It is no secret that the maternal infant mortality and morbidity outcomes in the United States need to be improved. It’s also no secret that we see significant disparities among black, indigenous, and non-white women when compared to white peers, even when we account for income and education.
We also see concerning outcomes among women with maternity care provided by Medicaid insurance programs. The Doula Medicaid Project hopes to address some of these disparities on a national level. While many programs exist at the local and state levels throughout the US, there is not a national program truly addressing maternity care concerns.
What Is The Doula Medicaid Project?
The Doula Medicaid Project states, “The National Health Law Program’s Doula Medicaid Project seeks to improve health outcomes for pregnant Medicaid enrollees by ensuring that all pregnant individuals enrolled in Medicaid who want access to a doula will have one.”
Simply, their goal is that women desiring doula support have access to doula support. While on one hand doula support seems like a luxury, the evidence shows doulas play a huge role in maternity care.
Both the World Health Organization (WHO) and ACOG recognize continuous labor support, like that of a doula, improves maternal infant health outcomes. This means that from a medical ethics standpoint, and a public health standpoint, access to doula support simply makes sense.
Continuous labor support poses no risks. However, it does provide many benefits including but not limited to:
- Lower risk of c-section birth
- Increased likelihood of reporting a positive birth experience
- Lower rate of pharmacological pain relief
- Increased breastfeeding initiation and duration
- Shorter duration of labor
- Increased likelihood of spontaneous vaginal birth
All those outcomes, and others, are important markers for maternal health outcomes. The WHO recommends a c-section rate of about 10-15%. The US has about an overall 30% c-section rate, meaning half of all c-sections may be medically unnecessary.
Who Is Involved With The Doula Medicaid Project?
Surprisingly, doulas do not run the Doula Medicaid Project. Clearly, doulas are pivotal to projects related to doula care. However, other professionals run the national level program.
They explain on their site:
“We are lawyers, researchers, and policy advocates. We are not doulas. As such, we seek to do all our work in partnership with and with the guidance of community doula groups, doula collectives, and individual doulas, especially Black doulas and Black-led doula groups, as well as doulas and doula groups serving low-income clients.”
Given the complexities of national level healthcare initiatives and programs, the work of lawyers, researchers and policy advocates is vital. They maintain understanding of the importance of doulas in this process however, and work in close contact with them.
What Outcome Does The Doula Medicaid Project Hope To Achieve?
In short, their goal is that every woman on Medicaid who desires a birth doula have access to one. Their reasoning is not just that each woman feels supported, but that we see improved maternal infant health outcomes.
In their own words, the reason for this program goal:
“Low-income women are at the highest risk of poor birth outcomes in the United States, and women of color, especially Black women, are especially vulnerable. Doula care is among the most promising approaches to combating disparities in maternal health. Women receiving doula care have been found to have improved health outcomes for both themselves and their infants, including higher breastfeeding initiation rates, fewer low-birth weight babies, and lower rates of cesarean sections. Doulas can also help reduce the impacts of racism and racial bias in health care on pregnant women of color by providing individually tailored, culturally appropriate, and patient centered care and advocacy.”
What Is The Doula Medicaid Project Doing To Achieve Their Goal?
Unfortunately, making change on the national level can take quite a bit of time. However, as experienced attorney, researchers and policy advocates, they are working hard to implement change.
They are currently:
- Working with doulas to find and remove barriers for an equitable and sustainable Medicaid doula coverage program
- Educating legislators about the disparities and problems with our current maternal infant health outcomes
- Facilitating information gathering across states and counties that have Medicaid doula programs
- Advocating on the state level for Medicaid coverage of doula care
To learn more, visit the Doula Medicaid Project Website.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...