Despite decades of medical advancements, maternal and infant birth risks, illness and injury persist at alarming rates, particularly in communities of color and low-income communities.1 With almost half of the births in the United States covered by Medicaid, there is growing evidence that doula care (non-clinical) influences healthy pregnancies and positive outcomes. One study by the National Institute of Health (NIH) found that doula care could be associated with 22% lower odds of preterm birth.2
Doula care promotes health equity, especially in communities of Black, Indigenous and People of Color (BIPOC). Having a trusting relationship with an advocate who understands cultural and systemic barriers faced by pregnant people is essential to better outcomes. Doulas typically spend up to 11 times the amount of time with their clients compared to clinical providers. A North Carolina study predominantly focusing on Black maternal health concluded that those with doula support were four times less likely to have a low birthweight (LBW) infant, two times less likely to experience a birth complication involving themselves or their baby and significantly more likely to initiate breastfeeding.3 In comparison to individuals receiving no continuous labor support across the U.S., those with continuous doula support were less likely to have:
- A negative birth experience
- Any pain medication while giving birth
- Regional pain medication (such as epidural or spinal)
- An instrumental vaginal birth (with vacuum extraction or forceps)
- A cesarean birth
- A low 5-minute Apgar score (rating of the baby’s status shortly after birth)4
UnitedHealthcare Community & State aims to improve maternal and child health outcomes through community investments to build doula capacity and the doula workforce. In total, UnitedHealthcare Community & State has provided doula training scholarships for 180 doulas and has supported doula services in 24 of our Medicaid markets through pilots, covered benefits, value-added benefits and/or in-lieu of services.
In collaboration with The Doula Network, UnitedHealthcare Community & State launched a national doula pilot across six of our Medicaid markets. The national doula pilot is a program, in collaboration with The Doula Network, that is live within UnitedHealthcare Community & State markets including Arizona, Kansas, Kentucky, Texas, Washington and Wisconsin. The Doula Network recruits and leverages doula support for pregnant members and provides administrative support to participating doulas. The structure of the pilot includes five visits (for prenatal and post-partum support), continuous in-person support during labor, phone support during pregnancy and post-partum, 24/7 on-call support from 37 weeks until birth and screening for social drivers of health social needs. Doulas participating in the pilot have provided over 3,800 hours of care to UnitedHealthcare Community Plan members, with nearly one-third of this time occurring prenatally. Doulas within the pilot spend an average of 11.5 hours providing continuous support during labor and delivery to each member.
To date, most of the data supporting doula care has focused on individuals who access the benefit directly rather than through insurance coverage. Contributing to existing literature on the efficacy of doulas in addressing adverse maternal health outcomes and disparities affecting BIPOC communities, UnitedHealthcare Community & State initiated a large-scale evaluation of doula care using our member claims data in 2024. At UnitedHealthcare Community & State, we have claims data for 806 births involving members who had at least one visit with a doula during their perinatal period, along with an additional 82 births in states participating in the national doula pilot program.
Initial results from this evaluation show positive trends in clinical outcomes, including a 7% increase in timely prenatal visits, 14% increase in completion of the comprehensive postpartum visit and 35% lower instance of NICU for members receiving any doula support. Additionally, for members who had at least three or more visits with a doula, instances of pre-term birth were 50% lower and instances of low-birth weight were 58% lower than those without any doula support.
At UnitedHealthcare Community & State, we are committed to improving maternal health outcomes through accessibility of doula support services for our members.
