A regional framework to increase access to doula care for Medicaid members
Doulas have been recognized as a crucial part of maternal health care and an evidence-based solution to help improve birth outcomes. This is especially true when doula care is available to underserved populations — particularly for Black and Indigenous mothers who face systemic disparities in maternal health outcomes.
“There has been a great deal of research on how having a doula can support labor and birth outcomes, including decreasing cesarean sections and shortening the length of labor,” said Elizabeth Simmons, CEO and Founder of The Doula Network. What doulas bring to the birthing process, to the birthing person’s care team, is information, education and wisdom that isn’t encapsulated in the health care system. That includes culturally congruent care.”
A doula is a non-clinical support person who provides continuous emotional, informational and physical support for individuals before, during and after labor. This includes expanding health literacy by providing guidance on medical procedures in plain language, lactation support, helping with physical comfort during labor, education on coping skills and infant care, plus encouraging personal advocacy in collaboration with medical providers.
With Medicaid, there has been increasing support for doulas as a covered benefit within state Medicaid plans. UnitedHealthcare Community & State is launching a pilot which provides comprehensive doula support to eligible members in five states — Texas, Washington, Arizona, Kansas and Kentucky — for one year in partnership with The Doula Network (TDN). TDN’s mission is to create a foundational system of doula services that are aligned with a birthing person’s needs.
The pilot program in these five states includes:
- Five doula care visits (four perinatal visits plus labor support) at home or in a doctor’s office
- In-person labor support at birthing location
- Phone or email support between visits
- 24/7 on-call support from 37 weeks until birth
- Social determinants of health screening and support
“Our main goals are to positively impact maternal and child health outcomes and to use the data collected in this pilot to demonstrate that impact,” said Hannah Corbett, associate director of Maternity Provider Partnerships Design at UnitedHealthcare Community & State. “Hopefully one day every single pregnant Medicaid member will have the opportunity to be supported by a doula.”
Doulas have been found to improve clinical outcomes, especially for people of color. In addition, doulas may offer support as a patient advocate and familiar face in navigating a clinical environment that can be overwhelming. The pilot will match members with doulas of similar background, race, language, ethnicity, as much as possible.
“We’re working with teams like UnitedHealthcare Community & State to really bring robust services that honors what the doula does, honors what the medical system does well and make sure that we come together in a collaborative way that centers that birthing person,” Elizabeth said.
There is no one-size-fits-all approach to increasing access to doulas for the Medicaid population. The pilot with The Doula Network is one way to help expand access to wide-ranging, holistic support for improved birth outcomes on a larger scale — and to the communities that need it the most.
To learn more about this collaboration, visit the UnitedHealthcare Community & State website.