Increasing access to and awareness of doula support may be beneficial financially and medically

Charlie Plain | September 2, 2014

A new study shows increased access to continuous labor support from a birth doula may help decrease non-indicated cesarean births among women who desire doula care. The research was conducted at the School of Public Health at the University of Minnesota.

A doula is a trained professional who provides support to women before, during, and after childbirth. This study examined who has access to doula care and the benefits of that access among a national sample of 2,400 women who gave birth in 2011-2012.

The findings were published today in the American Journal of Managed Care.

Annual U.S. childbirth costs exceed $27 billion. In 2009, the average U.S. costs of maternity and newborn care were $27,866 for a cesarean delivery and $18,329 for a vaginal delivery.  Prior studies show that continuous labor support from a trained birth doula is associated with improved health outcomes for the mother and child.

“In previous studies, it is unclear if good outcomes happen because of doula support or rather the particular types of women wanting doulas and having a preference for ‘natural’ childbirth. The survey we used asked women if they wanted doula support but didn’t have it, so we were able to account for this,” said Katy Kozhimannil, Ph.D., M.P.A., lead author and assistant professor in the School of Public Health. “Our findings showed doula support during labor and birth, not the desire for doula support, is associated with 80 percent lower odds of non-indicated cesarean in comparison to non-supported births.”

According to the study, there is an unmet demand for doula care among American women. Women who were less likely to report doula support included women ages 25-29 and those over 35 years, experienced mothers (versus first-time mothers) and women whose pregnancies were unintended. However, different groups of women reported.

The highest unmet demand for doula care was found among African-Americans, women with public or no health insurance coverage, and women having a planned cesarean delivery. Barriers to doula care may include financial, geographical and cultural access.

Other key findings, placed in a national context:

  • 6 percent (approximately 240,000 nationally) of women reported doula support during childbirth
  • 40 percent (approximately 1.6 million nationally) of women were not aware of doula care
  • 27 percent (approximately 1 million nationally) of women who were aware of doula care would definitely want this type of support

“While average fees for doula care vary widely, most are around $1,000. With an approximate $10,000 mean difference between the cost of vaginal and cesarean delivery, the decision to cover 10 doula-supported births would be cost neutral if one non-indicated cesarean was avoided,” said Kozhimannil. “Even setting aside other crucially important emotional, psychosocial, and longer-term benefits of doula-supported care, the financial rationale is compelling.”

~ Post by Matt DePoint, Academic Health Center

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