How virtual doulas reduce C-sections: New data on what's working

This article has been updated. The original version was posted in 2023.

What you need to know:

• Doulas drive better decision-making and lower anxiety. In Maven's newest study, 99% of members felt better able to participate in decisions about their labor and delivery after meeting with a virtual doula, and 86% felt less anxious — with 80% taking a specific action during labor as a result.
• Virtual doula care measurably reduces C-sections. Peer-reviewed Maven research found that two or more doula visits cut the odds of C-section by nearly 20% overall — and by more than 60% for Black members and those with a prior C-section, at rates comparable to in-person doula care.
• The impact extends to cost and equity. Because C-sections can cost up to $6,000 more per birth than vaginal deliveries, lower C-section rates translate into real savings for employers and health plans, while closing some of the starkest racial gaps in U.S. maternal outcomes.

New research from Maven's clinical team answers a question the maternal health field has been circling for years: not just whether virtual doula care improves birth outcomes, but how — what a doula does in a screen-based appointment that changes what happens later in the delivery room.

Maven's newest study found that 99% of members felt better able to participate in decisions about their labor and delivery after meeting with a virtual doula, and 86% felt less anxious. That builds directly on Maven's earlier finding that meeting with a doula on the platform reduces the risk of C-section — including a nearly 60% reduction in odds of C-section among Black members who met with a doula at least twice, a group facing some of the starkest disparities in U.S. maternal outcomes.

The U.S. faces a severe maternal health crisis with devastating impacts on the health and well-being of birthing parents across the country. Compared to other high-income countries, women in the United States are more likely to die from complications related to pregnancy or childbirth. A driving factor behind the high mortality rate is the disproportionate number of Black and Indigenous women who experience pregnancy-related complications and death. What’s more, the CDC estimates that over 80% of maternal deaths in the U.S. are preventable.

Doula care, where trained professionals provide guidance and support along the birthing journey, is gaining prominence in the mainstream as an effective way to improve maternal health care for birthing parents in the United States and globally. Doulas have been a source of birthing care for pregnant people for centuries, but only in the past few decades have doulas seen broader recognition in the healthcare industry and government.

While doulas commonly provide in-person care before, during, and after births, virtual doula support has been increasing in popularity along with the rise of digital health. To investigate whether virtual doula care can have a positive effect on outcomes experienced by birthing parents, Maven recently conducted a study into the impact of digital doula utilization on C-section and birth experience outcomes. 

Read on to learn more about how virtual doula care improves birth experiences and reduces C-section rates, helping to lower cost of care for employers, health plans, and employees. 

Understanding the role doulas play in pregnancy, birth, and postpartum

A doula is a trained professional who provides emotional and physical support to birthing parents during childbirth and the postpartum period. Doulas are not medical professionals and do not provide medical care; rather, they offer information and advocacy to help pregnant people navigate the healthcare system, make informed decisions about their care, and understand their options throughout pregnancy. 

During virtual appointments, doulas may help pregnant people create a birth plan, discuss birth positions and breathing techniques, educate patients so they can advocate for themselves during the birthing process, and more.

“Doulas are so important because we help educate birthing parents,” says Blue Andrew, Maven Care Advocate and Doula at Brooklyn Birth. “We normalize advocating for yourself and having ownership and autonomy over one’s body, which many people don’t experience as part of their birthing process. Doulas are there to carry and support parents through one of the most vulnerable times of their lives.”

How virtual doulas change outcomes

Maven's clinical research team ran a study combining interviews with five Maven doulas and 19 members, and a survey of 215 Maven members who had met with a virtual doula during pregnancy. Two important things emerged: 

1. Doulas give people real information about their options. Across interviews, both doulas and members described appointments spent walking through the stages of labor, low-intensity ways to start or support labor, and pain management options most people don't hear about from their OB in a typical appointment, which is often too short to answer a patient’s questions and concerns. 

2. Doulas give people the confidence to use that information. Knowing your options only matters if you feel able to raise them with your care team. Members described their doula appointments as the place where they learned it was not only okay, but expected, to ask questions and state a preference — and that this carried directly into how they showed up at their delivery.

The survey data backs this up:

• 99% of members felt better able to participate in decisions about their labor and delivery after meeting with their doula.
• 97% felt better able to ask their doctor or midwife questions, and to ask for what they wanted during labor and delivery.
• 86% said their doula provided information specifically about the things they were worried about, and 86% felt less anxious after their doula appointments.
• 80% took at least one specific action during labor — like changing position, requesting intermittent monitoring, or delaying an epidural — because of what they discussed with their Maven doula.

"As a first-time mother, I had many questions and a lot of anxiety about the birthing process,” one Maven member shared anonymously about her experience using a virtual doula. “From our very first meeting, I felt an immediate sense of calm and confidence in my doula's knowledge and experience — she was always available, providing evidence-based resources and great advice."

The physical, emotional, and psychological advantages of doula support benefit not only employees and their family members but also their employers. Both in-person and virtual doula care are linked to more positive birth outcomes and a more positive childbirth experience. Virtual doulas are an accessible option for those in care deserts, where care is difficult to find or unaffordable, or for patients who don’t want a doula present. No matter what, if a doula has prepared the birthing person with the right information and the confidence to use it, that preparation travels with them into the delivery room. 

Building on Maven’s research in virtual doula care and its impact on outcomes

As the world’s largest virtual clinic for women and families, Maven is well-positioned to examine the effects that digital doula care can have on birth outcomes. In a Maven study previously published in Obstetrics and Gynecology, our clinical research team examined the impact that virtual doula care has on C-section rates and birth experiences. 

Virtual doula care reduces C-section rates

Maven’s research found that members with a prior C-section saw a reduced risk of C-section after one meeting with a doula. Other members experienced a reduced risk of C-section after two or more doula appointments. 

Those who met with a doula two times or more reduced the odds of C-section by nearly 20% for all members. For those who met with a doula two or more times and have had a prior C-section, the impact was even greater: more than 60% of these members saw reduced odds of C-section. 

The positive effects of doula care are also reflected among Black Maven users specifically. Black members who met with a doula at least twice on Maven had nearly 60% decreased odds of C-section, compared to Black members who did not meet with a doula. 

These findings show us that virtual doula care is effective and can reduce risk of C-section by a comparable amount to that seen with in-person doula care.

Virtual doula care improves birth experiences

Maven’s research also found that meeting with a doula on the Maven platform increased our members’ likelihood of reporting a better birth experience. We defined “better birth experience” based on the following factors:

• Feeling like they had support in deciding a delivery preference
• Learning medically accurate information
• Feeling like they received a high level of emotional support
• Better managing their mental health

Members reported greater birth experience outcomes if they met with a doula two or more times, compared to those who met a doula once or no times. 

Why does this research matter?

Removing barriers to care

In-person doula care is powerful, but cost and availability keep it out of reach for many. Virtual doula care removes those barriers — and this research suggests the in-person component can be supported with alternative options to care. 

"I really wanted a doula to support me throughout pregnancy but found it to be financially challenging,” one Maven member wrote. “When my husband shared the Maven resource with me from his job, I immediately had access to a variety of doulas." 

Reducing overall cost of care

C-sections can cost up to $6,000 more per birth than vaginal deliveries. Lower C-section rates mean real savings for employers, health plans, and employees alike.

Improving health equity

Doula-supported birth is one of the most promising tools for narrowing racial disparities in birth outcomes. The greatest reduction in C-section risk in Maven's first study was seen among Black members — and this new research suggests virtual doula care can extend that support well beyond the limits of local, in-person doula availability, which is especially scarce among non-white doulas.

How Maven cares for birthing parents

The study shows that digital health platforms like Maven can help improve outcomes through virtual doula care while reducing access barriers associated with in-person support. 

Doulas are among the 30+ specialists that Maven members have unlimited access to as part of Maven’s Maternity & Newborn care program. Nearly two-thirds of Maven members who met with a doula also met with one or more providers on the platform, with the top three most-used providers being OB/GYNs, lactation consultants, and mental health providers. Through Maven, members seeking in-person support throughout labor and postpartum can also access referrals to doulas in their community.

To learn more about how Maven provides better care for parents-to-be and parents as they navigate their family journey, contact us today. 

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