Doula care linked to improved maternal health outcomes

Doula care linked to improved maternal health outcomes | Image Credit: © Pixel-Shot - © Pixel-Shot - stock.adobe.com.

Introduction

The rate of vaginal birth after cesarean delivery (VBAC) is increased by doula care, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

A widening disparity in maternal morbidity and mortality has been reported in the United States, with a 2.6-fold increased risk of maternal death reported among Black patients vs White patients in 2021.² This has led to the use of doula support to improve outcomes. Benefits include reduced cesarean delivery and preterm birth rates.¹

“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,” wrote investigators.

Study design and methods

The study was conducted to determine the impact of doula care on a range of obstetrical and neonatal outcomes. Live births at the Magee-Womens Hospital between January 2021 and December 2022 receiving prenatal care from the University of Pittsburgh Medical Center (UPMC) health system were included in the analysis.

Exclusion criteria included gestational ages under 16 or over 44 weeks and receiving care from a doula outside the study program. Doula care was provided through referral or direct outreach and was free for the patient. UPMC’s Clinical Data Warehouse stored exposure, outcome, and covariate data.

Doula exposure was determined by at least 1 encounter with a doula both prenatally and during the delivery admission. Doula care only during the prenatal period was assessed in secondary analyses.

Key outcomes

Outcomes included cesarean delivery, cesarean delivery of nulliparous, term, singleton, vertex infants, successful VBAC, gestational hypertension after 20 weeks’ gestation, preeclampsia after 20 weeks’ gestation, postpartum emergency department (ED) visit, readmission, and postpartum office visit.

These outcomes were recorded at delivery or within 6 weeks after delivery. Neonatal outcomes such as neonatal intensive care unit admission, unexpected complications in term newborns, breastfeeding, preterm delivery, and intrauterine growth restriction were also reported.

Study findings

There were 17,831 deliveries included in the final analysis, with 486 receiving doula care. A median of 5 doula encounters was reported, most of which occurred during the prenatal period.

Patients receiving doula care were more often Black, insured by Medicaid, living in a disadvantaged neighborhood, diagnosed with gestational hypertension early in pregnancy, visited the ED, and underwent prenatal admission. These patients also had increased rates of VBACs at delivery vs those without care, at 34.4% and 18.8%, respectively.

Preterm, early preterm, and indicated preterm delivery rates were reduced among patients receiving doula care, with rates of 7.2%, 1.2%, and 3.3%, respectively, vs 10.8%, 3.3%, and 5.5%, respectively, among those without care. Exclusive breastfeeding was reported in 44.7% of patients receiving care and 37.1% not receiving care.

An office visit within 6 weeks was reported in 83.1% vs 78.2%, respectively. The data indicated an additional 5.4% to 6.8% adherence among patients receiving doula care, along with an increase from 15.6% to 34.2% in VBACs for every 100 patients receiving care.

Conclusion

Significant improvements following doula care were reported for exclusive breastfeeding and preterm birth. However, other neonatal outcomes were not significantly associated with doula care. Overall, the data highlighted VBAC, postpartum office visit, and exclusive breastfeeding odds as benefits associated with doula care.

“Although our findings reaffirm the possibility of benefit of doula care for delivering persons with public insurance that were presented in previous studies, in addition, they demonstrated additional benefits and that those also extend to commercially insured patients,” wrote investigators.

References

1. Lemon LS, Quinn B, Young M, et al. Quantifying the association between doula care and maternal and neonatal outcomes. Am J Obstet Gynecol. 2025;232:387.e1-43. doi:10.1016/j.ajog.2024.08.029
2. Maternal mortality rates in the United States, 2021. Centers for Disease Control and Prevention. Accessed April 1, 2025. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.pdf.