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

Cesarean deliveries were 47% less likely among Medicaid enrollees who received doula care, according to research conducted by US health care insurance provider Elevance Health, Inc. Women with doula support also had a 29% lower risk of preterm birth and were 46% more likely to attend postpartum checkups compared to those without a doula.

Doulas are trained professionals who provide continuous physical, emotional, and informational support to women before, during, and after childbirth. They are not medical providers, do not offer medical advice, and are not actively involved in delivery like a midwife might be.

A doula’s influence on childbirth comes from offering education, guidance and patient advocacy. This includes setting up a birthing plan, items from home that should be in the “go bag” when the day comes, 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 deliveries, 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 “Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014–2023,” published in the American Journal of Public Health, researchers analyzed Medicaid claims data from 2014 to 2023, covering more than one million pregnancies across nine U.S. states. The study focused on women aged 15 to 49 enrolled in Medicaid-affiliated health plans.

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

Doula care was associated with reductions in maternal health risks and a 29% lower risk of preterm birth. In counties with high infant mortality rates, cesarean deliveries dropped by 57% for women with doula support. Increased postpartum checkup attendance 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-supported pregnancies in the study occurred after 2020, following Medicaid expansions in several states. The non-clinical support they offer during pregnancy and childbirth and the improved maternal outcomes seen in previous studies were the basis for the Medicaid expansion.

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

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