Why Are Some Private OBs in Perth So Resistant to Working with Doulas?

Doulas have supported birthing women for generations, offering emotional steadiness and unwavering advocacy. Yet, despite solid evidence highlighting their benefits, a surprising number of private obstetricians (OBs) in Perth remain reluctant to work with them. So, what’s going on?

Here are my thoughts.

First Things First—What is a Doula?

A doula is a trained support person who offers continuous emotional, physical, and informational support during pregnancy, birth, and the early postnatal period.

They’re not midwives. They don’t perform clinical tasks. Instead, they create calm, boost confidence, and advocate for the birthing woman’s needs and choices.

What’s especially impactful is that doulas offer continuous unbiased support, coming from outside the woman’s personal network—yet standing firmly in her corner.

According to the 2017 Cochrane Review, this continuous, objective support can lead to:

•Higher birth satisfaction

•Greater autonomy

•Improved birth outcomes

“To me it’s a if they don’t like/won’t work with doulas. They are there for the Mother’s comfort and emotional support…so essentially they are saying that’s not important  ~ Bree

 

The Research Is Not New—We Know Doulas Make a Difference

But here is the latest research.

A 2025 study in the American Journal of Obstetrics & Gynecology reinforced what other studies have found and what many birth workers already knew. This large-scale analysis reviewed nearly 18,000 births across two years.

Here’s what they found—out of every 100 women who had doula support:

• ✅ 15 to 34 more had a vaginal birth after caesarean (VBAC)

•✅ 3 to 4 fewer had preterm births

• ✅ 7 to 11 more exclusively breastfed

•✅ 5 to 7 more attended their postnatal check-up

Across thousands of women giving birth, this makes a huge difference. And these benefits were seen across all demographics, including high-risk pregnancies, varying socio-economic groups, and insurance status.

This backs earlier studies showing that doulas help:

•Reduce C-section rates

•Shorten labour durations

•Lower use of pain medications

•Increase maternal satisfaction

So this latest research just confirms what many women and midwives have been saying for years: Doulas make a difference.

Better outcomes = less cost

Fewer surgical births. Fewer preterm babies. More breastfeeding. These all reduce costs to the healthcare system, improve recovery, and support long-term health for mums and babies.

In the US, this kind of data has prompted several states to fund doula services through Medicaid. Here in Australia, we still tend to treat doulas as a ‘nice extra’—if you can afford one. But the evidence says they should be seen as essential.

So… Why the Resistance from Private OBs in Perth?

If doulas are such a clear win, why do some private obstetricians in Perth still push back?

Here’s what might be going on:

1. Power Dynamics in the Birth Room.

Having another knowledgeable person present may feel threatening to some OBs who are used to complete control during birth.

2. Misunderstanding the Doula Role

Some OBs wrongly believe all doulas are anti-medical or push specific birth agendas. In truth, most doulas work collaboratively and respectfully.

3. A Medicalised Approach to Birth

Private maternity care often leans heavily on interventions and tight schedules, clashing with the more fluid, intuitive style of doulas’ support.

But here’s the truth: Doulas don’t interfere—they enhance.

They help women feel safe, reduce stress hormones, and foster better outcomes.

4. Financial and Systemic Incentives

Here’s a harder truth—better outcomes from doula support often mean fewer interventions, shorter hospital stays, and less reliance on surgical births. While this is fantastic for women and the healthcare system overall, it may result in a perverse disincentive for some private OBs, whose income can be tied to the volume and type of procedures performed. In such cases, fewer interventions could mean less revenue—creating an unspoken conflict of interest.

5. A Past Negative Experience—Personal or Secondhand

In some cases, reluctance stems from a previous negative experience with a doula—either directly or based on a colleague’s account. While those situations can be challenging, it’s important not to let isolated incidents influence how all doulas are viewed or to shape policy or attitude. This risks unfairly penalising the many doulas who are professional, collaborative, and deeply committed to supporting birthing women and working respectfully with care teams.

The overwhelming body of international research consistently shows the positive impact of doula support—from improved birth outcomes to enhanced maternal satisfaction. These well-documented benefits should carry more weight in shaping attitudes. After all, decisions in maternity care should be driven by evidence, not anecdotes. Dismissing doulas on this basis risks denying women access to a proven source of support.

Of course, these are only possible reasons—as I find myself wondering why, despite all the evidence, some private OBs continue to resist working with doulas. Have you been told by your OB that they don’t work with doulas? What reason did they give you?  I’d love to hear your experience.

The Future of Birth in Perth: Collaboration, Not Competition

We’re lucky in Perth to have a growing community of passionate, well-trained doulas—many of them trained by my dear friend Vicki Hobbs, who runs the Doula Training Academy. I’m so proud of the incredible work she’s doing to nurture the next generation of birth workers. Her graduates are changing the game for birthing families across WA.

It’s worth noting that some doulas, because of their birth philosophy or values, choose not to work within the private hospital system. Instead, they focus exclusively on supporting home birth clients or working alongside independent midwives in continuity-of-care models, where physiological birth is more often supported and respected.

However, there is also a strong and growing group of doulas who actively choose to work within the private system. These doulas understand the landscape and are committed to improving birth outcomes from the inside. They know how to collaborate with OBs, midwives, and hospital staff while centring the woman’s needs and wishes—helping her feel safe, informed, and in control.

These doulas aren’t there to disrupt—they strive to uplift, support, and advocate, while building respectful, professional relationships with care providers. Their presence is not about challenging authority but about ensuring women have the best possible birth experience—on their terms.

“A doula doesn’t take the place of anyone—they hold the space for everyone. Steady in the flow, radiant in the rhythm, and unwavering in their belief in a woman’s ability to birth her way.”

~ Pip Wynn Owen

FAQs: Doulas and OBs

Want to learn more about becoming a doula in Perth or hiring one for your birth? Check out the Doula Training Academy by Vicki Hobbs.

📸 With Gratitude

A heartfelt thank you to the incredible Perth doulas who generously shared these powerful images of their work. Your dedication, compassion, and unwavering support for birthing women shine through in every photo. These moments not only capture your strength and care, but also help bring visibility to the vital role doulas play in transforming birth experiences across WA. We see you. We appreciate you. And we’re so grateful for the work you do.