BabiesMidwiferyPregnancy & Birth

What’s the Use of Midwives and Doulas?

Debug the myths of the birthing room.

By Darcia Narvaez, PhD

Note: First author is Elizabeth Ledden

Doulas have been assisting childbirth since time immemorial. A doula is a support to the mother throughout the perinatal period (see more about doulas here).

A doula is a professionally trained birth coach, who accompanies the mother during the birth and the next few days afterwards. A doula doesn’t replace a doctor, but is present during the birth, along with the doctor, to support the new mother.

A midwife is professionally trained to help give birth to the child and serves as a replacement for the doctor during the birth.

Although decreasing, there is currently a stigma in popular culture against the use of a doula or midwife in the birthing process. Many criticisms stem from the concern for the safety of both mother and baby, with the thought that doctors can provide a better quality of care during the birth.

However, studies have determined that expectant mothers assisted by either doulas or midwives are significantly more pleased with the birth process than are mothers assisted by doctors1,2. Women assisted by midwives have had a more positive attitude about their birth experience and are more satisfied with the care they received1. Women assisted by doulas find an increased communication and empowerment during the birth process, as well as a more positive attitude about their role in giving birth to their child2.

Are doulas and midwives safe?

A doula acts as a birth coach in the birthing room and does not replace the presence of the doctor. Having a doula present does not serve as a type of safety hazard for the mother or the baby. A midwife is professionally trained to help the mother give birth, and thus is qualified to replace a doctor in the birth process. Women assisted by a midwife as opposed to a doctor in a hospital setting had similar maternal and infant outcomes concerning the birthing process3.

What role does a doula play?

Doulas serve as advocates for the expectant mother during the birth process. Doulas offer physical comfort, physical assistance, and emotional, social, and verbal support4. Doulas offer support through praise, reassurances, acts that improve the comfort of the mother, such as holding her hands and rubbing her back, and explanations of what is happening during the labor and delivery process. The use of doulas is comparable to longstanding traditions of having experienced women help the expectant mother through the birth process4. Overall, the presence of a doula leaves women feeling more supported and informed during the birth2.

What are the influences of using midwives or doulas on the birthing process?

The use of doulas and midwives is associated with a more natural birth experience and fewer, often-unnecessary medical interventions. C-sections, episiometry, epidurals, and admission to the NICU occurred more frequently in doctor-assisted deliveries than in midwife-assisted deliveries1. Women attended to by doulas find the overall pain more bearable2, and women assisted by midwives experience lower rates of obstetric interventions, narcotic analgesia, electronic fetal monitoring, and use of amniotomy3. Babies delivered by midwives as opposed to doctors are less likely to receive drugs for resuscitation, but show similar Apgar scores and outcomes as babies delivered by doctors3.

Do doulas improve outcomes?

Yes, they do. In a meta-analysis (a study of studies) by Scott and colleagues, continuous support from a doula, when compared with no doula support, was significantly associated with less need for painkillers, artificial oxytocin, forceps, and c-section. Continuous support was also significantly related to shorter labor. Intermittent support did not have these positive outcomes. In one study, friends of expectant mothers (randomly assigned to condition) were trained to be doulas in two 2-hour sessions. Their presence decreased the length of labor, and the babies had higher Apgar scores at both one and five minutes. So doulas can help mothers and babies.

References

1. Harvey, S., Rach, D., Stainton, M., Jarrell, J. & Brant, R. (2002) Evaluation of satisfaction with midwifery care. Midwifery, 18(4): 260-267.

2. Campero, L., Garcia, C., Diaz, C., Ortiz, O., Reynoso, S. & Langer, A. (1998) Alone, I wouldn’t have known what to do”:A qualitative study on social support during labor and delivery in Mexico. Social Sciences & Medicine, 47(3): 395-403.

3. Janssen, P.A., Ryan, E.M., Etches, D.J., Klein, M.C., & Reime, B. (2007). Outcomes of planned hospital birth attended by midwives compared with physicians in British Columbia. Birth: Issues in Perinatal Care, 34(2), 140-7.

4. Deitrick, L. & Draves, P. (2008) Attitudes towards Doula Support during Pregnancy by Clients, Doulas, and Labor-and-Delivery Nurses: A Case Study from Tampa, Florida. Human Organization, 67(4): 397-406

5. Scott, K.D., Klaus, P.H., & Klaus, M.H. (1999). A comparison of intermittent and continuous support during labor: A meta-analysis. Journal of Women’s Health & Gender-Based Medicine, 8(10), 1257-1264.

6. Campbell, Lake Falk & Backstrand (2006). A Randomized Control Trial of Continuous Support in Labor by a Lay Doula. JOGNN Clinical Research, 35(4), 457-464.

Darcia Narvaez, PhD

Darcia Narvaez is a Professor of Psychology Emerita at the University of Notre Dame. She is the founder of the public and professional educational outreach project The Evolved Nest Initiative whose nonprofit mission is to share her science research into developing appropriate baselines for lifelong human wellness by meeting the biological needs of infants. This wellness-informed baseline is imperative at this time as the United States ranks 41st out of 41 developed countries in public policies that support families.

In a 2020 analysis of top scientists, Narvaez emerged in the top 2% of scientists worldwide. Of the eight million scientists in the world, the analysis concerned those who had at least five articles published in scientific journals between 1996 and 2017-- over six million scientists. Individuals were ranked according to various criteria, including number of citations of their work.

In 2022, she was named a fellow of the American Association for the Advancement of Science(AAAS), the largest international body of professional scientists in the world and publisher of the prestigious journal Science. Narvaez was honored for her distinguished contributions illuminating typical and atypical development in terms of well-being, morality and sustainable wisdom. Narvaez examines how early life experience — the “evolved nest” — influences moral functioning and well-being in children and adults. She integrates evolutionary, anthropological, neurobiological, clinical, developmental and education sciences in her work. The election of AAAS fellows is an honor bestowed upon members by their peers.

Narvaez’s book, Neurobiology and the Development of Human Morality: Evolution, Culture and Wisdom, was chosen for the 2017 Expanded Reason Award from among more than 360 total entries from 170 universities and 30 countries. Narvaez received the prize, including a substantial monetary award, at the Pontifical Academy of Sciences in Vatican City on September 27, 2017. The book also received the William James Award from the American Psychological Association in 2015.

Narvaez hosted interdisciplinary conferences at the University of Notre Dame regarding early experience and human development in 2010, 2012, and 2014. In 2016 she organized a conference on Sustainable Wisdom: Integrating Indigenous KnowHow for Global Flourishing. (Click on the links to see the full conferences in video on the Evolved Nest's YouTube Channel.)

She is the author or editor of numerous books and articles, see The Science page for listings.

She is the president of the venerable American nonprofit, Kindred World, a contributing editor to Kindred, the first global eco-parenting magazine, an advisory board member of Attachment Parenting International and the Association for Pre- and Perinatal Psychology and Health, APPPAH.

Her recent book, Neurobiology and the Development of Human Morality: Evolution, Culture and Wisdom (2014), won the 2015 William James Book Award from the American Psychological Association, as well as the 2017 Expanded Reason Award. She is former executive editor of the Journal of Moral Education.

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