Doula Care and Health Outcomes: A Systematic Review.

Abstract

Maternal-infant health inequities remain a critical public health issue in the US, where adverse maternal and infant health outcomes disproportionately affect American Indian or Alaska Native and Black populations. Doula care-where trained doula professionals provide physical, emotional, and informational support across the perinatal continuum-is a community-based strategy to improve outcomes. To systematically evaluate clinical and pilot trial evidence on the association of doula care with maternal and infant health outcomes; identify gaps in study design, equity, and implementation; and propose future directions for clinical practice, health systems research, and policy. This systematic review included articles published between January 1, 2000, and January 31, 2026. Searches in PubMed, PsycINFO, Web of Science, and CINAHL, plus reference and expert review, identified eligible clinical or pilot trials assessing maternal and infant outcomes. Protocols, secondary analyses, abstracts, and non-English articles were excluded. Data on study design, intervention characteristics, outcomes, and risk of bias were qualitatively synthesized. Twenty-two articles describing 21 unique interventions met inclusion criteria. Most were randomized clinical trials (17 of 21 [81.0%]), with others using quasiexperimental or preference-based designs. Interventions had heterogeneity in scope, intensity, and doula training. Findings were most consistent for improved maternal anxiety, postpartum follow-up, and breastfeeding initiation, while evidence for outcomes such as cesarean delivery and pain management was more variable. Few studies addressed postpartum, abortion, or broader reproductive health contexts (eg, fertility or bereavement doulas). Methodologic gaps included limited reporting of fidelity and implementation, underrepresentation of marginalized populations, and failure to account for crossover in control groups. The findings of this systematic review of clinical trials suggest that doula care may improve perinatal anxiety, health care utilization, and breastfeeding initiation, although the evidence for other outcomes was inconsistent. Future studies should use rigorous designs, ensure equitable representation, examine full-spectrum care, and assess implementation to support sustainable integration into maternal health systems.