional support from a doula centers on calm presence, encouragement, and reassurance — helping the birthing person feel grounded and not alone.
✗ Not quite. Doulas provide emotional reassurance, not clinical mental health care, and they support — rather than replace — the partner.
4. True or False: One of the most valuable things a doula offers is continuous, uninterrupted presence throughout labor.
✓ Correct! Unlike hospital staff who change shifts, doulas typically stay through the entire labor — providing the steady, uninterrupted presence that makes such a difference.
✗ Actually, true. Continuous presence is one of a doula's most distinctive contributions — they stay through the whole labor, unlike rotating clinical staff.
5. How do doulas help families feel more informed and prepared?
✓ Correct! Doulas empower families with information and guidance, while always preserving the family's right to make their own informed decisions.
✗ Not quite. Doulas don't make decisions for families — they help families feel informed and confident in making their own choices.
6. Which of the following is NOT a typical comfort technique a doula might use?
✓ Correct! Epidurals are administered only by anesthesiologists. Doulas focus on non-medical comfort measures like positioning, pressure, and breathing.
✗ This is actually a typical doula comfort technique. Look for the option involving a clinical or medical procedure — that's outside a doula's scope.
7. Why might labor feel more manageable when a doula is present?
✓ Correct! Steady support helps regulate the nervous system, reduce fear and stress, and improve the birthing person's ability to cope with the intensity of labor.
✗ Not quite. Doulas don't numb pain or speed up labor. They help labor feel more manageable through continuous physical and emotional support that lowers stress and improves coping.
8. How does doula support typically benefit partners during labor?
✓ Correct! Doulas don't replace partners — they support them. By offering guidance and reassurance, doulas help partners feel more involved and effective in their support role.
✗ Not quite. Doulas support partners rather than replace them — helping them feel confident and engaged, not sidelined.
9. Which of these best describes the informational support a doula offers?
✓ Correct! Informational support means helping families understand what's happening and what their options are — without telling them what to choose.
✗ Not quite. Doulas share information and explain options, but they don't make decisions for families or perform clinical tasks.
10. Which statement best summarizes the overall benefits of doula support?
✓ Correct! That's the heart of doula support — a holistic, three-part care approach (physical, emotional, informational) that helps families navigate labor with more confidence and less fear.
✗ Not quite. Doulas don't guarantee outcomes or replace medical care, and they support families throughout the entire labor — not just one stage.
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Studies show that doula-supported births are associated with shorter labor, fewer interventions, and higher satisfaction with the birth experience.
Doulas provide emotional reassurance, comfort, and advocacy, helping birthing individuals feel empowered.
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Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 2017(7), Article CD003766. https://doi.org/10.1002/14651858.CD003766.pub6 pretermbirthca.ucsf.edu+3Cochrane Library+3Cochrane Library+3
Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of doulas on healthy birth outcomes. The Journal of Perinatal Education, 22(1), 49–58. https://doi.org/10.1891/1058-1243.22.1.49 PMC+2NCIOM+2
Knocke, K., & others. (2022). Doula Care and Maternal Health: An Evidence Review. U.S. Department of Health & Human Services. Retrieved from https://aspe.hhs.gov/sites/default/files/documents/dfcd768f1caf6fabf3d281f762e8d068/ASPE-Doula-Issue-Brief-12-13-22.pdf ASPE
Alvarado, G., & colleagues. (2024). United States Doula Programs and Their Outcomes. Journal / Publisher. (current article). Retrieved from https://www.sciencedirect.com/science/article/pii/S1049386724000215 ScienceDirect
World Health Organization. (2019, March 19). Why having a companion during labour and childbirth may be better for you. Retrieved from https://www.who.int/news/item/19-03-2019-why-having-a-companion-during-labour-and-childbirth-may-be-better-for-you World Health Organization