Doulas Provide a Valuable Service. Medicaid Should Cover it.

As a Black woman and a medical student, I am frightened and frustrated by stories about the concerns of Black women being dismissed during prenatal visits, labor, or postpartum checkups, resulting in poor maternal health outcomes. My desire to help address this public health crisis led me to become a volunteer doula at UNC Hospitals.

In that role, I saw the value that doulas bring to the birthing experience by solely focusing on supporting the mom and their well-being. But public policy has not kept up with the clear positive impact a doula can provide. In North Carolina, it is essential that legislators extend Medicaid benefits to cover doula care.

The benefits are many.

Take “Emma,” a mom I met who was experiencing anxiety in the midst of an unplanned C-section. Although her delivery did not go as expected, I helped her make the most of the situation by providing unwavering encouragement, playing her favorite music, taking pictures for her family, and serving as her advocate with the healthcare team. Emma’s primary need in that moment was the essential emotional support that doulas provide to patients.

Doulas offer other advantages as well. According to NIH research, women who had doula support experienced fewer delivery complications and had more success with initiating breastfeeding compared to those that did not work with a doula.

Despite the proven benefits of doula care, many pregnant people do not have access to it due to the high costs associated with private doulas, the scarcity of volunteer doula programs, and the absence of insurance coverage for doula services in North Carolina. Emma’s birth story may have unfolded quite differently if she had delivered at any other hospital in North Carolina, as most do not have volunteer doulas or staff that can focus their attention on one patient.

Reimbursement of doula services through Medicaid would help overcome these limitations by enabling disadvantaged populations, who need these services the most, to access them for free while also ensuring that doulas receive well-deserved compensation. With Medicaid coverage, people like Emma could elect to work with a doula and enhance their likelihood of feeling safe and supported during their pregnancy and childbirth. That, in turn, would help combat maternal health disparities.

This would be a financial win for everyone. Beyond improving birth outcomes, doula-assisted deliveries could reduce healthcare spending in North Carolina. A study published in the Birth journal revealed that doula care was associated with a decreased risk of preterm birth compared to those without a doula. And, among full-term patients, doula care was linked to a lower risk of cesarean delivery. Offering doula services through Medicaid could reduce the rates of preterm and cesarean births, both of which impose heavy financial burdens on patients and the health care system.

Although North Carolina lawmakers have proposed bills on Medicaid coverage for doula care, none have ever passed. And yet, as the rate of preventable maternal deaths continues to rise, the need for the implementation of new policies is evident. Many Black women who had traumatic births are courageously opening up about their experiences, and it is imperative that legislators listen. Additionally, it is crucial for lawmakers to collaborate with community programs and doulas who consistently advocate for pregnant people. Together, they can determine the best path forward and develop a Medicaid coverage plan that will benefit doulas as well as the most vulnerable populations.

Siera Lunn is a medical student at Duke University and a 2023–24 Schweitzer Fellow.



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