The American Journal of Managed Care August 2014
Potential Benefits of Increased Access to Doula Support During Childbirth
Table 4 presents the unadjusted (crude) and adjusted odds of cesarean delivery and cesarean without definitive medical indication by doula support and desire for doula support, controlling for sociodemographic and pregnancy-related characteristics. In each comparison, unadjusted results were similar in direction and magnitude to results from the adjusted models. Doula support was associated with a nearly 60% reduction in odds of cesarean delivery (AOR = 0.41, 95% CI, 0.18-0.96) and 80% lower odds of nonindicated cesarean delivery (AOR = 0.17, 95% CI, 0.07-0.39), compared with not having doula support. When comparing women who had doula support with those who indicated a desire for doula support but did not have it, women who had doula support had substantially lower odds of cesarean delivery overall (AOR = 0.31, 95% CI, 0.06-0.33) and of nonindicated cesarean delivery (AOR = 0.11, 95% CI, 0.03-0.36), compared with those who expressed a desire for doula care. Additionally, women who wanted doula support but did not have it had higher odds of cesarean delivery (AOR = 1.48, 95% CI, 1.00-2.19) and nonindicated cesarean delivery (AOR = 1.73, 95% CI, 1.10-2.73), compared with women who did not express a desire for doula support.
This analysis found that, among a nationally representative sample of US women who gave birth in 2011-2012, women with doula support had substantially lower chances of having a cesarean delivery and even lower rates of nonindicated cesarean, compared with women without support from a birth doula. This is consistent with prior research.4,5,26 However, prior observational research has noted the challenge of selection bias; that is, disentangling the desire for doula care from birth outcomes, given that measured and unmeasured characteristics associated with choosing a doula may also impact choices about delivery mode.27,28