It stands to reason that pregnant women with strong, steady support during labor and delivery have better birth experiences. Indeed, a 2012 Cochrane review conclusively finds that continuous labor support is associated with a number of positive outcomes for moms and babies and cites no known adverse effects. These effects are most consistent when labor support is provided by someone who isn’t a friend or family member, and not a member of the hospital staff – someone like a doula.
A doula is a trained professional who provides continuous physical, emotional and informational support to the mother before, during and after birth. Unlike physicians, midwives, and obstetrical nurses who provide medical care, a doula provides support in the nonmedical aspects of labor and delivery.
For the past year and a half, I have had the pleasure of collaborating with Everyday Miracles, a Minnesota-based non-profit organization that aims to reduce health disparities by providing perinatal education and doula services to low-income women. Everyday Miracles employs a diverse group of doulas (including Somali, Latina, Hmong and African-American doulas) and attempts to match doulas to clients based on language and race/ethnicity.
This organization does great work, and it’s clear to see the value in the care that doulas provide to women they support; however, many women can’t afford the cost of a doula (which can run $800-1200, on average), and most health insurance companies don’t pay for the service.
Given the strong evidence base for the health benefits of doula care, we gathered and analyzed data to look at both the health and cost impacts of doula care among low-income women. In a paper published this spring in the American Journal of Public Health, we reported that cesarean rates were about 40 percent lower for doula-supported births, compared with similar women nationally. We also estimated potential financial impacts to state Medicaid programs associated with cesarean rate reductions of this magnitude and suggested that states investigate whether reimbursing birth doulas may result in improved birth outcomes and potentially even generate cost savings within their Medicaid programs.
Minnesota took up this challenge, and our state legislature has decided that doula care is a service worth providing to Minnesota’s mothers. On May 23, 2013, Governor Dayton signed “the doula bill” (SF 699, HF 768) into law as part of the Omnibus health bill (SF 1644, HF1233). Starting in July, 2014, Minnesota Statues Chapter 108, Sec. 11 will allow Medicaid payment for services from a certified doula for pregnant women in our state. The passage of this legislation resulted from more than a decade of work by community members and by the Minnesota Better Birth coalition and was fueled by our collaborative research efforts.
Our team also worked with the Minnesota Department of Health’s Community and Family Health Division, which facilitated access to Minnesota’s Pregnancy Risk Assessment Monitoring System (PRAMS) data which we used to study the relationship between doula support and breastfeeding among diverse, low-income mothers. Our analysis revealed that breastfeeding initiation was near universal among the doula-supported births studied (97.9 percent). These results suggest that access to culturally-appropriate doula care may facilitate higher rates of breastfeeding initiation among vulnerable populations, and a manuscript highlighting these findings is published this month in the Journal of Midwifery and Women’s Health.
It is my hope that these findings will contribute helpfully to policy discussions about reimbursement for doulas and catalyze efforts to ensure that all women have financial access to culturally-appropriate support before, during, and after childbirth.