Impact of multicultural doula support on pregnant migrant women's healthcare service utilisation in Norway: a multi-centre case-control study.

Introduction: Newly arrived migrant women face barriers to accessing childbirth-related care, delaying necessary treatment and negatively affecting birth outcomes. Multicultural doula (MCD) support may help women overcome these barriers. This study aimed to evaluate the impact of MCD support on the use of hospital healthcare services during pregnancy and postpartum. Methods: This case-control study included 339 MCD-supported women and 339 controls (women who did not receive MCD support) from all nine Norwegian hospitals implementing the MCD programme (2018-2023). Cases met MCD programme's inclusion criteria, whereas controls met similar criteria but did not receive MCD support. Data from hospital records were analysed using binary logistic regression with crude and adjusted associations reported. Adjustments included parity, age, education, employment, maternal region of birth, reason for migration, delivery site in Norway, acute consultations, labour induction, preterm birth, mode of delivery, estimated blood loss ≥1000 mL and admission for newborn to intensive care. Results: Women in the MCD case and control groups were similar in age, marital status, parity and interpreter needs (95% vs 96%). Compared with controls, MCD-supported women more often had limited education (63% vs 42%, p<0.01) or were asylum seekers (82% vs 66%, p<0.01). They were more likely to consult for reduced foetal movement (adjusted OR (aOR) 1.86, 95% CI 1.22 to 2.84), other pregnancy-related concerns (aOR 1.46, CI 1.05 to 2.03), telephone before admission (aOR 3.21, 95% CI 2.26 to 4.58), had fewer unplanned out-of-hospital births (OR 0.06, CI 0.01 to 0.43) and reduced ambulance use (aOR 0.32, CI 0.18 to 0.58) and had fewer postpartum stays ≥4 days (aOR 0.58, CI 0.39 to 0.87), with a greater proportion discharged within 2 days after delivery (aOR 1.87, CI 1.26-2.78). Conclusion: MCD support was associated with increased antenatal hospital consultations and timely labour admission among migrant women in vulnerable circumstances. This assistance may improve the childbirth experience and positively influence migrant maternal health, birth outcomes and children's well-being.