Doula care for Medicaid enrollees was associated with lower rates of preterm birth and cesarean delivery, and higher use of postpartum care.

Background

Poor maternal health outcomes and persistent disparities continue to affect pregnant and postpartum Medicaid enrollees. Doula care is a support model in which trained, non-clinical professionals provide physical, emotional, and informational support before, during, and after childbirth. This observational study used Medicaid claims data from a Medicaid managed care organization to examine maternal health outcomes for women across nine states — 722 who received doula care compared to 722 of those who did not. Examined outcomes included delivery outcomes, postpartum care utilization, acute care utilization after delivery, postpartum depression and anxiety, and prevalence of severe maternal morbidity.

Findings

The most substantial reported impacts of doula care include a 47% lower risk of a cesarean delivery, a 29% lower risk for preterm birth, and being 46% more likely to attend a postpartum checkup. The study also stratified results based on county rates of infant mortality to assess how doula interventions may address maternal health disparities, and found that doula care was associated with a 57% reduction in cesarean delivery rates in counties with high infant mortality rates. There were no significant differences in other outcomes.

Program/Policy Takeaways

Doula care may be a promising strategy for improving birth outcomes and postpartum care engagement among Medicaid enrollees. The study also suggests potential value in communities experiencing poorer maternal and infant health outcomes. Policymakers, health plans, and providers can use these findings to inform decisions about expanding, targeting, and integrating doula services within Medicaid maternal health initiatives.