How Do Doulas Reduce the Rate of Cesareans?

"I just really want to avoid a cesarean section, if possible," is one of the NUMBER ONE things I hear when talking to women about their birth preferences. And it's no wonder: current research supports the idea that for low-risk women with uncomplicated pregnancies, the risks of a cesarean delivery outweigh the risks of a vaginal delivery. If you are interested, the 2014 American College of Obstetrics and Gynecology (ACOG) report, Safe Prevention of the Primary Cesarean Delivery, summarizes the research nicely.

As a result, many women are keen to find ways to reduce the chances that they might have a cesarean, if possible. One of these ways is to hire doula support for their pregnancies and labor. This is something that ACOG supports in the same report referenced above

Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery... Given that there are no associated measurable harms, this resource is probably underutilized...

Greater satisfaction and a chance that you might avoid an unwanted cesarean with virtually no negative effects? Sign me up! You can find the meta-analysis referenced above right here (don't worry, it's short, and it includes a plain-English summary of the findings at the end!)

What isn't clear, though, is exactly how and why the continuous support of a labor doula has this positive influence on the birth experience of women.

Before I give my thoughts, though, I do want to point out that having a doula at your birth is not a silver bullet for avoiding a cesarean. Birth is unpredictable, and sometimes a cesarean is necessary, despite every effort to avoid one. There is a difference between reducing and eliminating the chance of a cesarean. The good news is that the reports about the benefits of professional doula support don't just highlight the fact that they reduce the cesarean rate, but that their trained and professional support also improves the overall satisfaction of all birthing women, including women who have a cesarean

So, how and why do labor doula's help to reduce the cesarean rate and increase satisfaction of women in the birthing space? Here are my thoughts:

  1. You, right now, already have what it takes. That might seem like a contradiction, so let me explain. You might have heard that doulas "empower" women, but the truth is that doulas don't possess the power. Birthing women do. They just don't always know it yet. Seeking out a professional doula is one {really awesome} step women can take to gain the confidence needed to tap into that power. Professional doulas aren't magical, but they can help you find your voice and navigate some of the options available to reduce the cesarean risk and increase satisfaction.
  2. Professional doula support enhances the normal, physiological process of birth. Fear and stress can negatively effect labor. This fact sheet on the importance of low-stress labor environments from Childbirth Connection discusses how this can happen. Lack of progression, especially once active labor is established, and a baby whose heart rate isn't responding well to the force of contractions can both be indications for a cesarean. A professional doula's specialty is the increased comfort of the laboring woman. A doula accomplishes this through emotional support, being a source of information, and providing physical comfort measures to reduce stress, tension, and pain.
  3. Satisfaction often comes from knowing that you have done your best, and from feeling involved, heard, and respected as a part of a team. This is true in labor and birth as well. The more that you feel valued and respected as a human individual in your birth process, and that you are involved in decision making to the extent that you feel most comfortable, the better your overall feelings about your birth, even if things don't go quite as planned. A professional doula can help you communicate with your birth team, and can help you utilize decision-making skills to help you get the most out of your experience. If a cesarean does become necessary, your doula will also be there continue helping you get your questions answered, ease your fears, and improve comfort before, during, and after the birth. Ideally these measures will help you to feel satisfied overall with your experience, no matter what the outcome.

Is hiring a professional doula the only way to help you navigate your pregnancy and birth, and possibly avoid a cesarean if that is what your preference is? Nope. But a professional doula plays a documentable, irreplaceable role in labor that can certainly enhance the experience. It is our pleasure at Tender Beginnings to partner with you to help you have the best birth possible.