OHSU Research Study

Doula care makes a difference!

OHSU nurse-midwives investigated the impact of doula support in a formal clinical study, comparing women who had a doula attending their birth with those who did not. As part of that study, PDX Doulas provided professional doula care to OHSU patients from June 2007 to April 2009. The benefits observed for women who had doula support was significant in several ways. The results showed that doula care is cost-effective, decreases the need for cesarean birth, and fosters more positive birth experiences. PDX Doulas was privileged to contribute to this study and we hope it may influence the standard of care for birthing families.

This study demonstrated a significant difference in the cesarean birth rate between doula-attended women compared to matched cases.

This study strengthens the growing body of evidence that doula care has a positive impact on obstetrical outcomes and patient satisfaction, as well as has the potential to decrease health care expense.


The primary author of the study was Cathy Emeis, PhD, CNM, Assistant Professor at OHSU, with co-authors Natalie Jacobson-Dunlop, Jeanne-Marie Guise, Christen OHaire, Carol Howe, and Lani Doser. The study was presented at the Western Institute of Nursing (WIN) 2010 Conference and published in 2011 in the Virginia Henderson Nursing Library. The abstract is below:

Author: Emeis, Cathy, CNM
P.I. Institution Name: Oregon Health & Science University
Title: Assistant Professor
Contact Address: 3455 SW US Veterans Hospital Rd., SN-5S, Portland, OR, 97239, USA
Email: emeisc@ohsu.edu
Co-Authors: Natalie Jacobson-Dunlop; Jeanne-Marie Guise; Christen OHaire; Carol Howe; Lani Doser

The purpose of this study was to investigate the obstetric outcomes and economic implications associated with the provision of doula care, as well as its effect on patient satisfaction.
The cesarean birth rate in the United States is among the highest in the developed world and continues to rise at an alarming rate. Few interventions have been identified that significantly and consistently decrease the cesarean birth rate. Among those interventions studied is labor support by doulas. Several studies have demonstrated that doula care lowers the cesarean birth rate and is associated with high patient satisfaction. While strong evidence supports the beneficial impact of doula care on selected birth outcomes, health plans are inconsistent in their willingness to cover the expenses associated with doula services.
A case-controlled, descriptive design was chosen to reduce the possibility of bias. Laboring women deemed vulnerable by insurance status were prospectively enrolled and assigned to doula care (n = 172). Using a random number generator, the control group (n = 344) was matched using Robson’s criteria (scale 1-10) and infant status to the cases (n = 172) (Robson, 2001). Descriptive statistics, x2 test, and independent samples t- test were performed to determine differences between doula versus non-doula attended labors for the following outcomes: provider type, birth interventions (epidural use, amniotomy, episiotomy), or birth outcomes (operative vaginal delivery, cesarean delivery, Apgar scores less than or equal to 7, and infant disposition). The length of stay was analyzed using Wilcoxen Mann-Whitney test. Economic impact was assessed utilizing current fees instituted at the study institution. Provider and patient satisfaction regarding doula care was evaluated using a 5 question, Likert-scale survey in the immediate postpartum period. The p level was set at < .05.
No significant differences were detected between the cases and controls for gravidity, parity, length of gestation, fetal presentation, previous uterine scar, induction of labor, and number of fetuses. Comparison of racial/ethnic groups was limited due to missing data (>20%) in the control group. Women receiving doula care were statistically less likely to have an epidural during labor (p = 0.03), have an episiotomy (p = .03), or cesarean delivery (p = .006). On average, doula attended women had a shorter hospital stay compared to the control group (p = .002). Overwhelmingly, patients and providers rated the doulas as being very helpful to the laboring mother and her family.
This study demonstrated a significant difference in the cesarean birth rate between doula-attended women compared to matched cases. The results of this study have implications for health care providers, organizations, and policy makers. This study strengthens the growing body of evidence that doula care has a positive impact on obstetrical outcomes and patient satisfaction, as well as has the potential to decrease health care expense. Future studies are needed to determine the particular aspects of doula care that influence these outcomes.