Washington Birth Doulas Advocated for a Pathway to Certification — and Won

by Megan Burbank

With Gov. Jay Inslee's signoff, birth doulas in Washington State have established their work as a profession based on voluntary competency-based state certification, paving the way for reimbursement under Medicaid. ESHB 1881 passed both chambers in Olympia earlier this month, where it drew broad support, passing with a wide margin of 85—8, backing from both parties in the House, and unanimous support in the Senate, according to a media release from Surge Reproductive Justice, an organization backing the legislation. It was among a docket of bills Inslee signed into law on Wednesday, March 30, in a ceremony at the State Capitol streamed live on TVW.

By setting up a certification process, ESHB 1881 will make birth doulas eligible for Medicaid reimbursement, broadening their capacity to serve patients on the program; this includes over half of births in Washington. The bill was crafted and championed by the Queer, Trans, Black, Indigenous, and People of Color-led Doulas for All Coalition, with the goal, Surge wrote, of making doula services available to "the communities that need birth doulas the most … who are overrepresented on Medicaid and do not always have the means to pay for birth doula support on their own."

The coalition defines a birth doula as "a person that is a non-medical birth coach or support person trained to provide physical, emotional, and informational support to birthing persons during pregnancy, antepartum, labor, birth, and the postpartum period" who can "advocate for and support birthing people and families to self-advocate by helping them to know their rights and make informed decisions."

Birth doulas do not provide medical care, but the continuous support they give birthing people has been shown to improve perinatal outcomes, especially for low-income and QTBIPOC birthing people. A 2017 literature review conducted by researchers from the World Health Organization's Department of Reproductive Health and Research found that such support could reduce the need for interventions during birth, that it alleviated poor Apgar scores (health screenings for newborns), and that it even resulted in fewer "negative feelings about childbirth experiences."

Jasmyne Bryant, co-facilitator of the Doulas for All Coalition, told policymakers birth doulas could be especially important for people giving birth without traditional familial support, saying, "the work of birth doulas is long established: we take on the role of a family member for those who do not have the familial bonds or ancestral knowledge around birth passed down within their family. People just want to know what to expect when they give birth and bring this tiny new life home with them."

In a national political environment where the future of reproductive health care remains uncertain — and coming in the same month that Idaho passed its own copycat version of Texas' extreme 6-week abortion ban — policies like ESHB 1881 buck national trends toward restricting access to reproductive health care by centering the experiences of birthing people and their allies through a lens of reproductive justice.

With Inslee's signature, the next step for the Doulas for All Coalition will be working in partnership with the Department of Health and the Healthcare Authority on an 18-month rule-making process to iron out the details of the pathway to certification. The coalition plans to introduce a Medicaid reimbursement rate next year.

Featured Image: Photo courtesy of Governor Jay & First Lady Trudi Inslee on Flickr, used under a Creative Commons license (CC BY-ND 2.0)