Kozhimannil: Doulas & Medicaid (AJPH, 2013)
Nearly halves C-sections. Closes the racial breastfeeding gap.
Medicaid births with doula: 22.3% C-section vs 31.5% without. Breastfeeding: 97.9% vs 80.8%. Black women: 92.7% vs 70.3%. For every 9 women with a doula, one C-section prevented.
Kozhimannil's 2013 paper in the American Journal of Public Health is the foundational US study on doulas in publicly funded care. The team analyzed Medicaid births and compared outcomes for women who received doula support with those who did not.
Cesarean rates were 22.3 percent for the doula group versus 31.5 percent for the no-doula group. Breastfeeding initiation was 97.9 percent with doula versus 80.8 percent without.
The effect on Black women's breastfeeding was particularly large, 92.7 percent versus 70.3 percent, which closed nearly the entire racial gap on that outcome. The team calculated that for every nine women receiving doula support, one cesarean was prevented. The paper became the evidence base for subsequent Medicaid policy expansion.
22.3% vs 31.5%
C-section with vs without doula
97.9% vs 80.8%
Breastfeeding initiation
92.7% vs 70.3%
Black women breastfeeding rate
1 in 9
Cesareans prevented per woman
Why it matters
A single intervention nearly closes the racial breastfeeding gap and prevents one cesarean for every nine women who receive it. That is rare in maternal health policy.
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.