Doulas offer safety, cost savings, University of Minnesota study finds

Low-income women who receive support from doulas during their pregnancies are less likely to have premature births or costly surgical deliveries, a University of Minnesota researcher reported Thursday.

The findings suggest that expanded public coverage of certified doula care could pay for itself by reducing costly birth complications, said Katy Kozhimannil, the U associate professor who led the research.

"This is the first study that does a proper cost-effectiveness analysis," she said. "There are a lot of things that benefit people; the question always is the trade-off for the benefit … and how much it is going to cost you."

Reducing preterm births is a key public health goal, locally and nationally, because they result in higher rates of birth defects and infant mortality.

The study compared 1,935 singleton births by low-income women who received doulas and other support through the Everyday Miracles program in Minneapolis with births from a comparable population of low-income women in the Midwest.

A lower rate of cesarean section deliveries was expected — and proven in other studies — because women who embrace doulas tend to favor natural childbirth. But the lower rate of preterm births — 4.7 percent for doula-supported mothers vs. 6.3 percent in the comparison group — was significant, Kozhimannil said.

The comparison group of women had higher rates of hypertension and diabetes — conditions that are well-known risks for preterm births — but those differences were statistically ironed out in the study, along with variations in age, ethnicity and race that could have tainted the results.

"It was actually the doulas that made the difference," Kozhimannil said.

Her research also has monitored the impact of Minnesota's 2013 decision to cover doula services for low-income women on Medical Assistance, the state's version of Medicaid, which funds 42 percent of births in Minnesota.

Janis Koscielak sought a doula through Everyday Miracles because she is a transplant to Minnesota and wanted emotional support along with someone who will be with her during early labor so she can remain at home as long as possible. Now at 31 weeks gestation, Koscielak is counting on her doula's guidance and exercise tips as she tries to help her first baby flip from a breech position to a head-down position, which increases the odds of a healthy vaginal delivery.

"I need her support more than anything else," she said. "My family is all over the country. It's truly just me and my husband, and I am a little nervous."

If doulas can prevent preterm births and C-sections at the same rate found in the study, then Medical Assistance could pay them $986 per birth and break even. That was the conclusion of Kozhimannil's study, published in the journal Birth.

Education and doula support give "a woman the confidence she needs to allow her body to do what it naturally knows to do," said Debby Prudhomme, founder of Everyday Miracles.

The term doula refers to a broad range of birth attendants who provide emotional and medical support in about 6 percent of U.S. births. But the study focused on outcomes involving doulas who obtained professional certification and registered with the state — a level of training and competence required before they can serve women covered by Medical Assistance.

Certified doulas must be supervised by doctors, certified nurse midwives or nurse practitioners.

While the study results are also applicable to higher-income and privately insured women, Kozhimannil said it is important to establish benefits of doulas for low-income women and minorities, who are predisposed to poorer health during pregnancies and higher complication rates.

Koscielak moved to Minnesota because of her husband's work, but his nonprofit employer doesn't extend benefits to spouses, so she has been grateful for her state-subsidized health insurance and its coverage of a doula.

"For the kind of birth that I want," she said, "a doula is really truly" important.

Jeremy Olson • 612-673-7744