Karwa et al1 identified a coding error in their data set that has slightly affected the way their numbers were tabulated. The key results and messages were not affected.

In the corrected analysis, the reported numbers primarily differ by small amounts, such as in the first or second decimal place. The description of user characteristics has been updated to reflect the retabulation (Table 1). In some instances, the updated analyses have revealed a greater effect than the authors originally reported, and, in one instance, a minor finding was no longer significant. Specifically, meeting with a doula is now significantly associated with reporting learning medically accurate information among parous users (Table 2) and with help deciding delivery preference among Black parous users (Table 3). Among Black users, meeting with a doula two or more times is no longer significantly associated with learning medically accurate information among nulliparous users and overall (Table 3). The primary outcome of reduced cesarean delivery rate is effectively unchanged for both the full cohort and Black users. The authors have corrected text in the abstract Results, the Results and Discussion in the article's body text, Tables 1–3, Appendices 2 and 3 (available online at https://links.lww.com/AOG/D522), and Figure 2 to reflect the corrected results. The corrected text, tables, and figure appear below.

Table 1.:

Selected Characteristics of Digital Platform Users, Stratified by Mode of Birth (N=8,989)

Table 2.:

Fully Adjusted Associations Between Digital Doula Utilization and Birth Outcomes Among the Full Cohort (N=8,989)*

Table 3.:

Fully Adjusted Associations Between Digital Doula Utilization and Birth Outcomes Among Black Users of the Digital Health Platform (n=531)*

Fig. 2.:

Forest plot of doula utilization with odds of cesarean birth (n=8,983). Model 1 adjusts for age, race, Social Vulnerability Index, presence of medical conditions, body mass index, history of anxiety or depression, current pregnancy-related anxiety, and parity. Model 2 adjusts for all covariates present in Model 1, in addition to overall Maven utilization (in minutes). Black vertical line indicates the null value of the odds ratio (1.00). All horizontal lines not crossing the null value indicate statistical significance.

RESULTS: Overall, 8,989 platform users were included. The completion of at least two appointments with a virtual doula on the digital health platform was associated with a reduction in odds of cesarean birth among all users (adjusted odds ratio [aOR] 0.81, 95% CI, 0.65–0.99) and among Black users (aOR 0.32, 95% CI, 0.14–0.72). Among platform users with a history of cesarean birth, completion of any number of doula visits was associated with a reduction in odds of repeat cesarean birth (one visit: aOR 0.35, 95% CI, 0.17–0.72; two or more visits: aOR 0.37, 95% CI, 0.17–0.83). Analyses among all users indicated dose–response associations between increased virtual doula use and greater odds of users reporting support in deciding a birth preference (one visit: aOR 2.45, 95% CI, 2.11–2.84; two or more visits: aOR 3.85, 95% CI, 3.19–4.64), receiving a high level of emotional support during pregnancy (one visit: aOR 1.99, 95% CI, 1.74–2.28; two or more visits: aOR 3.25, 95% CI, 2.70–3.94), learning medically accurate information about pregnancy complications and warning signs (one visit: aOR 1.47, 95% CI, 1.28–1.69; two or more visits: aOR 1.70, 95% CI, 1.39–2.10), and help managing mental health during pregnancy (one visit: aOR 1.35, 95% CI, 1.13–1.62; two or more visits: aOR 1.76, 95% CI, 1.41–2.20).

RESULTS (corrected sentences only)

In our secondary analysis, 531 (5.9%) identified as Black, a category including those who also identified as Hispanic ethnicity or multiracial and Black.

After further adjusting for minutes of digital health platform use, results from model 2 yielded similar odds ratios; users who completed two or more virtual doula appointments experienced a 19% reduction in odds of having cesarean births (aOR 0.81, 95% CI, 0.65–0.99) when compared with users who did not meet with a doula (Table 2, Fig. 2).

Additionally, parous users with and without a history of cesarean birth who met with a doula two or more times had higher odds of reporting that the platform helped them manage their anxiety or depression compared with users who did not meet with a doula (history of cesarean birth: aOR 2.46, 95% CI, 1.09–5.38; no history of cesarean birth: aOR 2.93, 95% CI, 1.42–5.95; Table 2).

Among nulliparous Black users, the completion of two or more doula appointments was associated with a 68% reduction in odds of having a cesarean birth (aOR 0.32, 95% CI, 0.12–0.75) compared with nulliparous Black users who did not meet with a doula.

Black users who completed doula appointments had higher odds of reporting that the platform helped them decide their birth preference and that they received a high level of support during pregnancy. We did not see consistent, statistically significant associations in the dose–response relationships for learning medically accurate information and managing mental health among all Black users, with no association between one visit and improved mental health management (aOR 1.49, 95% CI, 0.74–2.89), but almost three times the odds of reporting that the platform helped them manage their anxiety or depression (aOR 2.81, 95% CI, 1.24–6.23) with completion of two or more doula appointments, compared with users who did not meet with a doula (Table 3).

Stratified analyses by parity among Black users showed similar dose–response associations between doula utilization among Black nulliparous users in helping them decide their birth preference, but no significant associations were found for managing their anxiety or depression.

Although we did not find dose–response associations for managing mental health among Black parous users, those who completed two or more doula appointments had 7.9 times the odds of reporting that the platform helped manage their anxiety or depression, compared with Black parous users who did not meet with a doula (Table 3).

DISCUSSION (corrected sentences only)

This analysis revealed that completing at least two virtual doula appointments on a comprehensive digital health platform is associated with a 19% and 68% reduction in odds of cesarean births for all users and Black users, respectively.

REFERENCE 1. Karwa S, Jahnke H, Brinson A, Shah N, Guille C, Henrich N. Association between doula use on a digital health platform and birth outcomes. Obstet Gynecol 2024;143:175–83: doi: 10.1097/AOG.0000000000005465