An Economic Model of Professional Doula Support in Labor in British Columbia, Canada

Spending on care in childbirth represents a sizable portion of health care budgets. This has engendered a growing interest in potential clinical tools that could be used to improve patient experience and population health at a lower cost. A possible such tool is continuous support in labor from a trained doula, as doula care can decrease the likelihood of cesarean birth, epidural analgesia, and assisted vaginal birth. In addition, there is some emerging evidence suggesting that involving doulas in prenatal care can reduce rates of preterm birth.

We used data on the associations between doula care and these outcomes derived from a Cochrane review of continuous labor support to create an economic model of universal doula support in the Canadian province of British Columbia. These relative risks were used to estimate procedure reductions and the resulting cost savings using data on the number of relevant procedures performed from Perinatal Services BC coupled with cost information from the Canadian Institutes for Health Information.

For the calendar year 2013, we estimated savings in Canadian dollars (CaD) of CaD $10,428,171 (95% confidence interval [CI], $5,430,650-$14,434,740) if every low-risk birth were attended by a professional doula, not including the cost of the doula's services. Including reduction in preterm birth increases total savings to CaD $17,847,370 (95% CI, $6,772,341-$27,054,610). A professional doula providing labor support would yield an estimated savings of CaD $269.55 (95% CI, $141.70-$374.14) per low-risk birth or CaD $418.67 (95% CI, $158.87-$634.65) if including reductions in preterm birth. Any cost savings disappear at a doula reimbursement rate above CaD $418.67 per birth.

There is potential to reduce health care costs while improving patient experience and population health by providing universal doula coverage. However, our results suggest that reimbursement rates for doulas would have to be lower than the current range (CaD $300-$1500).