A recent study by Elevance Health Public Policy Institute showed the impact this change in policy has on maternal outcomes in New York, California, and Florida. The study showed doula use reduced inpatient hospital admissions during pregnancy by 8%, lowered the odds of Cesarean delivery by 8%, lowered overall prenatal and birthing costs by $1675, and reduced the likelihood of having babies with low birth rates by 4%.
The Benefits of Using a Doula
Traditionally by definition, a doula is a non-clinical health professional trained specifically to provide educational, physical, and emotional support to a birthing person and their partner during pregnancy, labor, and childbirth. A doula’s goal is to empower the birthing person to advocate for their own healthcare choices so they can have a positive birth experience with as little intervention as possible. There are many different types of doulas that service other areas of maternal health. For example, a full-spectrum doula supports a variety of reproductive health and life issues outside of childbirth, including fertility, pregnancy and infant loss, postpartum, and mental health. Doulas help to create body literacy, which gives birthing people their power back. “In addition to providing emotional reassurance and physical touch, a doula can help clients navigate through the medical system, provide resources, and implement birth techniques that are sometimes overlooked by medical staff,” says Nicky Dawkins, a birthing doula based in Miami. She says doula support has been shown to reduce c-section rates, decrease the length of labor, and improve birth experiences for birthing people and their families. Community-based doulas who share similar backgrounds, languages, and cultures to their clients can be even more beneficial in preventing negative birth outcomes. They can help facilitate communication between their clients and hospital staff, help clients navigate complex healthcare systems, and connect clients with community support. They are also trained in a cultural context on how race, institutional and interpersonal bias, and other social drivers play an integral role in birth disparities affecting communities of color. Because they have a better understanding of that client’s particular situation and are familiar with their environment, they can often provide better local resources and offer a community of support. “Doulas are not just for birthing people looking to have an unmedicated birth. The right doula will provide the right support for the person’s unique needs and will never judge your decisions about birth location, pain relief, or anything else,” emphasized Dawkins.
Why Are Doulas Important for Pregnant People With Medicaid?
According to the Centers for Disease Control and Prevention (CDC), in 2021, one in ten babies was born prematurely in the United States. Since 2018, there’s also been a 37% increase in the U.S. maternal death rate during pregnancy, and labor and delivery. However, those numbers are staggeringly worse for women of color. “There is a critical connection between infant health, maternal health, and the health of a family," explains Tiffany Inglis, MD, a board-certified OB/GYN and medical director of Elevance Health. “All are dependent on their lived social context, the quality, and accessibility of healthcare, and the policies within a state.” State health facts generated by the Kaiser Family Foundation show in 2020, Medicaid paid for 42% of all births in the U.S. and paid for a greater share of deliveries by Hispanic, Black, American Indian, and Alaska Native women compared to private insurance. Doula care can improve birth outcomes and address racial health disparities. Multiple studies have found that doula care leads to improved outcomes for pregnant people across many aspects of health. “Compared to women who did not receive doula services, women receiving doula care had fewer inpatient hospital admissions during pregnancy and had significantly greater odds of having a full-term birth,” says Dr. Inglis. “They were less likely to have babies with low birth weight or that required NICU admissions. They were less likely to have a Cesarean delivery and were significantly less likely to experience postpartum depression or anxiety.” She also shared that in general, women who worked with doulas had a greater engagement with their maternal care providers and reported higher satisfaction with the care they received.
State Policy Changes For Doula Use Under Medicaid
The inclusion of doula services as a covered Medicaid benefit has been considered by states for nearly a decade, with each state taking a different approach. Pilot programs have been deployed to evaluate the impacts of doula access, creating a rapidly-evolving landscape and limiting consistency across markets.
State Efforts
“Doulas offer a personalized and effective approach for improving the delivery of culturally competent maternal health care and mitigating birth inequities," reiterates Dr. Inglis. “That’s why we believe it’s critical that state Medicaid programs continue reimbursing and approving policies to cover doula services as part of their overall maternal health strategies.” Brandy Lipton, PhD, a visiting associate professor of health, society, and behavior at the University of California, Irvine’s program in public health notes it may take some time before enough data is available for a complete assessment of changes in maternal health. “Based on available research, it seems likely that doula care will have health benefits for Black mothers and children,” says Dr. Lipton. There are lessons from states that have already started including doulas on Medicaid. Some of those lessons include a fair reimbursement rate, a doula certification process, and ways to attract and involve individuals, groups, and organizations who may benefit or be affected by Medicaid coverage for doulas. “Doula care could play an important role in helping to reduce the gap in maternal mortality by race and ethnicity, but there are some important considerations," explains Brandy Lipton, PhD, an assistant professor in the Division of Health Management and Policy in the San Diego State University’s School of Public Health. “Concerns have been raised about lower reimbursement rates in Medicaid and doula participation in the program. Dr. Lipton also says a more diverse workforce of doulas is needed to help reduce disparity. “I think it is important to note that the vast majority of pregnant people with Medicaid coverage would not be able to afford doula care if they had to pay out of pocket,” she explains. “A Medicaid doula benefit makes this care much more accessible.” As more states implement and study the benefits of doula care in the Medicaid population, Dr. Lipton says she hopes that will build the evidence needed to encourage even more states to cover doulas. There was an error. Please try again.
