Doula Care, Early Breastfeeding Outcomes, and Breastfeeding Status at 6 Weeks Postpartum Among Low-Income Primiparae


  • Laurie A. Nommsen-Rivers,

    1. PhD, RD, IBCLC, is an assistant research professor of pediatrics at the Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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  • Ann M. Mastergeorge,

    1. Ann M. Mastergeorge, PhD, is an assistant research education psychologist and adjunct faculty in the Department of Human and Community Development and MIND Institute, University of California, Davis
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  • Robin L. Hansen,

    1. Robin L. Hansen, MD, is a professor of pediatrics, director of the Center for Excellence in Developmental Disabilities, and director of Clinical Programs at the MIND Institute, University of California, Davis
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  • Arlene S. Cullum,

    1. MPH, is the director of Women's and Children's and Ambulatory Services, Sutter Medical Center, Sacramento, CA
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  • Kathryn G. Dewey

    1. PhD, is a professor of nutrition and director of the Program in International and Community Nutrition, Department of Nutrition, University of California, Davis
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Laurie A. Nommsen-Rivers, PhD, RD, IBCLC, Division of Neonatology, Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7009, Cincinnati, OH 45229-3039.


Objective: To examine associations between doula care, early breastfeeding outcomes, and breastfeeding duration.

Design: Prospective cohort.

Setting: Regional hospital in northern California.

Participants: Low-income, full gestation primiparae receiving doula care (n=44) or standard care (n=97).

Measures: Birth outcomes and newborn feeding data obtained from the hospital record. Follow-up interviews conducted at day 3 to record the timing of onset of lactogenesis and breastfeeding behavior and at 6 weeks to obtain current breastfeeding status.

Results: Adjusting for baseline differences, women receiving doula care were significantly more likely to have a short stage II labor, a noninstrumental vaginal delivery, and to experience onset of lactogenesis within 72 hours postpartum (timely onset of lactogenesis). Overall, 68% of women receiving doula care and 54% of women receiving standard care were breastfeeding at 6 weeks. In the subset with a prenatal stressor (n=63), the doula care group was more than twice as likely to be breastfeeding at 6 weeks (89% vs. standard care, 40%). Breastfeeding at 6 weeks was also significantly associated with timely onset of lactogenesis and maternal report that the infant “sucked well” at day 3.

Conclusions: Doula care was associated with improved childbirth outcomes and timely onset of lactogenesis. Both directly and as mediated by timely onset of lactogenesis, doula care was also associated with higher breastfeeding prevalence at 6 weeks.