A Hospital-Based Doula Program and Childbirth Outcomes in an Urban, Multicultural Setting



The objective of this study is to determine whether there are differences in birth and breastfeeding outcomes for women who received labor support through a hospital-based doula program, compared with those who did not receive doula support in labor.


We conducted a retrospective program evaluation to compare differences in birth outcomes between births at 37 weeks or greater with doula support and births at 37 weeks or greater without doula support through the first seven years of a hospital-based doula support program. Log-binomial regression models were used to compare differences in cesarean delivery rates, epidural use, operative vaginal delivery, Apgar scores, breastfeeding intent and early breastfeeding initiation after controlling for demographic and medical risk factors. The propensity score was included as an additional covariate in our regression model to minimize issues of selection bias. Analyses were conducted for the whole cohort of 11,471 women and by parity and provider service in subgroup analyses. Cochran-Mantel-Haenszel test was performed to detect differences in effects over time.


For the whole cohort, women with doula support had significantly higher rates of breastfeeding intent and early initiation. Subgroup analysis showed that having doula support was significantly related to: (a) higher rates of breastfeeding intent and early initiation rates for all women regardless of parity or provider with the exception of multiparous women with physician providers; (b) lower rates of cesarean deliveries for primiparous women with midwife providers.


A hospital-based doula support program is strongly related to improved breastfeeding outcomes in an urban, multicultural setting.

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We acknowledge the support of Dr. Howard Cabral, PhD, MPH, Boston University School of Public Health, as consultant for the statistical analysis. Birth SistersSM is a registered service mark of Urban Midwife Associates and is used with permission. This study was unfunded.

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Correspondence to Julie Mottl-Santiago.

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Mottl-Santiago, J., Walker, C., Ewan, J. et al. A Hospital-Based Doula Program and Childbirth Outcomes in an Urban, Multicultural Setting. Matern Child Health J 12, 372–377 (2008). https://doi.org/10.1007/s10995-007-0245-9

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  • Doula
  • Labor support
  • Midwifery
  • Breastfeeding
  • Cesarean birth