The value of providing labouring women with continuous emotional support, physical comfort, and encouragement has been recognized worldwide.

Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement. Hodnett, E.D. Support from caregivers during childbirth (Cochrane Review) in Cochrane Library, Issue 2. Oxford Update Software, 1998. Updated Quarterly.

A doula provides support consisting of praise, reassurance, measures to improve the comfort of the mother, physical contact such as rubbing the mother's back and holding her hands, explanation of what is going on during labour and delivery and a constant friendly presence. Such tasks can also be fulfilled by a nurse or midwife, but they often need to perform technical/medical procedures that can distract their attention from the mother. Care in Normal Birth: a Practical Guide . Report of a Technical Working Group. World Health Organization, 1996.

Facing unprecedented pressures to reduce expenses, many hospitals are targeting the largest single budget item - labour costs. (An) unintended consequence of nursing cutbacks may be an increased cesarean rate; the inability of pared down nursing staff to provide continuous coverage to labouring mothers (has been) shown to increase the chance of a cesarean.Doulas clearly improve clinical and service quality; they provide an absolutely safe way to reduce cesareans and other invasive birthing interventions. Coming to Term: Innovations in Safely Reducing Cesarean Rates . Medical Leadership Council, Washington D.C. 1996.

Professionals have paid much attention to innovative technology and the many new options for monitoring and managing labour. While the technology is important, it can become so prominent that clinicians ignore both the natural aspects of labour and the non-technical needs of women in labour. Changes that support the patient in labour and reinforce the natural, physiologic process.. Includes providing one-to-one psychological support for patients using nursing staff or doulas. Reducing the Cesarean Section Rates while Maintaining Maternal and Infant Outcomes . Bruce L. Flamm et al. Institute for Healthcare Improvement, Boston , 1997.

The continuous availability of a caregiver to provide psychological support and comfort should be a key component of all intrapartum care programs, which should be designed for the effective prevention, and treatment of dystocia (non-progressive labour). Guidelines on Dystocia . Society of Obstetricians and Gynaecologists of Canada , 1995.

Kennell, JH & McGrath, S.K. 1993 'Labour support by a doula for middle-income couples: the effect on cesarean rates'.

Hofmeyer, G.J., Nikodem, V.C & Wolmen W. 1991 'Companionship to Modify the clinical birth environment:
Effects on progress and perceptions of labour and breastfeeding' British Journal of Obstetrics & Gynecology vol.98 pp 756-764.

Hodnett ED. Caregiver support of women during childbirth. Cochrane Database of Systematic Reviews 2002.

Berry , LM 1988. Realistic expectations of the labour coach. Journal of Obstetric, Gynecologic and Neonatal Nursing. Sept/Oct:354-55.

Bertsch, TD, Nagashima-Whalen, L, Dykeman, S, Kennel, JH, McGrath, S. 1990. Labour support by first-time fathers:direct observations with comparison to experienced doulas. Journal of Psychosomatics in Obstetrics and Gynaecology 11:251-260.

Copstick, SM, Taylor, KE, Hayes, R, Morris, N. 1986. Partner support and the use of coping techniques in Labour. Journal of Psychosomatic Research. 30(4): 497-503.

Hodnett, ED and Osborn RW. 1989. Effects of continuous intrapartum professional support on childbirth outcomes. Research in Nursing & Health 12(5):289-297.

Hofmeyr, GJ, Nikodem, VC, Wolman, WL, Chalmers BE, Kramer T. 1991 Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding. British Journal of Obstetrics and Gynaecology 98:756-764.

Kennel, J, Klaus, M, McGrath, S, Robertson, S, Hinkley, C. 1991. Continuous emotional support during labour in a US hospital. Journal of American Medical Association 265(17): 2197-2201.

Klaus, MH, Kennell, JL, Robertson, SS, Sosa, R. 1986. Effects of social support during parturition on maternal and infant morbidity. British Medical Journal 293(6547): 585-7.

McNiven, P, Hodnett, E, O'Brien-Pallas, LL. 1992. Supporting women in labour: a work sampling study of the activities of intrapartum nurses. Birth : in press.

Shearer, B. 1989. Birth Assistant: new ally for the parents-to-be. Childbirth Educator Spring:26-31.

Sosa, R, Kennel, J, Robertson, S, Urrutia, J. 1980. The effect of a supportive companion on perinatal problems, length of labour, and mother-infant interaction. The New England Journal of Medicine. 303(11):597-600.