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Doula care improves health outcomes for pregnant women with Medicaid, according to a new report from public policy institute Elevance Health.
The country’s worsening maternal health crisis has stirred interest in using doulas as an additional support for expecting mothers, especially Black women, who have the highest maternal mortality rate in the U.S.
But most insurance companies do not cover doula care, and only 13 states, along with Washington D.C., offer reimbursed doula care through Medicaid.
Another 30 states are either in the process of implementing some Medicaid coverage of doula services or considering doing so, according to data from the National Health Law Program.
“Investments in offering these services have positive outcomes for women who are at greater risk of maternal morbidity mortality,” Jennifer Kowalski, vice president of Elevance Health Public Policy Institute, said.
The report compares the health outcomes of 869 women enrolled in Medicaid, the federal health insurance coverage for low-income Americans, who received doula care before, during or after a pregnancy with 1,094,005 women who did not.
Women who received doula care were less likely to undergo a Cesarean section during delivery than women who did not receive doula care.
In addition, women who received doula support had higher rates of postpartum visits and lower rates of postpartum anxiety or depression if their doula care started in the first trimester of their pregnancy.
Most of the doulas referenced in the study are community-based doulas or doulas who “live and work in the same communities they are from,” according to Kowalski.
In these communities, doulas act as “advocates” for expecting mothers, Kowalski added, helping women communicate with their doctors, develop birth plans, and connect new mothers to supplemental nutrition programs like WIC once a baby is born.
“There are a lot of different things doulas can do at every stage of the pregnancy, as well as in the postpartum period,” Kowalski said.
The majority of women receiving care from doulas are Black women, who comprise 44 percent of women receiving doula support. White women and Hispanic women make up 30 and 17 percent of those receiving care from doulas, respectively.
Over 90 percent of women who received doula care lived in either urban or suburban areas.
Women who received doula care tended to live in counties with fewer OB-GYNs and certified midwives, compared to women who did not receive doula care, the report found.
“Results, therefore, suggest that even though women with a doula had lower access to perinatal providers, they still had more favorable outcomes through the inclusion of an additional support person during their prenatal experience,” the report states.