Doula care, birth outcomes, and costs among Medicaid beneficiaries

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. We calculated descriptive statistics for Medicaid-funded births natio...

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Bibliographic Details
Published in:American journal of public health (1971) 2013-04, Vol.103 (4), p.e113-e121
Main Authors: Kozhimannil, Katy Backes, Hardeman, Rachel R, Attanasio, Laura B, Blauer-Peterson, Cori, O'Brien, Michelle
Format: Article
Language:English
Subjects:
Adult
Beneficiaries
Breastfeeding & lactation
Certification
Cesarean section
Cesarean Section - economics
Cesarean Section - statistics & numerical data
Childbirth & labor
Clinical Competence
Cost control
Doulas
Ethnicity
Female
Health care expenditures
Hospital costs
Humans
Infant, Newborn
Infant, Premature
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
United States
Vagina
Womens health
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Description
Summary: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. 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. 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. State Medicaid programs should consider offering coverage for birth doulas to realize potential cost savings associated with reduced cesarean rates.
ISSN:0090-0036
1541-0048
DOI:10.2105/AJPH.2012.301201