Doulas associated with lower C-section rates
November 21, 2024
Summary:
Use of doulas was associated with lower Cesarean section rates, more vaginal births after C-Section and more postpartum office visits in an observational study of Medicaid members.
Source: Falconi, et al AJPH November 2024 VBAC = Vaginal Birth after Cesarean Section. Total of 722 people in both the doula and no doula groups.
The United States has an unacceptably high rate of maternal mortality, and far too much severe maternal morbidity (illness, such as high blood pressure, or complications such as blood clots or infections). Birthing people of color face substantially worse pregnancy outcomes, and studies have shown that birth doulas (non-medical coaches) who attend deliveries decrease these disparities. Recent data have also shown a benefit from virtual birth doulas, even though they do not attend the birth in person.
Researchers published data in the American Journal of Public Health last week that demonstrates that in-person doulas are associated with improved outcomes in the Medicaid population. The researchers identified 1.1 million births nationally in a Medicaid insurance plan from 2014-2023 and studied births in nine states where they were able to obtain statewide data on pregnancy outcomes. They ultimately compared 772 women who had doulas assist in their births with 772 women matched by propensity score who did not use doulas.
They found that Cesarean Sections were 47% less common in the births attended by doulas, and vaginal birth after C-Section was 2.5 times more common in those with doulas but remained rare. Those with doulas were 46% more likely to have a postpartum visit.
This is an observational study (patients were not randomized), and despite the matching efforts those without doulas were almost twice as likely to have substance use disorder. Medicaid results might not be applicable to commercial populations.
A White House blueprint for improving maternal quality and safety recommended expanded access to doulas.
In the 2024 WTW Best Practices in Healthcare survey, 21% of employers reported helping members find birth doulas, and 13% of employers reported providing coverage or reimbursement for doula services. An additional 18% of respondents said they were planning or considering helping members find birth doulas in 2025 or 2026, and 14% of respondents said they were planning or considering offering payment for doula services in in 2025 or 2026. Most respondents reported that they were offering these services either through a third party or their medical carrier.
Implications for employers:
Employer interest in birth doula services is increasing.
This is further evidence that doulas have the potential to improve birth outcomes.
Employers can continue to consider adding doula benefits to improve birthing experience, address maternal disparities, and improve clinical outcomes.