Doula care can lead to fewer C-sections or premature births

Having a trained professional by your side can make a pregnancy easier.

Among a group of pregnant individuals covered by Medicaid, those who used a doula in addition to a medical team had a lower risk of having a cesarean section or preterm birth than those who did not, researchers reported in November. American Journal of Public Health.

Doulas support non-medical needs such as physical, emotional and informational support for a birthing person. For example, doulas can help people find birthing positions, provide massage and breathing techniques, and offer encouragement and praise.

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

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

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

To get a stronger comparison of the health outcomes of people who used doulas versus those who didn’t, Falconi and her colleagues used Medicaid data from nine US states. From more than 1 million records of women with a pregnancy outcome—which included a live birth, stillbirth, or miscarriage—the researchers selected 722 individuals who used a doula and compared them to 722 who did not. Individuals were matched based on characteristics such as age, race, ethnicity, state of residence, socioeconomic status, and whether 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. These 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 some questions.

One limitation the researchers note is that they were unable to match individuals based on when doula services were used during pregnancy. Alvarado also questions what the results would look like if the team matched individuals based on the year they used a doula. That matters because states continue to regulate their doula programs, she says. For example, in 2022, Oregon increased the reimbursement rate from $350 to $1,500, which could give 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 to justify [doula services],” says Alvarado, of the Arlington, Va.-based RAND Corporation.

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: 16.3.23). And while doulas can’t fix everything, Alvarado says, “I really think every person should have the opportunity to have someone advocate for them and help them make the decisions that are best for them. “