Study: Doula support improves birth outcomes by enhancing resilience among women of color

Friday, April 29, 2016

MINNEAPOLIS/ST. PAUL (April 29, 2016) A new study from researchers at the University of Minnesota School of Public Health found that support from a doula during pregnancy and childbirth could help improve health and well being for women of color and potentially reduce longstanding racial/ethnic disparities in birth outcomes. 

The researchers conducted focus groups with racially and ethnically diverse, low-income pregnant women and gathered the women’s perspectives on how care from a doula may influence the outcomes of pregnancy and childbirth. Specifically, they looked at how doula support relates to non-medical factors that influence health, sometimes called “social determinants of health," including economic stability, level of education, neighborhood and environment, and social relationships.

“Prior research shows a clear connection between doula support and positive birth outcomes. In this study, we talked with women of color to better understand how doula support translated to better outcomes.” said Katy Kozhimannil, Ph.D., lead author of the study and associate professor in the School of Public Health University of Minnesota. “Women told us that having a doula increased feelings of security, empowerment, and connection to others, and helped them participate in shared decision-making with their clinicians during pregnancy and childbirth.”

By addressing health literacy and social support needs, doulas helped women identify their needs, communicate more openly, and gain access to quality health care services. These supportive services outside of the medical care system may influence important clinical outcomes such as preterm birth, which has a higher prevalence among African-American women and is the leading cause of infant mortality. 

“Culturally-adept doula support can disrupt the well-worn pathways between social determinants of health and poor birth outcomes by addressing some of the underlying issues that evade clinical approaches to persistent disparities,” said Rachel Hardeman, Ph.D., a co-author on the study and assistant professor at Mayo Clinic. 

The study showed that doulas helped women prepare emotionally for the birth, have a sense of physical and emotional safety, understand the birthing process, and translate their doctors’ advice during clinical appointments. Doulas also helped women feel more connected to the resources available to them.

“Doulas specialize in the non-medical aspects of supporting women during pregnancy and childbirth,” says Shailendra Prasad, M.D. M.P.H, Associate Professor in Family Medicine and Community Health at the University of Minnesota, and co-author of the study. “Doula support is particularly crucial when the doula brings cultural knowledge that the clinical team does not have.”

Minnesota is one of two states where the Medicaid program covers doula services.  The results of this analysis suggest that greater access to doula services among diverse women may contribute to efforts to reduce racial/ethnic disparities that occur during pregnancy and childbirth.

The study findings will be published online Friday, May 7th, in the Journal of the American Board of Family Medicine’s special issue on social determinants of health. For interviews or an advance copy of the paper, contact Kali Dingman,

For more than 60 years, the University of Minnesota School of Public Health has been among the top accredited schools of public health in the nation. With a mission focused on research, teaching, and service, the school attracts nearly $100 million in sponsored research each year, has more than 100 faculty members and more than 1,300 students and is engaged in community outreach activities locally, nationally and in dozens of countries worldwide. For more information, visit