January 3, 2023
By Deepa Fernandes and Ashley Locke
Advocates say one way to address the high rate of maternal deaths in the U.S. is to increase support for pregnant people and their families.
One approach is to expand access to trained doulas.
Right now, Medicaid — or government-funded health insurance for low-income people — covers doula services in eight states. Six more are in the process of following this trend, including California.
Marianna Dale, a reporter for KPCC who covers early childhood, says state governments are realizing the economic advantages to providing this type of support.
“Healthy pregnancies are much easier to pay for than ones where there’s a lot of complications,” Dale says.
On the high rates of maternal deaths and how they’re even higher for Black mothers and babies
“For Black mothers, the maternal death rate is more than double the average and nearly three times higher than the rate for white women. And these rates persist across income and education levels.
“We also see similarly high rates of Black infant mortality. And now the good news, but also the thing that is kind of frustrating is that we’ve known about these health disparities for decades. But we also know that the vast majority of these deaths are preventable.”
On the role of a doula
“Doulas are a little different. They’re not medical professionals like an OB-GYN or a midwife is. And one misperception might be that the doula is only something you have if you want to have this kind of crunchy, granola birth experience with no medicine and you’re not in a hospital or something like that. …
“A few examples of support [include] helping you create a birth plan, answering questions you have about pregnancy or medications and then also helping you after the baby is born, helping you with your healing and caring for a newborn. Some doulas might even be certified lactation consultants who can advise with breastfeeding.”
On what decades of research show about how doulas impact outcomes
“Well, what we know is that they help a lot. Basically, mothers who work with doulas, they have healthier babies, they have fewer pregnancy complications and they’re more likely to initiate breastfeeding.
“There was a 2016 study that looked specifically at Medicaid funded births and found that women who worked with doulas were less likely to have pre-term or caesarean sections, which is good news not only for the health of the mother, but also that saves a lot of money if you don’t have to have a surgery like a C-section. And even the American College of Obstetricians and Gynecologists, they reviewed a lot of studies and say that the continuous support that doulas provide [is] one of the most effective tools to improve labor and delivery outcomes.”
On the question of whether a doula is needed if a mother has a doctor’s support
“Well, I would encourage people — even if they’re not pregnant — to think about their last doctor’s appointment. How long did you spend with the doctor? 10 minutes? 15 minutes? And in that setting, did you really feel like you had the time and space to get all of your questions answered? For a lot of the moms I’ve talked to, the answer is no. And also, to expect that you would have all your questions all ready to go and you’d get them all done in 10 minutes. That’s not that’s not really how our brains work. And pregnancy is such an amazing and complicated process.”
On how people pay for doulas
“Their rates are several hundred to several thousand dollars because they’re providing hours of continuous support. And this is how they make a living. And … for the most part, people are having to dig deep out of their pocket to pay for it because most private insurers do not pay for doula support.”
On California’s Medicaid doula program
“California’s Medicaid doula program was created by state law in 2021. They spent more than a year kind of setting it up with stakeholders, and they outlined everything from what they’re going to do, to how much they’re going to get paid. And that is critical because in states that already have Medicaid, doula programs like Oregon and Minnesota, some of the reimbursement rates were like $350, $450, and that wasn’t enough for a lot of doulas. And so if you don’t have doulas signing up to be part of the program, then people can’t access their services.
“In California’s program, which started on Jan. 1, doulas are going to get about $1,000 per pregnancy. Now it’s going to be a couple months for the program to kind of get up and running. But at least one insurer told me that they are already working to connect families with doulas.”
On whether the program will include other insurers:
“Here in California … you’ll have to be either qualified for Medicaid because of your income or because of your pregnancy to be able to get your doula paid for. We do have some hopeful examples in other states. Rhode Island is the first state that passed a law that requires not only Medicaid, but private insurers to also pay for doula services.”
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