Having a trained professional by your side during pregnancy might make the experience smoother. Among pregnant individuals insured by Medicaid, those who used a doula alongside their medical team had a lower risk of cesarean section or preterm birth compared to those who didn’t, according to a study published in the November issue of the American Journal of Public Health. Doulas provide nonmedical support, such as physical, emotional, and informational assistance to those giving birth. For instance, they can help with birthing positions, offer massages and breathing techniques, and provide encouragement and praise.
April Falconi, a women’s health services researcher at Elevance Health in Washington, D.C., explains that “Doulas are trained to help their clients become more involved in their prenatal care.” They assist clients in understanding their care and help them identify health warning signs, which can be particularly beneficial for those experiencing pregnancy complications. Although some studies have attempted to quantify the benefits of having a doula, these studies have mostly been limited to small samples, single hospitals, or single states. Additionally, no studies have examined the likelihood of a person attending a postpartum checkup if they have a doula.
Falconi and her team used Medicaid data from nine U.S. states to conduct a more comprehensive comparison of health outcomes for individuals who used a doula versus those who didn’t. They analyzed over 1 million records of women with a pregnancy outcome, selecting 722 doula users and matching them with 722 non-users based on factors like age, race, ethnicity, state of residence, socioeconomic status, and pregnancy complications. The study found that doula users had a 47 percent lower risk of cesarean section and a 29 percent lower risk of preterm birth, similar to previous findings. Notably, the study also revealed that doula users were 46 percent more likely to attend a postpartum checkup.
Gabriela Alvarado, a policy researcher focusing on maternal health, expressed satisfaction with the study’s size but raised questions about its limitations. For instance, the researchers couldn’t match individuals based on when doula services were used during pregnancy. Alvarado also wondered how the results might differ if the study matched individuals based on the year they used a doula, as states continually adjust their doula programs. For example, Oregon increased its reimbursement rate for doula services from $350 to $1,500 in 2022, potentially offering more services to individuals.
Alvarado emphasized that if higher reimbursement rates lead to more appointments and better outcomes, it would provide a clear justification for doula services. Ten years ago, only two states covered doula care through Medicaid; as of October, 17 states and Washington, D.C., do so, with many more in the process of expanding coverage. While doulas can’t solve all maternal health issues, Alvarado believes “every person should have the option to have someone advocating for them and helping them make the best decisions for their health.”
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