The Impact of Virtual Doula Services on Birth Outcomes in Rural Communities

Rand Corporation, Santa Monica CA

Investigators

Linked publications & trials

Abstract

Rates of maternal morbidity have been rising in the U.S., and there are rural-urban differences in cesarean births and adverse pregnancy outcomes. Increasing access to doula care is a promising strategy to improve maternal health in rural communities. Doulas are non-clinical providers who offer physical, emotional, and informational support throughout the perinatal period. Yet, despite documented evidence of effectiveness, fewer than 10% of U.S. births involve doulas because of costs and workforce shortages. Virtual doula services may increase access to support in communities that lack doulas and may decrease costs; however, there is minimal evidence of the effectiveness of this new care model. Lack of research in general, and randomized controlled trials in particular, represents a significant gap given that virtual doula services are currently offered by numerous organizations, and the states and payers adding doula benefits do not have evidence to inform their telehealth policies. In the first four years of our mixed-method R01, we assessed the impact of virtual breastfeeding (“telelactation”) services on breastfeeding rates. We demonstrated that telelactation improved breastfeeding duration and exclusivity among populations with lower baseline breastfeeding rates, and we generated insights on how telehealth services could better meet the needs of new mothers. This renewal will build on this foundation and apply many of the same methods that were refined in the original R01 to explore another promising virtual intervention that can improve access to and quality of care for rural mothers. In this renewal, we will conduct an innovative digital, parallel design randomized controlled trial (RCT) to assess the impact of virtual doula services in rural communities. We will recruit 866 primiparous, pregnant women who live in rural counties classified as maternity care deserts. Recruitment will occur via a pregnancy tracker mobile phone app used by millions of pregnant women. Participants will be randomized to unlimited, on-demand visits with virtual doulas throughout the perinatal period or usual care. Birth and postnatal outcomes will be captured via surveys and interviews.  This renewal uses mixed methods and aims to assess the impact of virtual doula services on primary outcomes including type of birth (cesarean vs vaginal), birth satisfaction, and parental self-efficacy and secondary outcomes including maternal depression and anxiety, breastfeeding initiation and duration, and receipt of prenatal and postnatal care. This study will also explore the acceptability of virtual care for different types of doula visits. Together, these aims will inform policy debates about regulation and reimbursement of doula services that incorporate virtual care. This study advances NINR’s research priorities to improve health outcomes for individuals with reduced access to care.