Katy Backes Kozhimannil, Rachel R. Hardeman, Laura B. Attanasio, and Cori Blauer-Peterson are with the Division of Health Policy and Management, School of Public Health, and Michelle O'Brien is with the Department of Family Medicine, School of Medicine, University of Minnesota, Minneapolis. Michelle O'Brien is also a family physician in private practice.
We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings.
We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279,008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births.
The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states' reimbursement rates, birth volume, and current cesarean rates.
State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.
[Show abstract][Hide abstract] ABSTRACT: The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.
Health & Social Care in the Community 06/2014; 23(3). DOI:10.1111/hsc.12112 · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There exists limited documentation of nonmedical methods of labor induction and pain management during childbirth in the United States. We estimated the prevalence of nonmedical interventions for induction and pain management and examined the association between medical and nonmedical care during labor.
We used a nationally representative survey of U.S. women who gave birth in 2005 (N = 1,382) to examine use of nonmedical methods of labor induction and pain management. Using logistic regression, we calculated odds of nonmedical and medical interventions to induce labor or mitigate pain, and the odds of medical induction and obstetric analgesia by whether nonmedical methods were reported.
Nearly 30 percent of women used nonmedical methods to start labor, and over 70 percent of women used nonmedical pain management. Doula support was the strongest predictor of nonmedical methods of labor induction (Adjusted Odds Ratio [AOR] = 3.0) and labor pain management (AOR = 5.7). Use of nonmedical pain management was significantly associated with decreased odds of medical pain management (OR = 0.65); this relationship was attenuated with covariate adjustment.
Nonmedical methods to induce labor and manage pain during childbirth are commonly used by U.S. women. Future research should examine effectiveness of these strategies and their influence on medical services use.
[Show abstract][Hide abstract] ABSTRACT: Background & Aim: Women who experience anxiety during labor are more vulnerable to physical and mental illnesses. Emotional support by a knowledgeable individual can improve physical and even mental conditions. This study aimed to determine the effect of presence of a Doula in delivery unit on parturient women’s anxiety.
Methods & Materials: This is an experimental study using a randomized interrupted time series with a control group. Using convenience sampling, 64 parturient women with research inclusion criteria were randomly assigned to the control or intervention groups.
The parturient women in the intervention group benefited from presence of a Doula and her support. The control group received the usual care without presence of the Doula. Data were collected using the Spielberger state-trait anxiety inventory and a checklist. The results were analyzed using parametric and non-parametric statistical tests in the Stata-11.
Results: The age, education, family income, location of residency, the trait and state anxiety did not have any differences between the two groups at the baseline. After the intervention, the state anxiety was reduced significantly in the intervention group compared with the control group at the time of leaving the labor room, delivery room and recovery room (P<0.001).
Conclusion: According to the present research findings, Doula can significantly reduce the anxiety level and its complications among parturient women during childbearing.
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