AUSTIN, TEX. – Having a trained doula in attendance at labor and delivery for nulliparous women could be a cost-effective strategy to prevent hundreds of thousands of cesarean deliveries yearly, according to a new analysis of the practice.
“We were interested in looking at the cost-effectiveness of having a professional doula at labor and delivery,” said Karen Greiner, a medical student at Oregon Health and Sciences University, Portland. She and her colleagues had their interest sparked after reading a Cochrane review that found reduced rates of cesarean delivery and shortened labor times with continuous support during labor, she said in an interview.
The cost-effectiveness analysis, presented during a poster session of the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists, used a two-delivery model to track the effect of doula attendance at a nulliparous term labor and delivery. Since most women in the United States have two deliveries, the researchers analyzed what effect having a doula attend the first delivery would have on the subsequent pregnancy as well.
Ms. Greiner and her colleagues used a theoretical cohort of 1.8 million women, about the number of nulliparous women with term deliveries in the United States annually, to see what effect doula care would have on cost and maternal outcomes. “We found that there was a significant reduction in cesarean deliveries – almost 220,000 – when a woman had a professional doula with her during labor and delivery, versus not having that doula support,” Ms. Greiner said in a video interview. “We also found a reduction in maternal deaths ... a reduction in uterine rupture, also in hysterectomies.”
The 51 maternal deaths, 382 uterine ruptures, and 100 subsequent hysterectomies averted by use of doulas would result in an increase of 7,227 quality-adjusted life years, the effectiveness metric chosen for the analysis. However, this benefit would come at an increased cost of $207 million for the theoretical cohort.
“We did find that doulas are expensive, that they do cost money,” acknowledged Ms. Greiner. She and her coauthors allocated $1,000 per doula – the median cost for doula attendance at labor and delivery in Portland, Ore. – in the model used for cost-effectiveness analysis.
“Overall, we found that having a doula during a woman’s labor and delivery is cost-effective up to $1,286 for the cost of the doula” when quality-adjusted life years are taken into account, said Ms. Greiner.
She reported having no relevant financial disclosures.
SOURCE: Greiner K et al. ACOG 2018. Abstract 25C.