Virtual doulas lower Cesarean section rates, especially for Black people

March 19, 2024

Source: “Health Disparities in Employer-Sponsored Health Insurance” Morgan Health, January, 2024 LINK Data is from 2021. Low risk (NTSV) is Nulliparous (first child), Term (not premature,) Singleton (not twins or triplets), and Vertex (head down).

We’ve long known that doulas, or birth coaches, improve the experience of delivery, especially for people of color who are more likely to feel that providers do not pay attention to their concerns. Doulas are now widely available, and many are credentialed, but insurance coverage remains rare. The people who might benefit most from doula support might be least likely to afford a doula, although some state Medicaid programs are now covering doulas. It’s also hard to “scale” a doula program across many communities.

Maven Clinic published data on  its virtual doula program, where doulas provide virtual visits that are generally 20 minutes long. They found that women who had 2 or more virtual doula visits were 20% less likely to have a Cesarean section and Black women were two-thirds (68%) less likely to have a Cesarean section compared to platform users who did not use virtual doulas. The total sample was about 6000 women, and the results were similar for a smaller sample where the researchers performed risk adjustment. Women who used virtual doulas also reported better birth experiences, like feeling more supported, informed, and able to manage anxiety and depression during pregnancy. The results suggest that virtual doula care could help improve maternal health outcomes, especially for Black women.

This data is especially important in light of data in the figure above, published in January by Morgan Health. This showed that Black women at low risk (first child, not premature, head first, and singleton) are much more likely to have a Cesarean section. 

Cesarean sections increase disability time, and place women at risk of placental abnormalities that can be life threatening in subsequent pregnancies. Cesarean sections are also about 50% more costly than vaginal deliveries. Interventions that are effective at lowering Cesarean section rates can improve quality and value of maternity care and can also save lives.

This is an observational study, and the authors point out that women who chose to have virtual doula appointments might have been more motivated to avoid operative interventions. It will be important that this type of study is duplicated elsewhere for confirmation.

Implications for employers:

-       Virtual doulas can be a mechanism to extend the value of doulas to more women who would benefit from this intervention.

-       In-person doulas are becoming more available in many geographies, and some employers provide reimbursement for doula care through pregnancies.

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Tomorrow: Rural hospital financial woes pose barriers to access to care