New Issue Brief - "Overdue: Medicaid & Private Insurance Coverage of Doula Care"

doula care 1Last week, Childbirth Connection, a program of the National Partnership for Women & Families, and Choices in Childbirth released an informative and useful issue brief: Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health. Both of these organizations are long time well-known and respected players in the field of maternal and infant health advocacy.

These two organizations, in partnership, are strongly calling for both Medicaid and private insurance to begin covering doula services as soon as possible.  The time has come to bring the professional doula out of the shadows and into the light of acceptance and recognize the full benefits of doula care.  Having doula attended births improves outcomes, with no reported risks. Families and babies are the deserving recipients of better birth outcomes. The USA is smack in the middle of a maternity care crisis.  Our neonatal mortality ranking is shameful.  Our maternal mortality is not much better.  We spend a tremendous amount of health care dollars to achieve these poor outcomes. One in three people who birth in the USA do so through an incision in their abdomen.

Currently only 6% of birthing families utilize the services of a doula.  Lamaze International recognized the importance of the doula role in their Third Healthy Birth Practice: Bring a Loved One, Friend or Doula for Continuous Support.  Doulas have long been thought of as a “luxury” but two decades of research say otherwise.  It is time to recognize that if we want better birth outcomes, increased birth satisfaction, lower healthcare costs and mother/baby dyads (and families) starting out healthier, than we need to officially recognize the role of the doula and make doulas a covered expense for both publicly and privately insured families, in a way that fairly compensates the professional doula while easing the financial burden of the consumer.

doulacare 2It is important that everyone, both consumers and professionals, step up to the plate and do everything they can to help bring about coverage and reimbursement for doula services by talking to and engaging insurers, policy makers, state and federal politicians and others involved in public and private health care management.

There are a multitude of resources included with the issue brief that I urge you to explore now.

  1. News releaseWidespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health
  2. Issue Brief: Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health
    Full Issue Brief (PDF)
    Executive Summary (PDF)
  3. Infographic (PDF) (PNG image) (PNG longform image)

This issue brief provides action steps that you can take now including:

  • Select and advocate for a policy pathway for reimbursement covered in the brief
  • Send the brief to a leader in your insurance plan who helps make coverage decisions
  • Engage maternity care providers and hospital leaders in learning how doulas can improve women’s experience of care, and in helping to make doula care available
  •  If you work for a large company that negotiates health insurance benefits, share the brief with the relevant HR people, and ask them to secure doula care reimbursement
  • Have you read this issue brief already? Do you talk about the evidence for doula support in your childbirth classes? With your clients?  Do you share what the research shows?  What steps can you take now to help provide doula care to all the families that want one – regardless of their financial situation?  Let us know in the comments section below.
3 Comments

Well Sharon, you are correct w

January 12, 2016 07:00 AM by Jacqueline Levine, LCCE,FACCE,CD, CLC
Well Sharon, you are correct when you say that itâ??s â??importantâ?Ł that everyone should â??step up to the plateâ?Ł. Indeed itâ??s important that doula care be available to all because it's a best-evidence care intervention, and OBs and other caregivers should hardly need urging to be the loudest voices advocating for doula care as a necessary part of optimal maternity care. Do they need prodding to â??step up to the plateâ?Łâ??to be willing and eager to advocate for and adhere to evidence-based care for their patients? Even medical journals have announced the efficacy of having a doula with a birthing woman. The journal Clinical Obstetrics and Gynecology (Volume 44, Number 4, pp 692â??703?? 2001, Lippincott Williams & Wilkins, Inc.) gave doula care an official imprimatur, as far back as 2001, via the publication of a thorough, in-depth study which explored each and every aspect of the positive effects of having a doula. So whatâ??s been holding docs and other clinicians back all this time from jumping in as strong advocates for legitimizing the use of this best-evidence tool with its proven beneficial effects? As a Lamaze educator and birth and postpartum doula for fifteen years, I have rarely heard of a doc who explained the benefits of doula care to patients or urged them to find a way to make doula care part of their plans for birth. Iâ??ve always been interested in finding out the reasons that best-evidence, optimal maternity care is hard to come by because of the unwillingness of caregivers to change the way do what they have always done, so in a piece I did for this site some time ago, I gathered some info on why docs wonâ??t adopt new methods or protocols that are proven to be better for their patients. One piece of info I found was thisâ?? Why Do OBs and Policymakers of Maternity Care Resist Changing Their Protocols to Reflect Best-Evidence Scientific Practices for Childbearing Women? Abstract: In 1998, a questionnaire mailed to family physicians and obstetricians found that only 40% felt that evidence-based medicine was "very applicable to obstetric practice". Concerning comments from this survey included "obstetrics requires manual dexterity more than science", "evidence-based medicine ignores clinical experience", and that following guidelines could result in "erosion of physician autonomy". These views were described as obstacles to the adoption of evidence-based practices, and the authors recommended emphasis of critical analysis of the literature as part of medical education. Olatunbosun OA, Eduoard L, Pierson RA. Physicians' attitudes toward evidence based obstetric practice: a questionnaire survey. Br. Med. J. 316, 365â??366 (1998). And this little tidbit from an AMA journal: the title of the article says it best: The Difference between Science and Technology in Birth: Obstetrics seems to be particularly resistant to making evidence-based changes to common practice, perhaps because of the emotional climate surrounding pregnant women and babies. Aron C. Sousa, MD, and Alice Dreger, PhD September 2013, Volume 15, Number 9: 786-790. So itâ??s the â??emotional climateâ?Ł that makes it difficult for docs to advocate for and adhere to best-evidence care? Itâ??s not just a patientâ??s right to be fully informed about their care and to accept or refuse that care in an informed way: itâ??s a patientâ??s right to get only best-evidence care and nothing less. If you asked a birthing momma if sheâ??s paying for less than optimal care or whether sheâ??s paying for best-evidence care for herself and her baby, we all know what the answer would be.

I am new to the birth communit

January 16, 2016 07:00 AM by Dee Dee Grayson
I am new to the birth community but I am excited to see that research confirms what women have known all along. Doulas are wonderful support for expectant and birthing moms. I look forward to serving the women in my community.

Being pregnant, it was disappo

January 21, 2016 07:00 AM by Stacee DeAnne Smiddy, LCCE
Being pregnant, it was disappointing to find out that my insurance would not cover a doula. I plan on presenting this to them and to my employment, which is a state agency.

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