Doula support was found to be significant and impactful for Medicaid patient outcomes

According to research by the American health insurer Elevance Health, Inc. was 47% less likely to have a cesarean section among Medicaid participants who received doula care. Women with doula support also had a 29% lower risk of preterm birth and were 46% more likely to have preterm birth. to attend postpartum checkups compared to people without a doula.

Doulas are trained professionals who provide women with ongoing physical, emotional, and informational support before, during, and after childbirth. They are not medical providers, do not provide medical advice and are not actively involved in the birth, as a midwife might be.

A doula’s influence on childbirth comes from offering information, guidance and advocacy for the patient. This includes creating a birth plan, items from home that should be in the ‘go bag’ when the day arrives, explaining options and answering questions about what to expect, and communicating the mother’s decisions to the doctor.

Previous research cited in the current study has linked doula care to lower rates of cesarean section, birth complications, and postpartum depression. In 2020, the Surgeon General recommended coverage for doula services to expand access to quality maternity care, followed by a 2022 White House initiative to address maternal health disparities.

In the study titled “The Role of Doulas in Improving Maternal Health and Health Equity among Medicaid Enrollees, 2014-2023,” published in the American Journal of Public Healthresearchers analyzed Medicaid claims data from 2014 to 2023, covering more than one million pregnancies in nine US states. The study focused on women ages 15 to 49 enrolled in Medicaid-affiliated health plans.

For the analysis, propensity score matching narrowed the focus to 722 pregnancies with doula support, compared to 722 without doula support, controlling for factors such as age, race, socioeconomic status and geographic location.

Doula care was associated with a reduction in maternal health risks and a 29% lower risk of preterm birth. In counties with high infant mortality rates, cesarean section rates fell by 57% for women with doula support. Increased attendance at postpartum checkups was also observed.

There was a lack of significant findings regarding emergency department visits, inpatient admissions, and postpartum depression or anxiety, indicating that doulas did not have an impact in these areas.

Most doula-assisted pregnancies in the study occurred after 2020, following Medicaid expansions in several states. The non-clinical support they provide during pregnancy and childbirth and the improved maternal outcomes from previous studies provided the basis for the expansion of Medicaid.

The current study could be viewed as a follow-up to the expansion policy using Medicaid claims data and a large geographically diverse sample. As doula programs under Medicaid expand, these findings suggest that broader access to doula care could play a critical role in reducing cesarean section rates and improving maternal health, especially in high-risk populations.

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