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Member Research & Reports

Member Research & Reports

Minnesota Finds Increasing Access and Awareness of Doula Support May be Beneficial

A new study shows increased access to continuous labor support from a birth doula may help decrease non-indicated cesarean births among women who desire doula care. The research was conducted at the School of Public Health at the University of Minnesota.


[Photo: Dr. Katy Kozhimannil]

A doula is a trained professional who provides support to women before, during, and after childbirth. This study examined who has access to doula care and the benefits of that access among a national sample of 2,400 women who gave birth in 2011-2012.

The findings were published in the American Journal of Managed Care.

Annual U.S. childbirth costs exceed $27 billion. In 2009, the average U.S. costs of maternity and newborn care were $27,866 for a cesarean delivery and $18,329 for a vaginal delivery.  Prior studies show that continuous labor support from a trained birth doula is associated with improved health outcomes for the mother and child.

“In previous studies, it is unclear if good outcomes happen because of doula support or rather the particular types of women wanting doulas and having a preference for ‘natural’ childbirth. The survey we used asked women if they wanted doula support but did not have it, so we were able to account for this,” said Dr. Katy Kozhimannil, lead author and assistant professor in the School of Public Health. “ Our findings showed doula support during labor and birth, not the desire for doula support, is associated with 80 percent lower odds of non-indicated cesarean in comparison to non-supported births.”

According to the study, there is an unmet demand for doula care among American women. Women who were less likely to report doula support included women ages 25-29 and those over 35 years, experienced mothers (versus first-time mothers) and women whose pregnancies were unintended. However, different groups of women reported.

The highest unmet demand for doula care was found among African-Americans, women with public or no health insurance coverage, and women having a planned cesarean delivery. Barriers to doula care may include financial, geographical, and cultural access.

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