title: Doula care, birth outcomes, and costs among Medicaid beneficiaries.
abstract: OBJECTIVE
  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.
authors: Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA. kbk@umn.edu
authors: Katy Backes
authors: KB
authors: Kozhimannil
authors: Rachel R
authors: RR
authors: Hardeman
authors: Laura B
authors: LB
authors: Attanasio
authors: Cori
authors: C
authors: Blauer-Peterson
authors: Michelle
authors: M
authors: O'Brien
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data*; D002983:Clinical Competence; D059037:Doulas; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007743:Labor, Obstetric; D016015:Logistic Models; D008484:Medicaid / Q000191:economics*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics; D014481:United States