{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:07:58Z","timestamp":1787508478177,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T00:00:00Z","timestamp":1556496000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Multiple studies have demonstrated the benefits of intrapartum doula care, including lower risk for cesarean birth and shortened labor time for nulliparous women. However, analyses investigating the cost\u2010effectiveness of doula care are limited. This study evaluated the potential cost\u2010effectiveness of professional doula support during a woman's first birth in a theoretical population of US women, with all women having a second birth without doula care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cost\u2010effectiveness model was designed to compare outcomes in women with a professional doula versus no doula labor support. A theoretical cohort of 1.6 million women, the approximate number of annual low\u2010risk, nulliparous, term, singleton births in the United States, was used. Outcomes included mode of birth, maternal death, uterine rupture, cesarean hysterectomy, costs, and quality\u2010adjusted life years (QALYs). Probability estimates used in the model were derived from the literature, and a cost\u2010effectiveness threshold was set at $100,000 per QALY. Sensitivity analyses were used to investigate the robustness of the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In this theoretical model, professional doula care during the first birth resulted in fewer cesarean births and improved QALYs. Additionally, doula support resulted in 202,538 fewer cesarean births, 46 fewer maternal deaths secondary to fewer cesarean births, 99 fewer uterine ruptures, and 26 fewer hysterectomies, with an additional cost of $185 million and 7617 increased QALYs for the first and subsequent births. Sensitivity analyses demonstrated a professional doula was potentially cost\u2010saving up to $884 and cost\u2010effective up to $1360 per doula.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Professional doula care during a woman's first birth may lead to improved outcomes and increased QALYs during her first and second births. Given the limitations of this analysis, the cost\u2010effectiveness estimate is likely conservative, further supporting broader integration of professional doulas into the US maternity care system and highlighting the need for higher doula care reimbursement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jmwh.12972","type":"journal-article","created":{"date-parts":[[2019,4,30]],"date-time":"2019-04-30T20:50:27Z","timestamp":1556657427000},"page":"410-420","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["The Cost\u2010Effectiveness of Professional Doula Care for a Woman's First Two Births: A Decision Analysis Model"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6495-3781","authenticated-orcid":false,"given":"Karen S.","family":"Greiner","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0601-9346","authenticated-orcid":false,"given":"Alyssa R.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally R.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University School of Nursing Oregon Health &amp; Science University  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse M.","family":"Remer","sequence":"additional","affiliation":[{"name":"Mother Tree Doula Services and Oregon Doula Association  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra C.","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron B.","family":"Caughey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2457-1807","authenticated-orcid":false,"given":"Ellen L.","family":"Tilden","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Oregon Health &amp; Science University  Portland Oregon"},{"name":"Oregon Health &amp; Science University School of Nursing Oregon Health &amp; Science University  Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,29]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Position Paper: The Birth Doula's Role in Maternity Care","author":"Simkin P","year":"2012"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogn.2015.12.009"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6909.2006.00041.x"},{"key":"e_1_2_7_5_1","volume-title":"Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health","author":"Choices in Childbirth; Childbirth Connection, National Partnership for Women and Families","year":"2016"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1991.03460170051032"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2008.00221.x"},{"issue":"2","key":"e_1_2_7_8_1","first-page":"58","article-title":"An economic model of the benefits of professional doula labor support in Wisconsin births","volume":"112","author":"Chapple W","year":"2013","journal-title":"WMJ"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12643"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/birt.12218"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.301201"},{"key":"e_1_2_7_12_1","unstructured":"WangA.Midwives doulas take center stage as Providence develops team approach to pregnancy care.The Oregonian. 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