Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries

ArticleinAmerican Journal of Public Health 103(4) · February 2013with48 Reads
Impact Factor: 4.55 · DOI: 10.2105/AJPH.2012.301201 · Source: PubMed

    Abstract

    Objectives:
    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.

    Methods:
    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.

    Results:
    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.

    Conclusions:
    State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.