It has been proven that using a doula improves birth outcomes as well as satisfaction with the birth experience. But what about the impact to health care costs, and the cost of long-term quality of life (presence of absence of disease/chronic conditions)? 

A new study published in the Journal of Midwifery & Women's Health uses a decision analysis model to determine how the use of a doula can impact costs. The study uses a theoretical population of women in the United States using a doula for their first birth as compared with using no professional labor support.

The study found that when using a doula, in theory, the outcomes were less cesarean births and improved cost-effectiveness (defined as quality-adjusted life years or QALYS). Additionally, the model revealed "202,538 fewer cesarean births, 46 fewer maternal deaths secondary to fewer cesarean births, 99 fewer uterine ruptures, and 26 fewer hysterectomies." Having a doula showed a potential cost savings of up to $884 and a cost effectiveness of up to $1360 per doula. 

Studies like this help strengthen the case for getting the cost of a doula reimbursed by health insurance companies. If having a doula present at birth reduces overall costs, health insurance companies may be more willing to cover the small (comparatively) cost of a doula instead of, for example, a cesarean birth. Authors of this study suggest that these cost savings are a conservative estimate, meaning that in real-life scenarios, cost-savings could be significantly higher. 

While the results of this study may not help you get your doula covered in the immediate future, it's important to know about the conversations and efforts going on to make doula coverage standard. Some parents have reported successful attempts to get the cost of their doula covered when writing appeal letters that show evidence of how their doula helped them avoid certain procedures. Knowing the kinds of costs and long-term complications that can be reduced by having a doula may also help inform your decision on whether or not to hire a doula for your birth. 

In the absence of health care insurance coverage for a doula, there are other ways to help cover the cost of a doula if you're having difficulty affording a doula:

• Put the doula fee on your baby registry
• Pay with your HSA/FSA account 
• Ask if your doula has a payment plan and/or sliding scale based on income
• Save early - applicable if you're early in your trying to conceive, or planning on becoming pregnant in the near future
• Hold a garage sale or list clothing/household goods on platforms like Marketplace, eBay, Poshmark, etc.

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