J Midwifery Womens Health

Introduction In the United States breastfeeding initiation rates have risen in recent years. However, there are notable disparities by socioeconomic status and race/ethnicity. Previous research has suggested that care from a doula (a trained professional who provides non-medical support during the perinatal period) may increase breastfeeding initiation. The goal of this study was to study whether doula support may be associated with breastfeeding initiation among low-income, diverse women. Methods We compared breastfeeding initiation rates (mean values and 95% confidence intervals) for 1,069 women who received doula care from Everyday Miracles, a Minnesota-based organization that employs a diverse group of certified doulas, to a state-based sample of Medicaid-covered women who gave birth in 2009 or 2010 and participated in the Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS) survey (weighted n=51,721). Results Women who had doula-supported births had near-universal breastfeeding initiation (97.9%), compared with 80.8% of the general Medicaid population. Among African-American women, 92.7% of those with doula support initiated breastfeeding, compared with 70.3% of the general Medicaid population. Discussion These results suggest that access to culturally-appropriate doula care may facilitate higher rates of breastfeeding initiation. When supported in their non-medical needs by birth doulas, the diverse, low-income patients of midwives and other maternity care providers may have a greater likelihood of initiating breastfeeding and experiencing the maternal and infant health benefits associated with breastfeeding.

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