Doula Care Reduces Cesarean Deliveries in Medicaid Patients

Jenni Laidman

February 19, 2013

Doula support in childbirth is associated with a 40% decrease in cesarean deliveries among Medicaid recipients, according to results from a study published online February 14 in the American Journal of Public Health.

Katy Backes Kozhimannil, PhD, MPA, assistant professor, School of Public Health, University of Minnesota, Minneapolis, and colleagues looked at 1079 Medicaid-funded singleton births supported by doulas in Minneapolis from 2010 to 2012. These births were compared with a nationwide sample of 279,008 Medicaid singleton births from the 2009 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project.

The researchers found that the odds for cesarean delivery in the doula-supported group were 40.9% lower than for other Medicaid-funded births (adjusted odds ratio [AOR] 0.59; 95% confidence interval [CI], 0.51 - 0.68; P < .001), after controlling for clinical complications and for maternal age, race, or ethnicity. Doula-supported births had a cesarean rate of 22.3% compared with 31.5% among other Medicaid recipients.

Women in the doula-supported group were slightly older than the other Medicaid recipients, at age 27 years compared with age 25 years, and they had lower rates of gestational hypertension (3.8% in the doula group vs 7.8% in the Medicaid population).

Half of all states would save money if they employed doulas at $200 per birth and reduced cesarean deliveries to 22.3% of Medicaid births, the authors write. Savings vary according to state reimbursement practices and cesarean delivery rate but could reach more than "$2.5 million for up a quarter of all states," they conclude.

The authors report that doulas charge from $300 to more than $1800, depending on location and experience level.

The results of this study support a recent Cochrane review showing that continuous labor support by a trained professional resulted in higher levels of vaginal birth and lower odds of cesarean delivery, as well as fewer epidurals and less frequent instrument-assisted delivery. The Cochrane review also found a correspondence between labor support and shorter labors, as well as higher levels of satisfaction among women receiving such support.

The risk for preterm birth and low birth weight infants is higher among Medicaid recipients. Medicaid programs covered 45% of all births in 2009.

Am J Pub Health. Published online February 14, 2013. Abstract