Doulas provide individualized support during labor and childbirth. Research has consistently shown that having doulas support increases positive physical and psychological outcomes. Professional medical organizations have begun to recognize the evidence showing the positive effects of doula support. Even though professional organizations recommend doulas to reduce non-medically indicated treatments such as overuse of cesarean delivery, many practitioners uphold their authority to intervene as they see necessary. I utilize interviews with 25 doulas to explore how doulas use scientific evidence to ensure that women receive appropriate care. Results indicate that doulas do not think that many obstetricians follow evidence-based practices; doulas feel compelled to serve as overseers who remind medical staff about the clinical guidelines. In addition, doulas use evidence to prepare mothers to confront providers. I argue that while doulas can help close gaps, obstetric medicine needs to implement evidence-based strategies more systemically to improve care for all women.
ArmstrongDavid. 2002. “Clinical Autonomy, Individual and Collective: The Problem of Changing Doctors’ Behavior.” Social Science & Medicine55:1771–77.
2.
BohrenMeghan A.BergerBlair O.Munthe-KaasHeatherTunçalpÖzge. 2019. “Perceptions and Experiences of Labour Companionship: A Qualitative Evidence Synthesis.” Cochrane Database of Systematic Reviews3:CD012449. Retrieved May 20, 2021 (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012449.pub2/full).
CarmichaelSuzan L.SnowdenJonathan M.. 2019. “The ARRIVE Trial: Interpretation from an Epidemiologic Perspective.” Journal of Midwifery & Women’s Health64(5):657–63.
5.
ChengYvonne W.ShafferBrian L.NicholsonJames M.CaugheyAaron B.. 2014. “Second Stage of Labor and Epidural Use: A Larger Effect Than Previously Suggested.” Obstetrics and Gynecology123(3):527–35.
6.
Davis-FloydRobbieBarclayLesleyTrittenJanDavissBetty-Anne, eds. 2009. Birth Models That Work. Berkeley, CA: University of California Press.
7.
DebbinkMichelle P.UgwuLynda G.GrobmanWilliam A.ReddyUma M.TitaAlan T. N.El-SayadYasser Y.WapnerRonald J.RouseDwight J.SaadeGeorge R.ThorpJohn M.ChauhanSuneet P.CostantineMaged M.ChienEdward K.CaseyBrian M.SrinivasSindhu K.SwamyGeeta K.SimhanHyagriv N.ShriverEunice KennedyNational Institute of Child Health and Human Development, Maternal-Fetal Medicine Units Network. 2022. “Racial and Ethnic Inequities in Cesarean Birth and Maternal Morbidity in a Low-risk, Nulliparous Cohort.” Obstetrics and Gynecology139(1):73–82.
8.
DeclercqEugueneCunninghamDeborah K.JohnsonCynthiaSakalaCarol. 2008. Mothers’ reports of postpartum pain associated with vaginal and cesarean deliveries: Results of a national survey. Birth35(1):16–24.
DeGrootJocelyn M.VikTennley A.. 2017. “Disenfranchised Grief Following a Traumatic Birth.” Journal of Loss & Trauma22(4):346–56.
11.
DeitrickLynn M.DravesPatrick R.. 2008. “Attitudes towards Doula Support During Pregnancy by Clients, Doulas, and Labor-and Nurses: A Case Study from Tampa, Florida.” Human Organization67(4):397–406.
EpsteinStevenTimmermansStefan. 2021. “From Medicine to Health: The Proliferation and Diversification of Cultural Authority.” Journal of Health and Social Behavior62(3):240–54.
Evidence-Based Medicine Working Group. 1992. “Evidence-based Medicine: A New Approach to Teaching the Practice of Medicine.” Journal of the American Medical Association268(17):2420–25.
16.
FlammBruce L.BerwickDonald M.KabcenellAndrea. 1998. “Reducing Cesarean Section Rates Safely: Lessons from a ‘Breakthrough Series’ Collaborative.” Birth25:117–24.
17.
FreidsonEliot. 1984. “The Changing Nature of Professional Control.” Annual Review of Sociology10:1–20.
18.
GimovskyAlexis C.BerghellaVincenzo. 2016. “Randomized Controlled Trial of Prolonged Second Stage: Extending the Time Limit Vs Usual Guidelines.” American Journal of Obstetrics and Gynecology214(3):361.e1–e6.
19.
GlaserBarney G.StraussAnselm L.. 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL: Aldine Pub. Co.
20.
GordonNancy P.WaltonDavidMcAdamEileenDermanJudyGalliteroGinaGarrettLynda. 1999. “Effects of Providing Hospital-based Doulas in Health Maintenance Organization Hospitals.” Obstetrics and Gynecology93:422–26.
GuestGregBunceArwenJohnsonLaura. 2006. “How Many Interviews Are Enough? An Experiment with Data Saturation and Variability.” Field Methods18:59–82.
23.
HenleyMegan M.2015. “Alternative and Authoritative Knowledge: The Role of Certification for Defining Expertise among Doulas.” Social Currents2(3):260–79.
24.
HodnettEllen D.AbelSharon M.. 1986. “Person-environment Interaction as a Determinant of Labor Length Variables.” Health Care for Women International7:341–56.
25.
KennellJohnMcGrathSusanKlausMarshallRobertsonStevenHinkleyClark. 1991. “Continuous Emotional Support During Labor in a US Hospital.” Journal of the American Medical Association265(17):2197–201.
26.
KlausMarshall H.KennellJohn H.KlausPhyllis H.. [1993] 2012. The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth. 3rd ed.Boston, MA: Da Capo Lifelong Books.
27.
KnaapenLoes. 2013. “Being ‘Evidence-based’ in the Absence of Evidence: The Management of Non-evidence in Guideline Development.” Social Studies of Science43(5):681–706.
28.
KozhimannilKaty B.HardemanRachel R.Alarid-EscuderoFernandoVogelsangCarrie A.Blauer-PetersonCoriHowellElizabeth A.. 2016. “Modeling the Cost-effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery.” Birth43(1):20–27.
29.
LuMichael C.NoursiSamia. 2021. “Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States.” Journal of Women’s Health30(2):280–84.
30.
Manning-OrensteinGrace. 1998. “A Birth Intervention: The Therapeutic Effects of Doula Support Versus Lamaze Preparation on First-time Mothers’ Working Models of Caregiving.” Alternative Therapies in Health and Medicine4(4):73–81.
31.
McGrathSusan K.KennellJohn H.. 2008. “A Randomized Controlled Trial of Continuous Labor Support for Middle-class Couples: Effect on Cesarean Delivery Rates.” Birth35:92–97.
32.
MeltzerBari. 2004. “Paid Labor: Labor Support Doulas and the Institutional Control of Birth.” PhD diss., Department of Social Sciences, University of Pennsylvania, Philadelphia, PA.
33.
MorrisTheresa. 2016. Cut It Out: The C-section Epidemic America. Revised Paperback. New York: New York University Press.
34.
MortonChristineCliftElayne. 2014. Birth Ambassadors: Doulas and the Re-emergence of Woman-supported Birth in America. Amarillo, TX: Praeclarus Press.
35.
Pascali-BonaroDebraKroegerMary. 2004. “Continuous Female Companionship during Childbirth: A Crucial Resource in Times of Stress or Calm.” Journal of Midwifery and Women’s Health49(4):19–27.
36.
PetersonEmily E.DavisNicole L.GoodmanDavidCoxShannaMayesNikkiJohnstonEmilySyversonCarlaSeedKristiShapiro-MendozaCarrie K.CallaghanWilliam M.BarfieldWanda. 2019. “Vital Signs: Pregnancy-related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017.” Morbidity and Mortality Weekly Report68(18):423–29.
PopeCatherine. 2003. “Resisting Evidence: The Study of Evidence-based Medicine as a Contemporary Social Movement.” Health7:267–82.
39.
PorterTheodore M.1995. Trust in Numbers: The Pursuit of Objectivity in Science and Public Life. Princeton, NJ: Princeton University Press.
40.
ReayMike. 2007. “Academic Knowledge and Expert Authority in American Economics.” Sociological Perspectives50:101–29.
41.
ReigerKerreen M.MortonChristine. 2012. “Standardizing or Individualizing? A Critical Analysis of the ‘Discursive Imaginaries’ Shaping Maternity Care Reform.” International Journal of Childbirth2(3):173–86.
RothLouise MarieHenleyMegan M.. 2012. “Unequal Motherhood: Racial-ethnic and Socioeconomic Disparities in Cesarean Sections in the United States.” Social Problems59(2):207–27.
44.
RothLouise MarieHenleyMegan M.SeacristMarlaMortonChristine H.. 2016. “North American Nurses’ and Doulas’ Views of Each Other.” Journal of Obstetric, Gynecologic, & Neonatal Nursing45:790–800.
45.
SackettDavid L.RosenbergWilliam M.C.GrayJ.A. MuirHaynesR. BrianRichardsonW. Scott. 1996. “Evidence-based Medicine: What It Is, and What It Isn’t.” British Medical Journal312(7023):71–72.
46.
SakalaCarolDeclerqEugeneTuronJessica M.CorryMaureen P.. 2018. Listening to Mothers in California: A Population-based Survey of Women’s Childbearing Experiences. Washington, D.C.: National Partnership for Women and Families.
47.
SalinasJuan L.SalinasManishaKahnMegan. 2022. “Doulas, Racism, and Whiteness: How Birth Support Workers Process Advocacy toward Women of Color.” Societies12(1):19. doi:10.3390/soc12010019.
SimondsWendy. 2002. “Watching the Clock: Keeping Time during Pregnancy, Birth, and Postpartum Experiences.” Social Science & Medicine55(4):559–70.
50.
SongFelicia WuWestJennifer EllisLundyLisaDahmenNicole Smith. 2012. “Women, Pregnancy, and Health Information Online: The Making of Informed Patients and Ideal Mothers.” Gender & Society26(5):773–98.
51.
StarrPaul. 1982. The Social Transformation of American Medicine. New York: Basic Books.
52.
TalaulikarVikramNagasekarUday. 2012. “Evidence-based Medicine: An Obstetrician and Gynaecologist’s Perspective.” Journal of Obstetrics and Gynaecology of India62(2):146–53.
53.
TaylorJamilia. 2020. “Structural Racism and Maternal Health Among Black Women.” Journal of Law, Medicine & Ethics48(3):506–17.
54.
The American College of Obstetricians and Gynecologists. 2014. “Safe Prevention of the Primary Cesarean Delivery.” American Journal of Obstetrics and Gynecology123:693–711.
55.
The American College of Obstetricians and Gynecologists. 2019. “Clinical Guidelines and Standardization of Practice to Improve Outcomes.” American Journal of Obstetrics and Gynecology134(4):e122–25.
56.
TimmermansStefanBergMarc. 2003. The Gold Standard: The Challenge of Evidence-based Medicine and Standardization in Health Care. Philadelphia, PA: Tempe University Press.
57.
TimmermansStefanEpsteinSteven. 2010. “A World of Standards but Not a Standard World: Toward a Sociology of Standards and Standardization.” Annual Review of Sociology36(36):69–89.
58.
TimmermansStefanMauckAaron. 2005. “The Promises and Pitfalls of Evidence-based Medicine.” Health Affairs24(1):18–28.
59.
WertzRichard W.WertzDorothy C.. [1977] 1989. Lying in: A History of Childbirth in America. New Haven, CT: Yale University Press.
60.
WintKristinaEliasThistle I.MendezGabriellaMendezDara D.Gary-WebbTiffany L.. 2019. “Experiences of Community Doulas Working with Low-income, African American Mothers.” Health Equity3(1):109–16.
61.
WolmanW. L.ChalmersB.HofmeyrG. J.NikodemV. C.. 1993. “Postpartum Depression and Companionship in the Clinical Birth Environment: A Randomized, Controlled Study.” American Journal of Obstetrics and Gynecology168(5):1388–93.
ZhangJunBernaskoJames W.LeybovichEtelFahsMarianneHatchMaureen C.. 1996. “Continuous Labor Support from Labor Attendant for Primiparous Women: A Meta-analysis.” Obstetrics and Gynecology88(4):739–44.
64.
ZhangJunTroendleJamesReddyUma M.LaughonS. KatherineBranchD. WareBurkmanRonaldLandyHelain J.HibbardJudith U.HabermanShoshanaRamirezMildred M.BailitJennifer L.HoffmanMatthew K.GregoryKimberly D.Gonzalez-QuinteroVictor H.KominiarekMichelleLearmanLee A.HatjisChristos G.VeldhuisenPaul van, and Consortium on Safe Labor. 2010. “Contemporary Cesarean Delivery Practice in the United States.” American Journal of Obstetrics and Gynecology203(4):326.e1–e10.
