Karwa et al.: Virtual Doula (Obstetrics & Gynecology, 2024)
20% C-section reduction virtually. 68% for Black women.
20% C-section reduction (aOR 0.80) for users with 2+ virtual doula visits (~9,000 users on Maven platform). Among Black users with 2+ visits: 68% reduction (aOR 0.32).
Karwa and colleagues published the first large-scale study of virtual doula care in Obstetrics & Gynecology in 2024, analyzing roughly 9,000 users of the Maven Clinic digital platform. Users who completed two or more virtual doula appointments had a 20 percent reduction in odds of cesarean (aOR 0.80) compared with matched controls.
The effect was substantially stronger in Black users with two or more visits, who showed a 68 percent reduction in cesarean odds (aOR 0.32). The study also found a dose-response relationship: more sessions correlated with larger effect sizes, which is the kind of pattern that strengthens causal inference. The results suggest virtual doula care can deliver comparable benefits to in-person care, which has practical implications for access, especially in rural areas where in-person doulas are not available.
20%
C-section reduction (2+ virtual visits)
68%
Reduction in Black users (2+ visits)
~9,000
Users in the study
2024
Obstetrics & Gynecology
Why it matters
If virtual doula care delivers most of the in-person effect, the access problem is solvable. The Black-women effect size is the largest yet documented, which matters given the racial disparities in US obstetric outcomes.
This is one finding from the research library behind How to Birth a Mother. Everything here traces back to a study, a dataset, or a systematic review.