Caitlin Levinson
The United States is facing a maternal health crisis. As the number of women dying during childbirth has steadily increased in recent years, states are moving to provide their residents with more comprehensive and effective reproductive health care services.
To improve the health outcomes of new mothers and their babies, various states have recently introduced labor doulas, trained non-clinical professionals who provide educational resources and emotional and physical support during the labor and birth process. have passed or are considering legislation to support
A doula's main goal is to make the client feel as comfortable and safe as possible during childbirth and to advocate for the patient's needs to the doctors and nurses, says the certified doula and public health nurse consultant with the Women's Health Association. said one Barbara Christianson. She is an obstetric and neonatal nurse. Doulas help patients cope with the high stress caused by pregnancy complications and uncertainty about medical terminology and processes. Stress can, for example, cause high blood pressure, putting patients at risk of preeclampsia, premature birth, and even death.
The U.S. maternal mortality rate has nearly doubled from 17.4 deaths per 100,000 live births in 2018 to 32.9 deaths per 100,000 live births in 2021, creating what officials are calling a national maternal health crisis. . At the same time, the infant mortality rate (infants who die before their first birthday) increased by 3% in 2022 for the first time in 20 years.
Although doulas do not have the authority to prescribe medications or perform clinical procedures, they can advise patients on techniques such as breathing and muscle relaxation techniques, which may help reduce pain and associated stress and improve labor and delivery. Yes, Christianson said. It also helps individuals navigate their roles and responsibilities as parents.
As the health care system is stretched thin, doulas provide complementary care to patients who doctors and nurses don't have time for, Christianson said. Additionally, doulas play an important role in patient advocacy. For example, we work with patients to create a birth plan. This includes the mother's wishes about who can be in the delivery room during the birth of her baby and rearranging the furniture in the hospital room to make it easier for the mother to move around. Make sure it is communicated to and implemented by the medical team. Doulas are also responsible for patient safety and may witness and report medical malpractice or abuse against mothers.
Christianson said a history of mistrust in the medical field, especially for people of color who have historically faced medical discrimination, is what motivates patients to seek better care. “People are speaking out, sharing information, reading statistics, and sharing each other's stories to try to protect (themselves),” she added.
Additionally, the reversal of Roe v. Wade could result in more women experiencing pregnancies that can pose risks to their mental or physical health. Christianson said doulas are critical in these situations, helping clients navigate the health care system and making them more comfortable with the process.
And the state is taking notice. For example, in early 2024, Delaware and New York began requiring doula services to be covered by Medicaid in an effort to further reduce and prevent maternal and child deaths. A New York state law passed late last year also requires the state health department to create and maintain an online directory that individuals can use to find and contact certified doulas in the state.
“Our nation's maternal and infant mortality rates are shameful,” New York Governor Kathy Hochul said in a statement in November. “Expanding access to doula services is an effective, evidence-based strategy to support expectant parents and enable their babies to grow and thrive.”
At least 10 states and the District of Columbia cover doulas with Medicaid, but only two states, Louisiana and Rhode Island, also require private insurance.
In Pennsylvania, the state Department of Human Services working with The nonprofit Pennsylvania Doula Board aims to increase the number of certified doulas by providing subsidies for the board's certification fees. And in November, New Jersey passed a bill requiring hospitals and birth centers to allow doulas to accompany mothers during childbirth and to inform providers and patients of the new rules.
Christianson said federal support has given states the opportunity to enact these programs. In June 2022, the Biden administration launched the White House Blueprint to Address Maternal and Child Health. It is a government-wide program aimed at reducing maternal mortality through, among other things, strengthening maternal and child care workforce training, expanding access to doulas and midwives, and improving maternal health data. the goal.
Last month, the Centers for Medicare and Medicaid Services announced the Maternal and Child Health Insurance Program, a funding opportunity for state Medicaid agencies aimed at improving maternal health for people enrolled in Medicaid and the Medicaid Children's Health Insurance Program. We launched the Health Transformation Model and expanded the blueprint.
