MCHbest. NPM 2: Low-Risk Cesarean Delivery
Strategy. Supportive Care from Lay Doulas
Approach. Implement a statewide community-based doula program which contracts to local hospitals.
Overview. Women who received labor support from a lay doula (female friend or family member who received two 2-hour doula training sessions) trended toward lower rates of cesarean delivery.1
Evidence. Emerging. Labor support, which includes supportive care from trained doulas, appears to be an effective provider-based intervention to reduce cesarean deliveries among low-risk first births. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).
Target Audience. Providers, including trained labor support.
Outcome. Reduction of primary cesarean delivery rates among nulliparous women. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.
Examples from the Field. There are currently 1 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Using the approach “Implement a statewide community-based doula program which contracts to local hospitals,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):
Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):
1Kozhimannil, K. B., Hardeman, R. R., Alarid‐Escudero, F., Vogelsang, C. A., Blauer‐Peterson, C., & Howell, E. A. (2016). Modeling the cost‐effectiveness of doula care associated with reductions in preterm birth and cesarean delivery. Birth, 43(1), 20-27.