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Comparative Study
. 2024 Dec 24;24(1):854.
doi: 10.1186/s12884-024-07073-y.

Multicultural doula support and obstetric and neonatal outcomes: a multi-centre comparative study in Norway

Hanna Oommen  1   2   3 , Linda Reme Sagedal  4   5   6 , Jennifer J Infanti  7 , Ulrika Byrskog  8 , Marit Stene Severinsen  9 , Mirjam Lukasse  10
Affiliations
Comparative Study

Multicultural doula support and obstetric and neonatal outcomes: a multi-centre comparative study in Norway

Hanna Oommen et al. BMC Pregnancy Childbirth. .

Abstract

Background: Migrant women face an increased risk of poor obstetric and neonatal outcomes. Norway implemented a multicultural doula (MCD) program in 2018, which was designed to improve pregnancy care for this group in vulnerable circumstances. This study aimed to assess the impact of MCD support, provided in addition to standard care, on obstetric and neonatal outcomes for selected newly arrived migrants.

Methods: This was a multi-centre case-control study involving all nine hospitals actively running the MCD program, which covers four of Norway's five regions. Women who received MCD support at the time of childbirth (n = 339), from 2018-2023, were compared to similar newly arrived immigrant women who did not receive MCD support (n = 339) and gave birth within the same timeframe. Hospital records were reviewed, and outcomes were analysed using binary logistic regression. The results are expressed as crude and adjusted associations with 95% confidence intervals (CIs).

Results: Women receiving MCD support exhibited a 41% lower likelihood of undergoing emergency caesarean sections (adjusted odds ratio [aOR] 0.59, 95% Cl 0.34-0.98) and those giving birth vaginally had a 75% lower risk of estimated blood loss ≥1000 ml (aOR 0.25, 95% Cl 0.12-0.52) compared with women without MCD support. Additionally, MCD support was associated with more use of pain-relief (aOR 2.88, 95% Cl 1.93-4.30) in labour and increased rates of exclusive breastfeeding at discharge (aOR 2.26, 95% Cl 1.53-3.36).

Conclusions: Our study suggests that MCD support may contribute to improved outcomes for migrants in vulnerable circumstances, potentially impacting their future reproductive health and children's well-being.

Keywords: Childbirth; Health Disparities; Health Promotion; Migrants; Perinatal Care.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was performed in accordance with the Declaration of Helsinki. The Norwegian Regional Committee for Medical Research Ethics South-East-C approved the study and modifications (REK 327056/2022). The Committee approved the decision not to obtain signed consent for this retrospective study due to several challenges, including participant relocation, language barriers, and difficulty in reaching individuals. Information about the study was available through meetings with the doulas, the study website, and meeting points organised by voluntary organisations such as the Norwegian Women’s Public Health Association. Privacy has been protected by ensuring individuals cannot be recognised in the presentation of the results. Data storage was approved by the Norwegian Centre for Research Data (SIKT) and the data protection officer of each participating hospital and formalised in a Data Protection Impact Assessment (DPIA). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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