Doula care for Medicaid enrollees was associated with lower odds of cesarean delivery and postpartum depression or anxiety.

Background

Poor maternal health outcomes, including high rates of cesarean delivery and maternal behavioral health conditions, continue to affect many pregnant and postpartum Medicaid enrollees. Doulas are trained, non-clinical professionals who provide physical, emotional, and informational support before, during, and after childbirth. This retrospective cohort study used Medicaid claims data from across three states to compare 298 Medicaid enrollees who received doula care with 298 matched enrollees who did not. This study examined outcomes including severe maternal morbidity, behavioral health, cesarean delivery, induction, rehospitalization within 60 days of delivery, emergency room visit from pregnancy complication within 30 days of delivery, and prenatal and postpartum visits.

Findings

The most substantial reported impacts of doula care include a 53% lower odds of a cesarean delivery and a 58% lower odds of postpartum depression or anxiety, and these odds were similar for a subgroup of women with high-risk conditions. Odds of cesarean delivery were most consistently reduced when doulas partnered with a midwife on a clinical team, and some other outcomes varied based on when doula support was received. There were no significant differences in other outcomes.

Program/Policy Takeaways

This study offers evidence from across multiple states on how doula care may improve maternal health outcomes among Medicaid enrollees, which may help to address maternal health disparities. As states and health plans expand Medicaid coverage for doula services, findings from this study suggest that how doulas are integrated into a larger care team may influence outcomes, with doula-midwife partnership associated with lower cesarean delivery rates.