Nulliparous women between the ages of 18 and 41 in the third trimester of an uncomplicated pregnancy, who expected to be accompanied during labor by their male partner, were asked to participate in a study of doula support. 555 low-, middle-, and high-income couples were randomly assigned to have continuous emotional support by a doula during labor (doula group) or to receive routine obstetric care (control group). Results of this study demonstrated that providing doula support even when the male partner is also present with the laboring woman has a positive impact on obstetric outcomes.

A primary criteria for inclusion in this study was an uncomplicated pregnancy, but 42 of the mothers enrolled required labor induction. 20 of these women were in the doula group and 22 were in the control group. The reasons for induction were similar in both groups. 21 women were post-dates, 10 developed pregnancy-induced hypertension, 3 had spontaneous rupture of membranes without labor, 1 was induced for “convenience”, and for 7 women no reason for induction was given. The rate of epidural use among women who had induced labor was 81% (N=34/42), with statistically similar rates when the two groups are considered separately (doula group = 90.0%, control group = 72.7%). The cesarean delivery rate for the full group was 42.9% (N=18/42). In the group without doula support, 63.6% (N=14/22) of mothers had a cesarean delivery. However, the cesarean delivery rate for mothers with induced labor who had the continuous support of a doula was significantly lower at 20% (N=4/20, p =.004).

Up to this time, randomized controlled trials of doula support have enrolled healthy women who were having a normal pregnancy and were anticipating uncomplicated vaginal deliveries. The powerful effects of doula support in these studies have been demonstrated repeatedly, with reduced cesarean rates and epidural use and shortened labor length. The present results from women who required induced labor highlight the importance of continuous doula support as an effective method for lowering cesarean delivery rates in this group. The positive impact of doula support for these women suggests the need for studies of labor support for women with other high risk conditions.