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Maternal health begins before pregnancy, lasts beyond birth, and has far-reaching consequences. To evaluate whether doula care improves outcomes for high-risk expectant mothers, a retrospective cohort study was conducted with our affiliate health plan Medicaid members. This group of people traditionally has experienced very limited access to doula care because most insurance plans do not offer coverage for doula services. As a result, doula care has primarily been used by those who can pay for this care out-of-pocket.

Findings: Study findings demonstrate doulas’ meaningful impact on maternal health. There was no significant difference between Black and White women, which suggests that doulas can help minimize disparities in maternal health outcomes.

  • Women who received doula care during pregnancy had 53% lower odds of cesarean delivery (c-section). When babies are delivered via c-section, there are increased risks for both baby (infection, respiratory complications) and mother (hemorrhage, infection), and recovery time is longer for the mother.
  • Doulas who provided care with a clinical team that included a midwife most consistently showed a reduction in odds of cesarean delivery, regardless of the trimester of when doula care was received.
  • Women who received doula care during delivery had 57% lower odds of postpartum depression or anxiety.
  • Women who received doula care during their first trimester showed the greatest (62%) reduction in odds of cesarean delivery.   

What’s Next: Elevance Health has doula care pilot programs through our affiliate health plans in Fresno County, California; Erie County, New York; and statewide in Florida. The study results helped secure funding to add pilot programs in our affiliated health plans in five regions of Missouri. This data is being continually evaluated for new learnings, and it is being used in a collaborative effort in California to standardize data from doula pilot programs. As our affiliated Medicaid plans seek to expand access to doula care, Elevance Health is working to share best practices for effective implementation. This has the potential to serve as an important mechanism for reducing maternal health risks and mitigating health disparities.

“Doulas are more than labor and delivery coaches,” said April Falconi, a lead researcher on this project for Elevance Health. “Doula care received during early pregnancy showed the greatest reduction in odds of cesarean delivery and may shift women into health trajectories that result in improved outcomes at childbirth.”

Read the Study:

Methodology: Using our affiliated health plans Medicaid medical claims between January 1, 2014, and December 31, 2020, we compared maternal health outcomes between women who did and did not receive doula care. The analysis included 298 pairs of women matched on age, race/ethnic group, state, neighborhood-level socioeconomic status, and hospital type (teaching or non-teaching).

53% lower odds of cesarean delivery when receiving doula care