Birth Doulas Rally for Pathway to Certification in Washington State

by Megan Burbank

When Seattle full-spectrum doula Jasmyne Bryant meets with a client for the first time, she often encounters one of two responses. "As Black and Indigenous doulas, when we're interviewing clients who are in our community, who are also Black birthing people, it's not nearly the same as interviewing with a white birthing person."

White clients, she said, tend to be more confident. "They already know that their body can do this. But our community is seeing headline after headline after headline about this perinatal death that can happen to them or their baby," she said. These clients are not just interviewing about a potential birth plan. "They're interviewing with us asking us to save their lives," she said.

Doula support like the type Bryant provides through her business Jazzy Bean Doula has been shown to improve birth outcomes, but patients who live in Washington State currently have to pay out of pocket for it. That's because birth doulas can't bill for their services under Medicaid. But that could change, thanks to a four-yearslong effort spearheaded by the QTBIPOC-led Doulas for All Coalition, a group facilitated by Surge Reproductive Justice, where Bryant is a birth justice organizer. The coalition is rallying behind House Bill 1881, which would establish a pathway to certification for birth doulas and — eventually — Medicaid reimbursement. The bill has passed in both chambers of the State Legislature.

At the hearing, bill sponsor Rep. Kirsten Harris-Talley (D-37) introduced the legislation, grounding it in her own parenting story. "Even under ideal circumstances, I know from experience — and I know many people here as well know — that childbirth can be challenging, and having someone to help you navigate that birth, delivery, and what it is to be a new parent … can make a big difference, to have someone there beside you, and birth doulas are those people," she said.

This can be especially important for historically marginalized communities, including Black, Indigenous, and People of Color, as well as low-income folks and members of the LGBTQ community. HB 1881 is rooted in awareness of this; the Doulas for All Coalition approaches their work through a health equity and reproductive justice lens, an intersectional framework created by Black women that centers "the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities."

Full-spectrum doula and coalition member Makeda Akoma Robinson, who testified in support of the bill in the House Health Care and Wellness Committee, put it this way: "Black and Indigenous birthing people and their infants have large and persistent disparities and outcomes compared to our white peers. It's a direct result of medical racism."

The bill is, in many ways, a response to racial disparities in perinatal health outcomes. These are numerous and well-documented. According to the Centers for Disease Control and Prevention, Black patients alone are three times more likely to die from pregnancy-related conditions than their white counterparts. And doula involvement is an evidence-based way to improve pregnancy outcomes. The American College of Obstetricians and Gynecologists lists doula support among techniques for reducing interventions for birthing patients.

At the committee hearing, Dr. Socia Love-Thurman, chief health officer for the Seattle Indian Health Board, said she'd witnessed its impact in her work. "As a provider specializing in care for the American Indian Alaska Native community, I have seen firsthand OB experience working alongside doulas who have provided culturally centered advocacy for birthing people who are disproportionately affected by perinatal mortality rates," she said.

But without Medicaid reimbursement, doula services are often out of reach for the patients who have the most to gain from them: About half of births in the state are covered under the program.

Gov. Jay Inslee opened the door to the possibility of Medicaid reimbursement with a 2019 budget proviso permitting Medicaid billing for doulas. By establishing a voluntary certification process for birth doulas, HB 1881 would be the next step in that process. Once a pathway to certification is created, a Medicaid reimbursement rate can be set.

Medicaid reimbursement stands to significantly expand doula support for birthing people, said Bryant. "I think that especially for Black and Indigenous doulas, with all of this history around the trauma of our bodies, of our communities, that it is so important that this bill be equitable and be something that Black and Indigenous doulas believe in and enroll in, because right now, doulas are really a luxury for the people who can pay privately our fees, because we also need to make a living, so that we're not in that poverty trap that harms our communities over and over again," she said.

By directly involving birth doulas, House Bill 1881 is a rare example of how longstanding inequities can be addressed through sensible policy and large-scale involvement from community members who know the issues the best and will be most impacted by the legislation.

Or as Bryant put it: "We're already doing it. Don't reinvent the wheel. Don't co-opt the wheel, don't paint a picture of the wheel and call it your invention, don't girlboss the wheel. Support us. Support us, and make the pathway so that we can keep on rolling."

The bill was passed in the State House in February, and the State Senate March 1, 2022.

Featured Image: Illustration by Ken Tackett/Shutterstock.com