Giving birth in the U.S. comes with a high maternal mortality rate and debilitating expenses, especially for Black and indigenous women. But access to doulas could give more families a fighting chance.
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This data further confirms that doulas are vital to a functioning
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"Doulas are trained to provide ongoing education and physical and emotional support to women before, during and after childbirth so the moms can achieve the best outcomes," says Kowalski. "We wanted to learn and understand to what extent providing doula services in Medicaid would help address the maternal health disparities we see across the country."
Unlike a midwife, a doula is not clinically trained and does not deliver the baby, but instead serves as a companion and educator to the birthing parent. And that companionship can make a world of a difference, especially for Black and indigenous women who are often discriminated against and dismissed in the U.S. healthcare system. Notably, pregnancy-related mortality rates are over three and two times higher for Black and indigenous women respectively, and both groups have a much higher share of preterm births compared to white women, according to the Kaiser Family Foundation.
Elevance found that women using doulas are less likely to experience preterm births and hence are approximately 5% less likely to have children born underweight or admitted into the neonatal intensive care unit. Kowalski points out that women receiving doula care are also more likely to have at least one prenatal visit with a doctor, hinting at the potential for preventative care.
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In fact, women with doulas are 8% less likely to be admitted to the hospital during pregnancy.
"You can equate prenatal visits with better outcomes in terms of delivery and birth," says Kowalski. "Those visits likely catch any problems that might arise before you get to the point of hospitalization."
Still, Elevance noted a higher prevalence of pregnancy complications in mothers using doulas — but Kowalski expected as much since women receiving doula care through Medicaid would likely have higher maternal health risks. But given the data, a doula still makes a positive impact on health as well as cost. Women using a doula saved between $1,181 and $1,675 more on prenatal and birth costs than women without a doula.
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"One of the things that's really nice about what some states have done is establishing doula access and programs through Medicaid that are designed for underserved populations," says Kowalski. "And these doulas are situated in the communities they serve, sharing the same culture and language with their clients."
Kowalski hopes that more state Medicaid programs start reimbursing patients for doula services. Additionally, she encourages employers to be aware of their state Medicaid plan offerings. Lower-income workers may choose to be on Medicaid, and employers should at least be educated on the risks and benefits of their state programs.
"Doulas are one tool that we have to potentially improve upon maternal health disparities," says Kowalski. "The more we can identify these inequities, the more good we can do."
