What 17,831 Births Tell Us About Doula Care
A large hospital study found that people who had a doula were more likely to have a VBAC, less likely to give birth early, and more likely to exclusively breastfeed. I have trained doulas for over two decades, and I still get excited when the research catches up with what our community sees at every birth.
This study matters because it comes from the American Journal of Obstetrics & Gynecology, one of the most respected journals in obstetrics. It also matters because it looked at almost 18,000 births, not a handful. Let’s walk through what the researchers found, what they didn’t find, and what it means for families and birth workers.
About the study
Researchers at the University of Pittsburgh Medical Center (UPMC) reviewed 17,831 births at Magee-Womens Hospital from January 2021 through December 2022. Of those, 486 birthing people received doula care and 17,345 did not. The study was led by Lara S. Lemon, PharmD, PhD, and Hyagriv N. Simhan, MD, and published in April 2025.
The hospital’s doula program was free to families. Clients were reached through referral or direct outreach, and most had a median of five doula visits, mostly during pregnancy. To count as “doula care,” a client had to see a doula both prenatally and during the birth admission.
The doula group looked different from the overall population. Clients were more likely to be Black, to have Medicaid, and to live in a disadvantaged neighborhood. Because the program had focused outreach on higher-risk patients, the researchers used several statistical methods to build a fair comparison group.
What the researchers found
Doula care was linked to better outcomes in four areas. These are the unadjusted rates reported for each group:
| Outcome | With a doula | Without a doula |
|---|---|---|
| Vaginal birth after cesarean (VBAC) | 34.4% | 18.8% |
| Preterm birth | 7.2% | 10.8% |
| Early preterm birth | 1.2% | 3.3% |
| Exclusive breastfeeding | 44.7% | 37.1% |
| Postpartum office visit within 6 weeks | 83.1% | 78.2% |
After adjusting for risk factors, the numbers still held up. Doula care was tied to 15 to 34 more VBACs for every 100 clients with a prior cesarean. It was also tied to about 4 fewer preterm births per 100 deliveries, and a 22% higher likelihood of exclusive breastfeeding.
The benefits were consistent across race and insurance type. That point is important. Earlier research focused mostly on people with public insurance, and this study found that commercially insured clients benefited too.
What the study didn’t show
Good advocacy means being honest about the limits of the evidence. This study did not find a statistically significant drop in overall cesarean rates, even though earlier studies have. The authors note that the only significant cesarean-related finding was the increase in VBACs.
Other newborn outcomes, such as NICU admission, did not differ significantly between groups. This was a retrospective study at a single health system, so it shows an association, not proof that doulas caused these results. The doula group was also small compared to the comparison group.
None of this weakens the case for doulas. It means we can share these findings with confidence while speaking accurately about what they do and don’t prove.
What this means for families and doulas
For families, the message is simple: doula support is worth asking about, especially if you are hoping for a VBAC. Many Medicaid programs, some insurers, and employer benefits now cover doula care, so check what your plan offers.
For doulas, this study gives you solid, peer-reviewed language for talking with clients, care providers, and payers. Notice where the benefits showed up: prenatal visits, birth support, breastfeeding, and getting clients to their postpartum appointment. That is the heart of doula work, and it all stays within our scope. We don’t diagnose or treat. We inform, support, and help clients use their voice with tools like the BRAIN framework.
The study also showed that most doula contact happened during pregnancy. Those prenatal visits are where trust is built and where education happens. Continuous support that starts early is not an extra. It is the work.
Ready to do this work?
Every new study like this one adds weight to what doulas have known for a long time: support changes outcomes. If you feel called to serve birthing families, Birth Arts International has trained doulas since 2000, with certification programs recognized by Medicaid programs in multiple states, Carrot Fertility, Maven, and MyCAA. Explore our doula programs and start your path today.
Sources
- Lemon LS, Quinn B, Young M, Keith H, Ruscetti A, Simhan HN. Quantifying the association between doula care and maternal and neonatal outcomes. Am J Obstet Gynecol. 2025;232(4):387.e1-43.
- Contemporary OB/GYN. Doula care linked to improved maternal health outcomes. April 2, 2025.