Birth Companions and Doulas Transform Maternal and Neonatal Outcomes in LMICs, Reducing Labor Time and Anxiety
Background
Maternal and neonatal morbidity and mortality remain disproportionately high in low- and middle-income countries (LMICs), often due to inadequate intrapartum support, psychosocial stress, and disrespectful maternity care. While continuous labor support from birth companions or doulas offers a low-cost, high-impact intervention with demonstrated benefits in high-income settings, LMIC-focused evidence has been fragmented. This review addresses the gap by synthesizing current evidence on the effects of such support on maternal, neonatal, psychosocial, and implementation outcomes in LMICs.
Study Design
A narrative review was conducted using structured searches across PubMed, Scopus, Web of Science, Lens.org, and WHO documents. Eligible studies, published between 2015 and 2025, were required to be conducted in LMICs or relevant to LMIC contexts, reporting empirical findings on continuous intrapartum support. The review included studies on informal companions, trained lay companions, or professional doulas. A total of 27 studies were included, comprising 8 primary studies in LMICs, 6 high-income country (HIC) studies involving marginalized populations, and 13 systematic reviews. Data were synthesized thematically across maternal, neonatal, psychosocial, and implementation domains, using a structured narrative appraisal due to diverse study designs and outcome measures.
Results
Continuous labor support was consistently associated with a range of positive outcomes. Maternal benefits included significantly shorter labor, higher rates of spontaneous vaginal birth, and reduced use of pharmacologic analgesia and oxytocin augmentation. Psychosocially, women experienced lower maternal anxiety and stress markers. Neonatal benefits were also notable: higher Apgar scores, earlier breastfeeding initiation, and enhanced mother-infant bonding. Psychosocial improvements were primarily mediated through emotional reassurance, advocacy, improved communication, and culturally responsive support provided by companions. Implementation barriers identified across LMIC studies included provider resistance and facility space limitations.
Continuous labor support consistently led to shorter labor, higher rates of spontaneous vaginal birth, and reduced use of pharmacologic analgesia and oxytocin augmentation.
Key Findings
- Continuous labor support consistently associated with shorter labor duration.
- Higher rates of spontaneous vaginal birth observed with continuous support.
- Reduced use of pharmacologic analgesia and oxytocin augmentation.
- Lower maternal anxiety and stress markers reported.
- Neonatal benefits included higher Apgar scores and earlier breastfeeding initiation.
Why It Matters
This review provides compelling evidence that integrating continuous labor support from birth companions or doulas into maternity care can be a transformative, low-cost intervention in LMICs. For clinicians and policymakers, this suggests a clear pathway to improve maternal and neonatal health outcomes without relying on expensive medical technologies. The findings highlight the importance of psychosocial support and advocacy, which can directly counteract the negative impacts of disrespectful care and stress during childbirth. Implementing such programs could lead to more positive birth experiences, better health for mothers and babies, and potentially reduce the burden on healthcare systems. Overcoming identified barriers like provider resistance and space limitations will be crucial for successful translation into widespread clinical practice.
birth-companionship
doula-care
maternal-health
neonatal-health
lmics
labor-support