Multicultural doula support and obstetric and neonatal outcomes: a multi-centre comparative study in Norway

Abstract

Background Migrant women face an increased risk of poor obstetric and neonatal outcomes. Norway implemented a multicultural doula (MCD) program in 2018, which was designed to improve pregnancy care for this group in vulnerable circumstances. This study aimed to assess the impact of MCD support, provided in addition to standard care, on obstetric and neonatal outcomes for selected newly arrived migrants. Methods This was a multi-centre case–control study involving all nine hospitals actively running the MCD program, which covers four of Norway’s five regions. Women who received MCD support at the time of childbirth (n = 339), from 2018–2023, were compared to similar newly arrived immigrant women who did not receive MCD support (n = 339) and gave birth within the same timeframe. Hospital records were reviewed, and outcomes were analysed using binary logistic regression. The results are expressed as crude and adjusted associations with 95% confidence intervals (CIs). Results Women receiving MCD support exhibited a 41% lower likelihood of undergoing emergency caesarean sections (adjusted odds ratio [aOR] 0.59, 95% Cl 0.34–0.98) and those giving birth vaginally had a 75% lower risk of estimated blood loss ≥1000 ml (aOR 0.25, 95% Cl 0.12–0.52) compared with women without MCD support. Additionally, MCD support was associated with more use of pain-relief (aOR 2.88, 95% Cl 1.93–4.30) in labour and increased rates of exclusive breastfeeding at discharge (aOR 2.26, 95% Cl 1.53–3.36). Conclusions Our study suggests that MCD support may contribute to improved outcomes for migrants in vulnerable circumstances, potentially impacting their future reproductive health and children’s well-being.