Doula care may lead to fewer C-sections or preterm births

Having an extra trained professional by your side might ease a pregnancy.

Among a group of pregnant individuals insured by Medicaid, those who used a doula in addition to a medical team had a lower risk of having cesarian section or preterm birth than those who didn’t, researchers report in the November American Journal of Public Health.

Doulas support nonmedical needs such as physical, emotional and informational support for someone giving birth. For example, doulas can help people come up with positions to give birth in, provide massages and breathing techniques, and offer encouragement and praise.

“Doulas are trained to help support their clients be more engaged in their prenatal care,” says April Falconi, a women’s health services researcher at Elevance Health in Washington, D.C. They support clients’ understanding of their care and help them recognize health warning signs which may benefit people experiencing pregnancy complications.

While a few studies have tried to quantify the benefits of having a doula, those studies have largely been limited to small samples, single hospitals or single states. And no studies have looked at how likely a person is to attend a postpartum checkup if they have a doula.

“So much of maternal morbidity and mortality occurs in the weeks following birth,” Falconi says, “so attendance at a postpartum checkup is really critical.”

To get a more robust comparison of the health outcomes of people who used a doula with those who didn’t, Falconi and her colleagues used Medicaid data from nine U.S. states. From more than 1 million records of women with a pregnancy outcome — which includes a live birth, stillbirth or miscarriage — the researchers selected 722 individuals who used doulas and matched them to 722 who didn’t. The individuals were matched based on characteristics such as age, race, ethnicity, state of residence, socioeconomic status and if they had any pregnancy complications, such as gestational diabetes or anemia.

Doula users had a 47 percent lower risk of having a C-section compared with those who did not have a doula, the team found, and a 29 percent lower risk of preterm birth. Those findings are similar to what previous studies have reported. But the new study also found that doula users were 46 percent more likely to attend a postpartum checkup.

Gabriela Alvarado, a policy researcher who focuses on maternal health, says she was happy to see how large the study was, but was left with a few questions.

One limitation the researchers note is that they weren’t able to match individuals based on when in the pregnancy doula services were used. Alvarado also wonders what the results would have looked like if the team matched the individuals based on what year they used a doula. That matters because states keep adjusting their doula programs, she says. For example, in 2022, Oregon increased its reimbursement rate from $350 to $1,500, which could grant people more services.

“If you can show that higher reimbursement rates mean more appointments, and more appointments mean better outcomes, then there’s a clear path for justifying [doula services],” says Alvarado, of the RAND Corporation based in Arlington, Va.

Ten years ago, only two states covered doula care through Medicaid. As of October, 17 states and Washington, D.C., do so, and many more are in the process of expanding coverage, according to the National Health Law Program.

The maternal mortality rate in the United States remains high (SN: 3/16/23). And while doulas can’t fix everything, Alvarado says, “I really feel that every person should have the option to have someone advocating for them and helping them make the decisions that are best for them.”