Doula care, birth outcomes, and costs among Medicaid beneficiaries.

Abstract:

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.

journal_name

Am J Public Health

authors

Kozhimannil KB,Hardeman RR,Attanasio LB,Blauer-Peterson C,O'Brien M

doi

10.2105/AJPH.2012.301201

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

e113-21

issue

4

eissn

0090-0036

issn

1541-0048

journal_volume

103

pub_type

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