A recent study published in the American Journal of Obstetrics & Gynecology reveals that doula care can significantly increase the chances of vaginal birth after cesarean delivery (VBAC). The research comes amid growing concerns over maternal health disparities, with Black patients in the U.S. facing a 2.6 times higher risk of maternal death than White patients in 2021. This has led to a push for doulas to help improve maternal and neonatal outcomes, including reducing cesarean and preterm birth rates.
Despite the known benefits of doula care, including its potential to decrease racial disparities in birth outcomes, research quantifying these effects has been limited.
Study Overview
The study aimed to examine how doula support influences various birth outcomes. Researchers analyzed live births at Magee-Womens Hospital between January 2021 and December 2022, all receiving prenatal care from the University of Pittsburgh Medical Center (UPMC). To ensure accuracy, the study excluded cases with gestational ages outside the range of 16 to 44 weeks and those receiving doula care outside the study program.
Doula care was provided free of charge and could be accessed either through referral or direct outreach. It was defined by at least one prenatal encounter and one during delivery.
Key Outcomes Measured
The study evaluated a range of maternal and neonatal outcomes, including:
- Cesarean delivery rates
- Success rates for VBAC
- Gestational hypertension and preeclampsia after 20 weeks
- Postpartum emergency department visits and readmissions
- Neonatal complications, such as NICU admissions and preterm birth
Study Findings
A total of 17,831 deliveries were included in the final analysis, with 486 receiving doula care. On average, patients had five doula encounters, most of which occurred before delivery.
Key findings include:
- Higher VBAC Rates: Patients who had doula care were more likely to achieve a VBAC (34.4%) compared to those who did not have doula care (18.8%).
- Lower Preterm Birth Rates: Preterm delivery rates were lower among those receiving doula care (7.2% vs 10.8%) and early preterm births were also reduced (1.2% vs 3.3%).
- Breastfeeding Rates: Exclusive breastfeeding was reported more frequently among patients with doula care (44.7%) compared to those without (37.1%).
- Postpartum Care: 83.1% of patients with doula care had a postpartum office visit within six weeks, compared to 78.2% of those without.
Conclusion
The study found that doula care notably improved exclusive breastfeeding rates and reduced preterm birth, though other neonatal outcomes were not significantly affected. Importantly, the research showed a strong increase in VBAC success rates, particularly among those with public insurance, with benefits extending to commercially insured patients as well.
The findings suggest that doula care plays a significant role in improving birth outcomes, especially for marginalized groups, and could be a key factor in reducing maternal health disparities.
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