title: Potential benefits of increased access to doula support during childbirth.
abstract: OBJECTIVE
  The annual costs of US maternity-related hospitalizations exceed $27 billion. Continuous labor support from a trained doula is associated with improved outcomes and potential cost savings. This study aimed to document the relationship between doula support, desire for doula support, and cesarean delivery, distinguishing cesarean deliveries without a definitive medical indication.
  
  
  METHODS
  Retrospective analysis of a nationally representative survey of women who delivered a singleton baby in a US hospital in 2011- 2012 (N = 2400).
  
  
  METHODS
  Multivariable logistic regression analysis of characteristics associated with doula support and desire for doula support; similar models examine the relationship between doula support, desire for doula support, and 1) any cesarean or 2) nonindicated cesarean.
  
  
  RESULTS
  Six percent of women reported doula care during childbirth. Characteristics associated with desiring but not having doula support were black race (vs white; adjusted odds ratio [AOR] = 1.77; 95% CI,1.03-3.03), and publicly insured or uninsured (vs privately insured; AOR = 1.83, CI, 1.17-2.85; AOR = 2.01, CI, 1.07-3.77, respectively). Doula-supported women had lower odds of cesarean compared without doula support and those who desired but did not have doula support (AOR = 0.41, CI, 0.18-0.96; and AOR = 0.31, CI, 0.13-0.74). The odds of nonindicated cesarean were 80-90% lower among doula-supported women (AOR= 0.17, CI, 0.07-0.39; and AOR= 0.11, CI, 0.03-0.36).
  
  
  CONCLUSIONS
  Women with doula support have lower odds of nonindicated cesareans than those who did not have a doula as well as those who desired but did not have doula support. Increasing awareness of doula care and access to support from a doula may facilitate decreases in nonindicated cesarean rates.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455. E-mail: kbk@umn.edu.
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.forename: Laura B
authors.initials: LB
authors.lastname: Attanasio
authors.forename: Judy
authors.initials: J
authors.lastname: Jou
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Joarnt
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Johnson
authors.forename: Dwenda K
authors.initials: DK
authors.lastname: Gjerdingen
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D059037:Doulas / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D036801:Parturition; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult