Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries.
Kozhimannil, Katy Backes PhD, MPA; Hardeman, Rachel R MPH; Attanasio, Laura B BA; Blauer-Peterson, Cori MPH; O'Brien, Michelle MD, MPH
[Miscellaneous Article]
American Journal of Public Health.
103(4):e113-e121, April 2013.
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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.
Copyright (C) 2013 by the American Public Health Association, Inc.