I Hear This Every Week: "I Didn't Think I Needed a Doula."

By Jen Crawford | Doula Trainer, Doula, Life & Business Coach

It is one of the things I hear most often from families after their birth. Sometimes said with a smile, sometimes with something heavier underneath it.

"I didn't think I needed a doula."

And I understand why. The word itself can feel unfamiliar. The role is often misunderstood. And in a maternity system where so much is already stretched, it can feel like one more thing to arrange, one more expense, one more person to manage.

But the research is clear. And the families who have had doula support are even clearer.

So let me explain what a doula actually does — and what two significant pieces of research now tell us about the difference it makes.

What the Research Says

The Cochrane Review — Bohren et al., 2017

The most robust evidence we have on continuous labour support comes from a Cochrane review of 26 randomised controlled trials involving more than 15,000 women. The findings are consistent and significant:

Continuous labour support — from a doula, a trained companion or a support person — reduces:

• Caesarean birth

• Instrumental birth (forceps or ventouse)

• The duration of labour

• The use of pain relief

• Negative birth experiences

• It increases spontaneous vaginal birth and satisfaction with the birth experience.

• This is not anecdotal. This is one of the strongest evidence bases in maternity care.

(Bohren et al., Cochrane Database of Systematic Reviews, 2017)

JAMA Network Open — Groves et al., 2026

A more recent systematic review of 22 studies published in JAMA Network Open in April 2026 found that perinatal doula care was most consistently linked to:

• Reduced maternal anxiety

• Improved postnatal follow-up attendance

• Higher breastfeeding rates in the early newborn period

These are different findings from the Cochrane review — different studies, different populations, different outcomes measured. I am sharing both because both matter, and because the picture they build together is compelling.

(Groves et al., JAMA Network Open, April 2026)

What a Doula Actually Does

A doula is not a medical professional. A doula does not replace a midwife or doctor. A doula does not deliver babies, provide clinical care or make medical decisions.

What a doula does is provide continuous emotional, physical and informational support — before, during and after birth.

In practice, this looks like:

• Before birth: meeting with the family, getting to know them, helping them think through their birth preferences, making sure they understand their options and their rights, and building a relationship of trust before labour begins.

• During labour: being present throughout — not just for part of the labour, not checking in between other tasks, but continuously present. Supporting the birthing person through contractions. Offering comfort measures. Helping the partner feel useful and confident. Communicating with the care team. Advocating for the family's wishes.

• After birth: being there in those immediate moments. Skin-to-skin. First feeds. The transition from labour to becoming parents. And, for postpartum doulas, continuing that support in the weeks that follow.

Common Myths About Doulas

"Doulas are only for people who want an unmedicated birth."

Not true. Doulas support all births. Medicated, unmedicated, induced, planned caesarean birth, home birth, hospital birth. If plans change — and they often do — your doula is still there. That consistency is the whole point.

"A doula replaces the partner."

Also not true. A doula supports the partner as much as the birthing person. Labour is long, intense and unpredictable. Partners often feel helpless. A doula gives them specific, practical ways to help, takes some of the pressure off, and ensures they can be fully present rather than anxious and uncertain.

Many partners say that having a doula was the single best decision they made.

"You only need a doula if something might go wrong."

Every birth benefits from continuous support. The Cochrane evidence covers routine births, complicated births, first-time parents and experienced parents alike. Continuous support improves outcomes and experiences across the board.

What a Postpartum Doula Does

A postpartum doula supports families in the weeks after birth — and this role is every bit as valuable as birth doula support, if not more so.

A postpartum doula might:

• Help with practical tasks — meals, light household tasks, sibling care

• Support with infant feeding — breastfeeding, bottle feeding, paced feeding

• Provide evidence based information about newborn behaviour and development

• Hold the baby so the parent can sleep

• Offer non-judgmental emotional support through the transition to parenthood

• Know what is normal, what is not, and when to gently encourage a family to seek additional support

In those exhausted, overwhelming first weeks, a postpartum doula can be genuinely transformative.

Here in Ireland

Doula support is not currently funded by the HSE. This means access to a doula is largely dependent on financial means — a significant inequality in a service with this level of evidence behind it.

In the United States, 26 states now cover doula care through Medicaid. The evidence for funding doula support as part of routine maternity care is strong and growing. Ireland will need to have this conversation.

Becoming a Doula

If you are reading this and something in you is responding to this work, I would love to talk to you about it.

My Birth Doula Training and Postpartum Doula Training programmes are open now. They are evidence based, values-led and built around the full reality of what this work involves — including scope of practice, working within the maternity system, supporting families through difficult experiences, and building a sustainable practice.

In Good Company — my CPD day for doulas and birth professionals — is taking place on 3rd October 2026 at the Marine Hotel in Sutton, Dublin. 70 spaces. A full day of coaching, connection and community.

Find out more at jen-crawford.com.

Jen Crawford is a Doula Trainer, Doula, and Life & Business Coach based in Ireland. She is the co-founder of DoulaCare Ireland, Ireland's first national doula agency.

@jen_crawford_doula_wisdom | jen-crawford.com