Providing greater access to doula care through Medicaid for healthier births

Among high-income countries, the U.S. has one of the highest rates of maternal deaths in the world.
This is particularly stark for Black mothers — who are three times more likely to die from childbirth than non-Hispanic white mothers. One potential solution shown to help improve maternal and infant health outcomes may be trained, professional doula care.

Doula care provides nonclinical emotional, physical and informational support to pregnant individuals and new parents. Doulas don’t directly provide care that a doctor would — they are there as a professional labor assistant for the mother. During labor and delivery, they provide comfort and coaching, and serve as patient advocates when issues such as pain management or other interventions are raised.

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Research has shown that doula care can be an absolutely crucial part of a healthy pregnancy and lead to improved outcomes for the baby — and moreover, they can be a trusted voice of support for a birth journey. For example, one study showed that doula care in a Medicaid population helped increase breastfeeding by more than 17%, and more than 21% for Black mothers.

Based on these results, a number of states are authorizing coverage of doula care as part of their Medicaid plans, in addition to a handful of states that previously implemented doula care in 2021. Studies in a few states have already shown Medicaid reimbursement for doula care is leading to cost savings and better outcomes. For example, in Nevada, a doula care pilot program, with 50 mothers enrolled, is proving to be an integral part of the mom’s pregnancy and birthing success.

One of the other key aspects of a doula is to ensure mother and baby are supported in the social conditions that may affect their overall health, or their social determinants of health. In Nevada, they may help mothers with proper nutrition, transportation to appointments and more. During the pandemic, some doulas have also embraced telehealth to help safely support moms-to-be — including in the delivery room when COVID-19 has imposed restrictions on visitors.

Continuous doula support during the pregnancy journey may lead to improved health outcomes and offer additional social, emotional, and physical supports for the pregnant and birthing person. Studies have also demonstrated that support from non-clinical providers, such as doulas, is associated with lower cesarean rates, fewer obstetric interventions, fewer complications, lower use of pain medication, shorter labor, higher rates of breastfeeding and higher scores on the Apgar test.

Given the research-based evidence in both lower income and diverse communities, doula care could potentially have a powerful role in increasing health equity and improving maternal health across the country.

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