How Doulas Help Reduce C-Sections: What the Research Actually Says
By: REbecca Belenky at Los Angeles birth
Research shows that continuous labor support — especially from a trained doula — significantly lowers the risk of unnecessary C-sections. Major reviews like Cochrane and Evidence Based Birth® report reduced cesarean rates, shorter labors, and better outcomes for parents and babies. Los Angeles hospitals vary widely in their intervention rates, making birth support even more important. Here’s what the evidence says and how a doula can help you have a safer, more supported birth.
Mother is doing skin to skin with her newborn baby
When families in my doula practice ask, “How will having a doula reduce my chances of having a C-section?” they’re not looking for vague reassurance — they want real data.
That makes perfect sense, because in Los Angeles, about 1 in 3 births is a cesarean. Some of these surgeries are absolutely necessary. But a growing body of research shows that many cesareans can be safely avoided with better support, better information, and more physiologic, unhurried care.
One of the most effective tools in lowering unnecessary C-sections?
Continuous labor support — especially from a trained birth doula.
This article breaks down what the evidence actually says, what major medical organizations recommend, and why having a labor doula on your team can make a meaningful difference in your birth experience.
Why C-Section Rates Matter (Especially in the U.S. & California)
A cesarean birth can be the right choice in many situations. But when a C-section happens unnecessarily, families face:
Longer and more painful recovery
Higher risk of infection or hemorrhage
More complications in future pregnancies
Higher rates of NICU admissions for babies
This is why the World Health Organization suggests that population C-section rates above ~19% don’t correlate with better outcomes — they correlate with increased interventions and costs.
In the U.S., the cesarean rate is over 32%.
In California, where many Los Angeles families give birth, the state has spent a decade working to reduce unnecessary primary C-sections, especially for low-risk first-time parents (called the NTSV group: Nulliparous, Term, Singleton, Vertex).
California’s quality-improvement effort — led by the California Maternal Quality Care Collaborative (CMQCC) — has successfully lowered these rates statewide. But hospital-to-hospital variation remains high. Some LA hospitals have NTSV C-section rates close to 40%, while others are in the low 20s.
This is why choosing your birth team — including your doula — matters.
What Is “Continuous Labor Support”?
Researchers use the term continuous labor support to mean:
A trained support person who stays with you throughout labor
Emotional, physical, and informational support
No competing responsibilities (unlike nurses with multiple patients)
Not performing medical tasks
In real life, the people who most consistently provide “continuous labor support” are professional labor doulas. Your birth doula arrives as labor becomes active (or sooner if you need support), stays with you through labor, helps you navigate decisions that may arise, and supports you through your baby’s arrival.
This continuous presence, without shift changes or competing responsibilities, is the core ingredient most closely linked to lower C-section rates.
What the Research Says: The Cochrane Review
The largest and most respected analysis of continuous labor support comes from the Cochrane Review, which pooled data from 26 clinical trials and more than 15,000 birthing people.
The findings are powerful:
Lower C-section rates
Shorter labors
More spontaneous vaginal births
Less use of pain medication
Higher satisfaction with the birth experience
Better Apgar scores for babies
One key detail: Continuous support worked best when the support person was not hospital staff, nor a partner or friend.
In other words, professionally trained doulas produced the strongest outcomes.
Cochrane Review (plain-language summary):
https://www.cochrane.org/evidence/CD003766/continuous-support-women-during-childbirth
PubMed abstract of the full review:
https://pubmed.ncbi.nlm.nih.gov/28681500/
Evidence-Based Birth: What Their Review Found
Evidence Based Birth® (EBB), one of the most trusted consumer-friendly research sites, analyzed the data and found that people who worked with a trained doula were:
39% less likely to have a C-section
15% more likely to have a spontaneous vaginal birth
31% less likely to need Pitocin
38% less likely to have a baby with a low 5-minute Apgar score
EBB also emphasizes something important:
Doulas provide continuous emotional and informational support, distinct from the roles of nurses, midwives, or partners. It isn’t about replacing anyone — it’s about creating a cohesive support team with different strengths.
Read more:
Evidence on Doulas (Evidence Based Birth®):
https://evidencebasedbirth.com/the-evidence-for-doulas/
Henci Goer: Why Labor Support Matters
Henci Goer — renowned author of The Thinking Woman’s Guide to a Better Birth — has spent decades analyzing obstetric practices and outcomes. Her writings describe clearly how unnecessary C-sections often originate from:
Misinterpreting “normal” labor progress as stalling
Overreliance on the outdated Friedman curve
Excessive monitoring or early admission
Lack of movement or position changes
Fear, tension, or unfamiliar environments that slow labor
Goer highlights that continuous labor support reduces these risks by:
Encouraging mobility
Supporting upright or asymmetrical positions for progress
Reducing fear and increasing the release of oxytocin
Helping families understand and navigate medical recommendations
Protecting the laboring person’s autonomy and comfort
Her conclusion:
Doulas are one of the most effective, safest, and least expensive tools we have for preventing unnecessary C-sections.
Read more by Henci Goer: “How Can You Avoid an Avoidable First Cesarean”
https://hencigoer.com/how-can-you-avoid-an-avoidable-first-cesarean/
What ACOG and SMFM Say About Doulas
This may surprise some families, but it’s important:
The American College of Obstetricians and Gynecologists (ACOG) — the organization that sets national standards for OBs — has publicly endorsed continuous labor support.
In their joint statement with the Society for Maternal-Fetal Medicine (SMFM) on preventing primary C-sections, they write:
“Continuous labor support, including support provided by doulas, is one of the most effective tools to improve labor and birth outcomes.”
“Increasing access to non-medical support, such as doulas, may reduce cesarean delivery rates.”
Read the ACOG guidelines here: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth
This is not fringe or alternative care — this is mainstream medicine acknowledging the benefits.
DONA International’s piece on the ACOG guidelines: https://www.dona.org/acog-smfm-statement-one-of-the-most-effective-tools-to-reduce-the-cesarean-rate-doulas
How Doulas Actually Lower C-Section Risk in Real Life
Beyond statistics, here’s what this looks like in practice.
1. Supporting Earlier, Calmer Labor at Home
Doulas help parents understand what’s happening, stay comfortable, and delay hospital admission until labor is active, which dramatically reduces the risk of unnecessary intervention.
2. Guiding Position Changes for Progress
Doulas are educated in physiologic birth. Position suggestions like asymmetrical lunges, hands-and-knees, belly lift-and-tuck, and upright positions for pushing all help the baby rotate and descend, making vaginal birth more likely.
3. Reducing Fear and Increasing Safety
When families feel safe, supported, and seen, the body releases oxytocin, the hormone that keeps labor progressing. Fear releases adrenaline, which can slow or stop contractions. Doulas support the birthing parent’s nervous system.
4. Helping You Understand Your Options
Doulas offer plain-language explanations of what’s being recommended, questions to ask, and alternatives. This reduces pressure and helps families make informed decisions and slow down non-urgent decision-making.
5. Supporting Physiologic Birth
Mobility, dim lighting, hydrotherapy, breathwork, hands-on comfort, vocalization, and reassurance all support the body’s own labor hormones, which reduce the need for surgical delivery.
6. Supporting the Partner Too
When partners feel confident and supported, the birthing person receives more consistent care — and everyone feels calmer and more connected. This contributes to a more positive experience, no matter the mode of delivery.
Podcasts for Parents Who Want to Go Deeper
If you prefer listening to reading, these podcast episodes break down C-sections, labor support, and options in a friendly, evidence-based way.
⭐ Evidence Based Birth® Podcast
• The Evidence on Doulas
• Friedman’s Curve and Failure to Progress
• Top Ten Evidence-Based Strategies to Lower Your C-section Risk
⭐ Birthful Podcast
• Avoiding Unnecessary Cesareans (with Dr. Neel Shah)
• Why Your Team is Not Complete Without a Doula (with Sabia Wade)
⭐ The Midwives Cauldron
• VBAC conversation with Dr Hazel Keedle - Episode 13
These are excellent resources for partners to learn about as well. Informed partners help ensure you receive individualized, not just routine, prenatal and birth care.
What This Means If You’re Giving Birth in Los Angeles
Los Angeles has many hospitals and skilled OBs and midwives to choose from. But cesarean rates vary widely from hospital to hospital.
Families here benefit tremendously from:
✔ Asking providers about their first-time parent C-section rate
✔ Touring hospitals and birth centers
✔ Working with doulas to understand what’s normal vs. what needs attention
✔ Being supported through long early labor
✔ Staying mobile and informed
As a birth doula supporting families throughout Los Angeles, I’ve seen over and over how continuous support transforms a family’s birth experience, regardless of whether they aim for an unmedicated birth or want an epidural right away.
Support isn’t about a specific outcome — it’s about making sure decisions are truly yours and that the process feels safe, affirming, and fully supported.
Related Guides: Birth Locations & Interventions in Los Angeles
Where you choose to give birth — and how your birth is supported — can strongly influence whether your labor unfolds physiologically or becomes intervention-heavy. If you’re exploring your options in LA, these two guides will help you make informed decisions:
✨ Where to Give Birth in Los Angeles: Hospitals, Birth Centers & Home Birth
✨ Are Episiotomies Still Done in Los Angeles Hospitals?
Both posts complement what we discuss here, because your birth location, your provider, and your support team all work together to influence your experience, your autonomy, and your likelihood of avoidable interventions like C-sections and episiotomies.
Curious Whether a Doula Is Right for You?
If you're expecting in Los Angeles and want to talk more about doula support, I’d love to meet you.
Through my birth support practice, I offer:
Birth doula support
Postpartum support
Private childbirth education
Help exploring birth locations: find the right homebirth midwife, LA hospital, or birth center
Calm, confident guidance from pregnancy through postpartum
✨ Schedule a free discovery call
Let’s talk about your hopes, your questions, and what support could look like for your family.
You deserve to feel informed, supported, and confident through your birth and postpartum process.
Rebecca Belenky is a Los Angeles–based postpartum doula, childbirth educator, and lactation specialist who has been supporting families since 2014. Through her practice, Los Angeles Birth, she offers compassionate, trauma-informed care that helps parents to feel informed, grounded, and confident throughout pregnancy, birth, and the postpartum journey. Her expertise in postpartum support, newborn care, and lactation education makes her a trusted resource for families in Los Angeles seeking guidance and reassurance.
