Doula Therapist Care And Treatment For Pregnant Couple.
Photo via Andrey_Popov/Shutterstock.com

As Washington State Adopts Medicaid Coverage for Doula Support at Birth, a New Study Shows How Critical It Can Be

Published on

For six years, a coalition of birth workers in Washington has been advocating for Medicaid coverage of doula support as a matter of equity, addressing the Black and Brown perinatal health crisis, and saving birthing people’s lives. After legislative wins, their goal is becoming a reality: In April, Washington State doulas obtained the highest Medicaid reimbursement rate in the country for their work with pregnant patients.

A new study shows just how important their presence can be — especially for folks on Medicaid.

Published Oct. 2 in the American Journal of Public Health and authored by researchers affiliated with Elevance Health, the study compares health outcomes between pregnant patients on Medicaid who had doula support at birth to those who did not, using Medicaid claims data. The researchers found that for patients who’d had access to a doula, the risk of cesarean delivery fell by 47%, and preterm birth risk dropped by 29%. Birthing patients who were supported by a doula were also more likely to receive follow-up care after delivery.

In short: For birthing people on Medicaid, having doula support improved their pregnancy outcomes.

This isn’t a complicated revelation, but it’s an important one.

The importance of doula support is something previous studies have already shown, but the body of research on doulas and their impact on pregnancy care is still growing. Many earlier studies were limited in scope, and studies on doula coverage under Medicaid specifically are scarce. That’s because so few states offer Medicaid coverage for doula support in the first place, although this is changing, too: In 2018, only two states reimbursed doulas through Medicaid. But after a push for greater equity in health care in 2020, Washington is now among 14 states and the District of Columbia that have made legislative moves to reimburse doulas through Medicaid.

The Medicaid study shows how important this shift has been: Patients with doula support were 116% likelier to give birth vaginally after a previous cesarean delivery. This evidence aligns with previous guidance from the American College of Obstetricians and Gynecologists, which has promoted doula support as a practical measure providers can embrace to reduce interventions during birth.

“As part of the blueprint for addressing the maternal health crisis in the United States, the federal government is actively making efforts to grow and diversify the doula workforce,” wrote the study authors in the American Journal of Public Health. “Results from this study provide evidence to support this endeavor, by showing the positive impact doulas can make toward decreasing maternal health risks.”

These are things doulas know through experience — they’ve told me as much — and with more and more research showing how important their presence can be, it’s more crucial than ever that private and public insurance plans cover them.

But it’s especially true of Medicaid. Like other kinds of reproductive health care, doula support will never be out of reach if you have the means to pay for it out of pocket, and without Medicaid coverage, that economic disparity is likely to worsen existing health inequities. And if you care about health equity at all, it’s hard not to see covering doula support under Medicaid as a social good.

The numbers speak for themselves, but even so, relatively few states have embraced Medicaid coverage. “Because doula services are an optional benefit through Medicaid … it is at the discretion of the state to reimburse doulas for providing services to Medicaid enrollees,” write the study authors of this dynamic. “Access to doula care, therefore, varies substantially among Medicaid programs, with some states operating a fully funded Medicaid doula benefit, some states offering small doula programs not widely available to all Medicaid beneficiaries, and some states where the only option for individuals is to self-pay for doula services.”

Washington may be one of the states on the cutting edge of this practice, but in a country where abortion rights have devolved and single women without children are being pilloried by far-right politicians, steps to expand reproductive health care access through a lens of reproductive justice could not be more crucial.

I hope others will follow our lead.

The South Seattle Emerald is committed to holding space for a variety of viewpoints within our community, with the understanding that differing perspectives do not negate mutual respect amongst community members.

The opinions, beliefs, and viewpoints expressed by the contributors on this website do not necessarily reflect the opinions, beliefs, and viewpoints of the Emerald or official policies of the Emerald.

Related Stories

No stories found.
logo
South Seattle Emerald
southseattleemerald.org