Journal Article

Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries

Attanasio, Laura B., Kozhimannil, Katy Backes, Hardeman, Rachel R., Blauer-Peterson, Cori, O’Brien, Michelle

2013

Overview

Objectives. We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas with outcomes from a national sample of similar women and estimated potential cost savings. Methods. We calculated descriptive statistics for Medicaid-funded births nationally (from the 2009 Nationwide Inpatient Sample; n = 279 008) and births supported by doula care (n = 1079) in Minneapolis, Minnesota, in 2010 to 2012; used multivariate regression to estimate impacts of doula care; and modeled potential cost savings associated with reductions in cesarean delivery for doula-supported births. Results. The cesarean rate was 22.3% among doula-supported births and 31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and sociodemographic factors, odds of cesarean delivery were 40.9% lower for doula-supported births (adjusted odds ratio = 0.59; P < .001). Potential cost savings to Medicaid programs associated with such cesarean rate reductions are substantial but depend on states’ reimbursement rates, birth volume, and current cesarean rates. Conclusions. State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.

• Publisher: American Public Health Association
• Subject: Adult / Beneficiaries / Birth rate / Breastfeeding & lactation / Certification / Cesarean section / Cesarean Section - economics / Cesarean Section - statistics & numerical data / Childbirth & labor / Clinical Competence / Cost control / Costs / Doulas / Ethnicity / Female / Government programs / Health care expenditures / Hospital costs / Humans / Infant, Newborn / Infant, Premature / Inpatient care / Labor, Obstetric / Logistic Models / Low income groups / Maternal child nursing / Medicaid / Medicaid - economics / Multiculturalism & pluralism / Online Research and Practice / Population / Postpartum period / Pregnancy / Pregnancy Outcome / Premature birth / Prenatal Care - economics / Prenatal education / Public health / Race / Reimbursement / Savings / Sociodemographics / Statistics / United States / Vagina / Women / Womens health