TOPLINE:
Doula care was associated with 15-34 more vaginal births after cesarean per 100 deliveries and increased exclusive breastfeeding rates by 20%. Support from doulas also reduced preterm births by 3-4 cases per 100 deliveries, with benefits consistent across race and insurance status.
METHODOLOGY:
- Researchers conducted a retrospective cohort study of 17,831 deliveries from January 2021 to December 2022 at a single institution, analyzing outcomes for 486 patients who received doula care compared with 17,345 patients who did not.
- Analysis included maternal outcomes (cesarean delivery, vaginal birth after cesarean, gestational hypertension, preeclampsia, or postpartum emergency department visits) and neonatal outcomes (neonatal intensive care unit admission, breastfeeding, or preterm delivery).
- Investigators used multiple methods including multivariate logistic regression and conditional regressions with propensity scores to generate appropriate comparison populations, accounting for targeted outreach to high-risk patients.
TAKEAWAY:
- Patients receiving doula care showed significantly higher rates of vaginal birth after cesarean (adjusted risk difference [ARD], 15.6; 95% CI, 3.8-27.4) and increased postpartum office visit attendance (ARD, 5.4; 95% CI, 1.4-9.5).
- Exclusive breastfeeding rates were 22% higher among patients with doula support (adjusted risk ratio, 1.22; 95% CI, 1.07-1.38).
- Doula care was associated with fewer preterm births (ARD, −3.8; 95% CI, −6.1 to −1.5) per 100 deliveries.
- Benefits of doula support remained consistent regardless of patient race or insurance status, as demonstrated across multiple analytical approaches.
IN PRACTICE:
“Although doulas are posited to have a significant impact on numerous maternal and neonatal outcomes and to decrease racial disparities, research that quantifies these effects is limited…The impact of doula support on the general population and the influence of race and payor status have been largely unexplored,” wrote the authors of the study.
SOURCE:
The study was led by Lara S. Lemon, PharmD, PhD, Magee-Womens Hospital, University of Pittsburgh School of Medicine in Pittsburgh. It was published online in the American Journal of Obstetrics & Gynecology.
LIMITATIONS:
According to the authors, the study was limited by using only electronic health records data, which lacked discrete documentation of social determinants of health such as employment and housing. The electronic health records also lacked discrete documentation of trial of labor, limiting reporting to successful vaginal births after cesarean rather than attempted ones. Additionally, preferential promotion of doula services to higher-risk patients may have potentially masked some benefits due to confounding by indication.
DISCLOSURES:
This study was funded by the Richard King Mellon Foundation, the Scaife Family Foundation, the Eden Hall Foundation, Thomas and Theresa Bone, and the University of Pittsburgh Medical Center Health Plan.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.