State Medicaid programs could reduce cesarean costs by covering birth doulas

New research from the University of Minnesota's School of Public Health, published Monday, has found lower cesarean birth rates among Medicaid beneficiaries with access to support from a birth doula than among Medicaid patients nationally.

Currently, taxpayers fund nearly half of all U.S. births through state Medicaid programs, which generally do not cover birth doula care. A cesarean birth costs almost 50% more than a vaginal birth, with the average Medicaid payment of $9,131 for a vaginal birth and $13,590 for a cesarean delivery.

What is a doula?

Although a doula is not a medical provider, she is a trained, experienced professional person who can provide information, physical assistance and support to a woman during childbirth. Doulas help advocate for women's wishes during labor and childbirth, and help in the postpartum period of transitioning into parenthood. Benefits of a doula include:

1. 50% reduction rate in cesarean births
2. 25% shorter labors
3. 60% less epidural requests
4. 40% reduction in epidural use
5. 30% less requests for other pain medication
6. 40% reduction in forcep deliveries

All of these reductions happen just by having a trained doula in the labor and delivery room, and all of them would reduce the medical cost on state Medicaid programs.

Support during childbirth may be especially important for women with low health literacy or patients whose first language is not English and who may not fully understand all their clinical options during childbirth.

According to the latest research:

• Many low-income women are at increased risk for poor birth outcomes
• Many low-income women are unable to afford the cost of doula services
• In 2009, Taxpayers funded 45 percent of all U.S. births through state Medicaid programs
• Medicaid does not typically offer coverage for doula care

Increasing financial access by offering coverage of birth doula care would be costly to state Medicaid programs, but these costs may be offset by reductions in hospital payments for cesarean deliveries, should cesarean rates decrease sufficiently.