(857) Use of Medicaid covered doula services and associated pregnancy outcomes

Doulas are non-medical professionals who provide support during pregnancy and postpartum and are a potential resource to mitigate perinatal disparities. State Medicaid programs have increasingly provided coverage for doula services with limited data on their effects on outcomes. We aim to describe the sociodemographic characteristics of birthing people who use doula services covered by Medicaid and pregnancy outcomes.

Study Design:
This cross-sectional analysis utilized T-MSIS Analytic File (TAF) data from 2016-2019 in Minnesota and Oregon (the earliest adopters of Medicaid covered doula services). Exposure was use of doula services during pregnancy through 6 weeks postpartum, where patients using doula services were matched 1:3 to patients not using doula service for sociodemographic and medical factors associated with doula use. Outcomes included cesarean delivery (CD), preterm birth (PTB) < 37 weeks, postpartum hemorrhage, postpartum anxiety or depression, severe maternal morbidity, and any ED visit or inpatient admission in the first 60 days postpartum. Conditional logistic regression determined the association of doula use on outcomes controlling for sociodemographic and medical factors.

Results:
Of 121,268 births, 0.6% (n=799) used doula services covered by Medicaid. Doula use was more common among Black patients and people living in zip codes with a higher median income (Table 1). In the matched cohort, PTB was 49% less likely (aOR 0.51, 95% CI 0.35, 0.74). Doula use was associated with lower odds of cesarean delivery (aOR 0.84, 95% CI 0.70–1.00). Other clinical outcomes were not associated with doula services (Table 2). 

Conclusion:

Use of Medicaid-covered doula services was associated with a 49% reduction in PTB even after accounting for SES and health differences in patients using doula services. However, these services are only used by < 1% of the eligible population and more common among Medicaid recipients living in higher median income zip codes. Expansion of such services may improve outcomes and address disparities in maternal child health.