Minnesota could reduce the cost of unnecessary Cesarean sections if its Medicaid program paid for for doulas, because they discourage pregnant women from undergoing these expensive surgical deliveries, according to a new University of Minnesota study.
Doulas don't replace obstetricians or midwives, but instead help women prepare and plan for births and provide emotional and physical support during deliveries. Studies nationally have already shown their presence at births reduces the likelihood of C-sections and other interventions. The U study confirmed that by comparing a national sampling of Medicaid-funded births in 2009 with more than 1,000 doula-supported births in Minnesota from 2010 to 2012. The C-section rate in the national group was 31.5% while the rate in the doula-supported group was only 22.3%
After controlling for factors such as the varying ages, races and health conditions of the pregnant women in the two groups, the researchers determined that the presence of doulas reduced the odds of a C-section by 40.9% If the use of paid doulas could have reduced C-sections by that much in Minnesota's Medicaid population in 2009, the study estimates the state would have saved $3 million to $5 million. (The variation depends on how much the state would pay doulas for this work -- a range of $100 to $300 in the study.)
The lack of public and private insurance coverage is limiting the use of doulas and the potential for cost savings, said Katy Backes Kozhimannil, a study author and an assistant professor within the U of M School of Public Health. C-section rates are actually higher in the private insurance population, so coverage in the private sector could achieve even more savings, she suggested.
"We really tried to put this in a policy and financial context so the people making financial decisions within a budget can actually have some information about the role of doulas," she said. Lawmakers are having discussions already about whether to propose bills that would make doula services covered by Medicaid, she said.
All care in the U of M study was provided by doulas who had training and certification. The study was published in the latest issue of the American Journal of Public Health.