Investing in Doulas: A Cost-Benefit Analysis

Background: The C-section rate in the U.S. rose approximately 60% from 1997- 2011. The cesarean prevention movement grew from this concern, and women who wanted to avoid C-sections were encouraged to have a labor advocate or doula whose purpose was to help them avoid routine procedures that could lead to a C-section.

Methods: 254 first-time mothers who delivered a baby between 2009 and 2013 in Indiana filled out a survey which consisted of various questions related to childbirth experiences and health outcomes. Statistical analyses were completed to compare the various health service costs and childbirth experiences between women who had a doula and those that did not have a doula. Comparisons were calculated on the following childbirth experiences: vaginal birth vs. cesarean birth, induction rate, pain medication use, weeks of gestation, length of hospital stay, and breastfeeding rates after delivery.

Results: The results indicated that 95% of first-time mothers that has a doula present had a vaginal birth. Vaginal birth rate among first-time mothers who did not have a doula present was only 68%.  Women who had a cesarean birth were more likely to stay in the hospital longer than those who had a vaginal birth. In regards to pain medication, epidurals were given to 34% of mothers who had a doula present and 72% of mothers who did not have a doula present.

Conclusions: Overall this study found that women who have a doula present at the time of delivery had better childbirth experiences than those who did not.