Association Between Doula Use on a Digital Health Platform and Birth Outcomes

Abstract

OBJECTIVE: To examine the association between the use of virtual doula appointments on a comprehensive digital health platform and users' mode of birth and their birth experiences, among all platform users and Black platform users. METHODS: Data for this retrospective cohort study were extracted from individuals who enrolled in a comprehensive digital health platform, between January 1, 2020, and April 22, 2023. Multivariable logistic regression models were used to estimate the association between number of virtual doula appointments completed on the digital health platform and odds of cesarean birth and user-reported birth experience outcomes, which included help deciding a birth preference, receiving a high level of support during pregnancy, learning medically accurate information about pregnancy complications and warning signs, and managing mental health during pregnancy, stratified by parity. The interaction of doula utilization by race for each outcome was also tested. RESULTS: Overall 8,989 platform users were included. The completion of at least two appointments with a virtual doula on the digital health platform was associated with a reduction in odds of cesarean birth among all users (adjusted odds ratio [aOR] 0.80, 95% CI, 0.65–0.99) and among Black users (aOR 0.32, 95% CI, 0.14–0.72). Among platform users with a history of cesarean birth, completion of any number of doula visits was associated with a reduction in odds of repeat cesarean birth (one visit: aOR 0.35, 95% CI, 0.17–0.72; two or more visits: aOR 0.37, 95% CI, 0.17–0.83). Analyses among all users indicated dose–response associations between increased virtual doula use and greater odds of users reporting support in deciding a birth preference (one visit: aOR 2.35, 95% CI, 2.02–2.74; two or more visits: aOR 3.67, 95% CI, 3.03–4.44), receiving a high level of emotional support during pregnancy (one visit: aOR 1.99, 95% CI, 1.74–2.28; two or more visits: aOR 3.26, 95% CI, 2.70–3.94), learning medically accurate information about pregnancy complications and warning signs (one visit: aOR 1.26, 95% CI, 1.10–1.44; two or more visits: aOR 1.55, 95% CI, 1.29–1.88), and help managing mental health during pregnancy (one visit: aOR 1.28, 95% CI, 1.05–1.56; two or more visits: aOR 1.78, 95% CI, 1.40–2.26). CONCLUSION: This analysis demonstrates that virtual doula support on a digital health platform is associated with lower odds of cesarean birth and an improved birth experience. Positive findings among Black users and users with vaginal birth after cesarean suggest that doula support is critical for patient advocacy, and that digital health may play a meaningful role in increasing health equity in birth outcomes.

Digital versus non-digital health interventions to improve iron supplementation in pregnant women: a systematic review and meta-analysis

“…It is noteworthy that future research could further explore the benefits of different digital technologies in improving adherence to oral iron supplementation in pregnant women ( 44 ). This investigation could include, but is not limited to, mobile applications, smart devices, remote monitoring systems, among others.…”

A Doula's Presence

“…This method of support reaches more birthing families, particularly during the coronavirus disease 2019 (COVID-19) pandemic, and with the increasing number of hospital deserts in rural communities. In this month's issue of Obstetrics & Gynecology, the study by Karwa et al 4 (see page 175) addresses this shift toward more telehealth access for birthing families, including access to doula care. Karwa et al demonstrate that, “…virtual doula support on a digital health platform is associated with lower odds of cesarean birth and an improved birth experience.” This conclusion is consistent with other studies related to the association between pregnancy outcomes and the presence of doulas in birth.…”

“…Typically, the intimacy of the client–doula relationship develops over a series of two to five visits for an average of 1.5–2 hours, depending on the birthing person's needs, as opposed to the up to 20 minutes per session in the Karwa et al study. 4 Further, the responsiveness of a doula who is present, who has cultivated an intimate relationship of care, gives families reassurance and a feeling of safety. If virtual doula sessions are conducted only with the pregnant individual, as in the Karwa et al study, the more holistic familial component of in-person doula care is lost.…”

Association Between Doula Use on a Digital Health Platform and Birth Outcomes: Correction

“…Karwa et al 1 identified a coding error in their data set that has slightly affected the way their numbers were tabulated. The key results and messages were not affected.…”