Effect of doula support during labor on perineal and anal sphincter injury in primiparous women

PURPOSE: To determine whether doula support during primiparous deliveries reduces the rate of perineal injury including obstetric anal sphincter injury (OASI). METHODS: A retrospective cohort study was conducted at a single, tertiary university-affiliated medical center. This study included all primiparous women between the ages of 18 and 45 who underwent a vaginal delivery with a singleton pregnancy at term between January 2020 and January 2024. The study group consisted only of women with explicit documentation of doula presence during labor. The control group consisted of women with explicit documentation of no doula presence in the medical records. Maternal and obstetrical parameters were analyzed and compared between groups. Multivariate regression analysis was employed to assess factors associated with perineal injury. RESULTS: Overall, 5866 primiparous women were included: 4,583 in the routine care group and 1283 with a doula support. Parturients in the doula group were older (32.5 vs. 30.7 years, p < 0.001) with lower rate of epidural analgesia (77.6% vs. 86.9%, p < 0.001). Women with doula support had slightly lower rates of overall perineal injury (91.2% vs. 92.9%, p = 0.041), a lower incidence of episiotomy (35.9% vs. 39.5%, p = 0.022), but no significant differences in the rates OASI (0.94% vs 1.1%, p = 0.630). Multivariate regression analysis revealed that doula support was not associated with a significant reduction in perineal injury. Epidural use (OR 1.571, p < 0.001), high birthweight (OR 2.649, p < 0.001), and vacuum extraction (OR 6.736, p < 0.001) were identified as significant contributors to perineal injury. CONCLUSIONS: In primiparous births, doula support was not independently associated with lower overall perineal injury. Perineal protection likely depends on mechanical and clinical factors rather than continuous support alone.