Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries.

• Autores: Katy B. Kozhimannil, Rachel R. Hardeman, Laura B. Attanasio, Cori Blauer-Peterson, Michelle O'Brien
• Localización: American journal of public health, ISSN 0090-0036, Vol. 103, Nº. 4, 2013, págs. 113-121
• Idioma: inglés
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• Resumen

  • Objectives. We compared childbirth-related outcomes for Medicaid recipients who received prenatal education and childbirth support from trained doulas without comes from a national sample of similar women and estimated potential costsavings. 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 and31.5% among Medicaid beneficiaries nationally. The corresponding preterm birth rates were 6.1% and 7.3%, respectively. After control for clinical and socio demographic 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. [ABSTRACT FROM AUTHOR]