Last night, New York Governor Andrew M. Cuomo announced a series of initiatives with the goal of reducing maternal mortality rates in New York State. In his words, “Maternal mortality should not be a fear anyone in New York should have to face in the 21st century.” Indeed, this sentiment could be echoed by any of the other 49 states. Compared to other wealthy nations, the US’s maternal mortality rates are soaring.
The pilot program is set to be finalized and put into action within 45 days. Specifically, it would aim to improve mortality rates for black mothers. In New York State, black women are four times more likely to die in childbirth than white women. In New York City, this statistic skyrockets to 12 times more likely. This goal will be accomplished by expanding Medicaid coverage for doulas.
Why doulas? The reason is two-fold.
First of all, studies show that having a birth partner provide one-on-one support to mothers throughout labor and delivery leads to better outcomes for mom and baby. This is precisely what trained doulas are taught to do.
Secondly, despite the advantages, doulas support is only utilized. For some, the cost can be prohibitive. Studies also show there is little diversity among doulas. Therefore, although black and low-income mothers may want the support, their access may be inadequate.
The hope is that expanding Medicaid coverage for doula services would bridge the gap of racial disparity.
If successful, New York will be joining Minnesota and Oregon as the only other states that offer this kind of coverage. However, the initiative is not without concern. Medicaid reimbursement rates for doula support in Minnesota have been low. There’s also concern that the expansion could potentially alter the doula profession.
Molly Deutschbien, a committee member of Rochester Area Birth Network, is in support but still has concerns: “When the doulas get paid by someone other than the mother, it gets to the question of, who does the doula work for?”
Conversely, Elan McAllister, a former doula, and co-founder of the New York Coalition for Doula Access believes this is a positive step, saying “We see it as this critical piece of improving outcomes most especially for at-risk mothers. There’s something about having a support person who can bring humanity into a situation and who cares that you survive childbirth and get through it.” (https://www.nytimes.com/2018/04/22/nyregion/childbirth-death-doula-medicaid.html)
Aliza Bancoff, the founder of International Doula Institute, is pleased with this step toward more doula-attended births in New York.
In her words, “we know that having a doula present reduces many common difficulties during childbirth, including lowering cesarean rates, decreasing the need for pain medication, and decreasing mortality rates, among others. So to have doulas covered under Medicare is a great step forward.”
Governor Cuomo will also create a Task Force on Maternal Morality and Disparate Racial Outcomes to partner with the Maternal Mortality Review Board. The plan will be to review each maternal death in New York. Additionally, the state will expand prenatal education programs and review hospital best practices regarding hemorrhaging.
Overall, Cuomo says, “We are taking aggressive action to break down barriers that prevent women from getting the prenatal care and information they need.” (https://www.nytimes.com/2018/04/22/nyregion/childbirth-death-doula-medicaid.html, New York to Expand Use of Doulas to Reduce Childbirth, accessed April 23, 2018)