Virtual doula care improves birth experiences and reduces the odds of a cesarean section at rates comparable to in-person doula care, a new study finds.
The peer-reviewed study was recently conducted by Maven Clinic, a recent Fierce 50 winner, and published in Obstetrics and Gynecology. The research drew on data from nearly 9,000 Maven members. This is the first-ever study tracking the impact of virtual doulas on birth outcomes, the company said.
Despite research showing that doulas can improve mental health outcomes and reduce disparities in care, only 6% of births in the U.S. are supported by a doula, per 2015 data. Barriers to accessing doulas persist, like lack of coverage and integration with routine prenatal care, the Maven study said.
C-sections are significantly costlier than vaginal births. The national average C-section rate is much higher than what the World Health Organization recommends, and the U.S. continues to rank lowest on maternal health outcomes among the developed world.
All doulas on the Maven platform received certification through DONA International. Video appointments were up to 20 minutes long and covered topics like developing a birth plan, educating and answering questions on childbirth and other resources. Of the cohort studied, just under a third had C-section births and 70% had vaginal births.
The odds of a C-section decreased by nearly 20% with two or more virtual doula appointments on the Maven platform, the study found. The greatest impact in reduced odds was among Black members. Those attending two or more virtual doula appointments with no prior history of C-sections saw a 68% reduction in odds.
For all members with a prior C-section, attending any number of virtual doula appointments was associated with a more than 60% reduction in the odds of repeat C-sections.
Meeting with a Maven doula increased a person’s likelihood of reporting a better birth experience, the study also found. Members indicated they felt they had support in deciding a delivery preference, learning medically accurate information and managing their mental health.
"At every point in our nine-year history, the Maven care model has included doulas. We have long heard from our members just how crucial they are in increasing a family's comfort and confidence during and after pregnancy," Kate Ryder, founder and CEO of Maven Clinic, said in a press release. "These findings reaffirm what we've also seen in our data: that virtual doulas have a critical role to play in driving better maternal health outcomes."
It is often assumed that the physical presence of a doula is necessary to influence outcomes, the study said. But the findings suggest that may not be necessary. Prenatal support, even when offered virtually, can drive comparable outcomes. The findings, the study suggested, demonstrate how digital health platforms can play a role in increasing access to quality care while driving down costs.
These findings also have important workforce implications, the study said, because the risk of burnout is high among doulas who need to be immediately available at a moment’s notice. This limits the number of clients doulas can support at any one time. Virtual doula care can expand a doula’s geographic service area, expanding access to patients.
Because the findings emphasize the robust association that virtual doulas can have in reducing C-sections among the Black population, greater accessibility to digital health may act as a key public health strategy aimed at closing racial disparities in birth outcomes, the study said.
Doulas are among the more than 30 specialists that Maven members have unlimited access to as part of Maven’s maternity and newborn care program. Nearly two-thirds of Maven members who met with a doula also met with one or more providers on the platform. The top three most utilized providers were OBGYNs, lactation consultants and mental health providers. Members can also access Maven referrals to doulas in their community and they can be reimbursed as an employee benefit through Maven Wallet.