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Women's Health Education Program Scholars' Projects

Break-Even Analysis of Doula Support on Cesarean Section Reduction

WHEP scholar Adam Elwood

WHEP Scholar Adam Elwood
Drexel University College of Medicine, Class of 2021

Cesarean deliveries have been increasing in frequency over the past two decades. With each cesarean delivery, there is a possibility of developing co-morbidities and complications, as well as future cesarean sections, in addition to greater costs to the individual than vaginal deliveries. Multiple studies have shown that non-medical, continuous supportive care by doulas during labor decreases risk for cesarean deliveries and can decrease expenses for the patient. Cesarean rates have been shown to decrease significantly with doula support — as much as 10% overall, combined with fewer preterm births and low-birth-weight infants. Continuous labor support has also shown a beneficial impact on outcomes, such as shorter labors, decreased analgesia, decreased oxytocin use, fewer forceps-assisted deliveries, and greater breastfeeding success.

One study showed that nulliparous mothers expect their nursing team to spend 53% of their time with them, when in actuality, nurses spend about 6-10% of their time supporting each new mother. To fill this role, doulas are trained support specialists capable of comforting and encouraging the laboring patients continuously. They provide emotional and informational support through the process of delivery and serve as advocates for mothers, empowering them to take part in their own health care and delivery of their child. One area of concern is the doula-physician relationship — a perceived schism within the care team, a perceived lack of coordination during labor, and possibly a “sidedness” for patients to choose. Doula services are often perceived as superfluous for women in labor.

Widespread doula care has the possibility to decrease costs for patients in most parts of the country and can help hospitals manage costs while providing continuous labor support for patients. Will it reduce money spent on a system-wide scale by decreasing number of cesarean sections? My research seeks to examine whether broad coverage of doula care would be cost-efficient for childbirth in the United States. If it is not cost-effective, at what price-range and insurance coverage would it be?

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