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Q&A

Health Equity/Community Health

Poster Session 1

(99) A meta-analysis on the impact of doula care on Cesarean section rates

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:


Cesarean section account for nearly one-third of all deliveries in the United States. We aimed to pool results from extant literature to determine whether the addition of doula services decreases caesarean delivery rates.






Study Design:


We conducted a systematic review and meta-analysis by searching electronic databases for randomized controlled trials (RCT) and observational studies comparing prenatal care plus doula services (PC+) to standard prenatal care (PC). The primary outcome was caesarean delivery (CD). Secondary outcomes included instrument assisted vaginal delivery (IAVD-forceps or vacuum) and epidural placement. We conducted a stratified analysis by study type (RCT or observational). Pooled relative risks (RRs) and weighted mean differences were calculated using random-effects models. The Q-test and I2 statistics assessed heterogeneity.






Results:


Sixteen studies (8 RCTs and 8 observational studies) met study criteria. Patients receiving PC+ were significantly less likely to have a CD overall (n=16 pooled rates 18.7% PC+ vs. 30.7% PC; pooled RR 0.32; 95% CI 0.25-0.40) and in stratified analysis of RCTs (8 studies: pooled rates 14.4% PC+ vs. 21.9% PC; pooled RR 0.25; 95% CI 0.17-0.37) and observational (8 studies: pooled rates 19.7% PC+ vs. 30.7% PC; pooled RR 0.37; 95% CI 0.27-0.50) studies. There was no difference in rate of epidural placement but those with PC+ were more likely to have an IAVD.






Conclusion:


Pregnant patients supported by doulas services are 68% less likely to undergo CD than those receiving standard prenatal care, more likely to have IAVD, and have no difference in epidural rates. Additional research is needed to elucidate the impact of doula services on neonatal outcomes. Nonetheless, doula support services represent a promising intervention to decrease the high rates of caesarean section in the United States.