Empowering Birth: How Doulas Help Prevent Unnecessary Cesarean Sections

Introduction

Cesarean sections (C-sections) are essential, life-saving procedures when medically necessary. However, the rising rate of primary cesarean deliveries in the United States has sparked growing concern among birth professionals. As of 2023, the cesarean (C-section) delivery rate in the United States has risen to 32.4%, up from 32.1% in 2022.  This means that nearly one in three births in the U.S. are now delivered via C-section. According to the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), preventing the first (or primary) cesarean is key to reducing overall cesarean rates and improving outcomes for both mothers and babies.¹ ​

One of the most effective, evidence-based strategies to prevent unnecessary cesareans is continuous labor support—especially from a trained doula. Doulas are professionals who provide emotional, physical, and educational support before, during, and after childbirth. Their presence is associated with lower intervention rates, shorter labors, and higher maternal satisfaction.²

The Doula’s Role in Labor

Doulas focus solely on the birthing mom's comfort, confidence, and well-being—something that is often difficult for busy clinical staff to do consistently. Their continuous support can:

• Reduce the need for interventions: Doulas help laboring women cope with intensity naturally, reducing reliance on interventions like epidurals, which are linked to longer labors and increased cesarean risk.³

• Shorten the length of labor: Women supported by doulas often have more efficient labors due to encouragement of movement, upright positions, and emotional calm.³

• Improve maternal satisfaction: Having a familiar, trusted person present increases feelings of empowerment and positivity—regardless of birth outcome.²

The presence of a doula is not just a “nice to have.” The 2014 ACOG/SMFM consensus statement found that continuous labor support is “one of the most effective tools to improve labor and delivery outcomes,” noting it is “underutilized.”¹

Additionally, Evidence Based Birth® notes, “When continuous labor support is provided by a trained doula, research shows that women experience a 39% decrease in the risk of cesarean birth.”⁵ That’s a significant reduction for a relatively low-cost intervention.

Preventing Labor Dystocia (Difficult or Slow Labor)

One of the most common reasons for cesarean delivery is labor dystocia—labor that is abnormally slow or stalled. However, recent evidence suggests many cesareans for dystocia may be avoidable with better understanding and support.

The ACOG article recommends updating outdated definitions of “normal” labor progress and stresses patience and non-invasive support.¹ Doulas are instrumental in helping women:

• Avoid unnecessary diagnoses of dystocia: By encouraging relaxation, movement, and gravity-friendly positions, doulas often help labor continue naturally.

• Cope without medications: Natural pain relief like massage, heat/cold, aromatherapy, and focused breathing can prevent a cascade of interventions.

• Avoid emotional stalls: Emotional support reduces stress, which can interfere with oxytocin production—the hormone that drives labor.⁴

Advocacy and Communication

Doulas also serve as important liaisons between the birthing woman (and her partner) and the medical team. They:

• Clarify options and explain procedures in real time.

• Remind the birthing mom of her preferences and encourage informed consent.

• Help the spouse/birthing partner feel confident and included, promoting teamwork and calm.

Many women who feel supported in their decisions and respected during their birth—even when interventions become necessary—report higher satisfaction and emotional well-being postpartum.²

Conclusion

The evidence is clear: continuous labor support by a trained doula can significantly reduce the chance of an unnecessary cesarean section. From hands-on physical comfort to emotional grounding and informed decision-making, doulas provide compassionate, personalized support that empowers women to trust their bodies and their choices.

With organizations like ACOG and SMFM calling for reduced primary cesarean rates, it's time for doulas to be recognized as a critical part of the birth team—not just for “natural” births, but for every kind of birth.

References

1. American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. (2014). Safe Prevention of the Primary Cesarean Delivery: Obstetric Care Consensus No. 1. American Journal of Obstetrics and Gynecology, 210(3), 179–193. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4210674/

2. Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD003766.pub6

3. Hodnett, E. D., Gates, S., Hofmeyr, G. J., Sakala, C., & Weston, J. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, (7). https://doi.org/10.1002/14651858.CD003766.pub5

4. Uvnäs-Moberg, K. (2003). The Oxytocin Factor: Tapping the Hormone of Calm, Love, and Healing. Da Capo Press.

5. Dekker, R. (2017). Evidence on: Doulas. Evidence Based Birth®. Retrieved from https://evidencebasedbirth.com/the-evidence-for-doulas/