A study by the US health care insurance provider Elevance Health, Inc showed that mediated beneficiaries who received care support had 47 % reduction in caesarean section Women with such professional support also had a 29% lower likelihood of preterm birth; they were 46% more likely to turn up for postnatal visits.
Doulas are childbirth attendants who offer supportive activities to women before, during and after the birth of their child. They are not holding a medical position; they do not prescribe and do not have constant interaction with the process of delivery like a midwife would.
A doula’s impact on birth is therefore derived from education, direction and clients’ support. Some of the roles include drawing up the birth plan, home items that should be in the ‘go bag’ when the day comes, explaining options and being able to answer questions about what to expect and finally being able to relay the mother’s decisions to the doctor.
The Chief Medical Adviser of the US launched a call for doula services as essential health care services to improve maternity outcomes for disadvantaged women in 2020, later the White House reiterated this call in 2022.
The research was conducted in nine states of the US and involved more than one million pregnancies between 2014-2023 and the type of research was conducted using Medicaid claims data in the article titled “Role of Doulas in Improving Maternal Health and Health Equity among Medicaid Enrollees, 2014–2023.” The result was published in the American Journal of Public Health. Medicaid-MOB was conducted among women aged 15–49 years who were members of Medicaid-affiliated health plans.
Whereas for the analysis, propensity score matching was conducted with attention to a sample of 722 pregnancies with doula support matching 722 without doula support while minimizing the differences in predictors such age, race, economic status, and geographical region.
Doula care was linked with a decrease in risks for maternal health and 29% decrease in preterm birth rate. Compared with low/MDCs, the caesarean delivery decreased by 57% in CoHCs for women who had doula attendance. The number and frequency of checkups also improved in the postpartum period.
As for the negative impacts, there was no substantial evidence of the four areas that would suggest that doulas had an influence on them; Emergency Department visit; Inpatient admission; and Postpartum Depression and Anxiety.
Majority of doula-supported pregnancies; in the study was after 2020, after expansion of Medicaid in some states. These non clinical services during pregnancy and childbirth as well as the enhanced maternal health outcomes noted in earlier studies were the basis for Medicaid expansion.
The current study could be seen more as a continuation of the expansion policies studied using Medicaid claims and a large diverse geographical sample. These findings imply that increased doula availability under Medicaid may have a significant action of lowering absolute caesarean delivery and enhancing overall maternal health among high-risk demographic groups where these programs are already steadily increasing.
Reference: Falconi AM, Ramirez L, Cobb R, Levin C, Nguyen M, Inglis T. Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees.
