Celebrating World Doula Week 2020

by Improving Maternal Health
March 25, 2020

A doula, sometimes referred to as birth coach or birth companion, is a trained professional who provides continuous support for women before, during, and after childbirth, offering education, physical support, and emotional support to mothers. A growing body of evidence suggests continuous support during pregnancy reduces the likelihood of adverse birth outcomes for mother and baby. Women receiving doula services throughout their pregnancy are less likely to have a caesarean birth (28% reduction in caesarean births on average), lower odds of preterm birth, require less pharmaceutical care during delivery, and spend less time in labor. The negative birth outcomes and procedures that are averted as a result of doula services add up to significant cost savings for hospitals, insurers, and state health programs. 

Maternal mortality and morbidity rates are on the rise in Texas.  Women with low incomes and African American women experience the highest burden of mortality and morbidity.  While women with low incomes who gave birth on Medicaid were 14% more likely to desire the support of a doula, these services are not covered by Medicaid in Texas, effectively denying these women access to services proven to reduce the likelihood of adverse birth outcomes.

Two states, Minnesota and Oregon, have approved legislation to mandate coverage for doula services through Medicaid and have documented positive health and financial outcomes.  Another three states, Vermont, New Jersey, and New York, introduced bills in 2018 to cover doula services through Medicaid.  New York’s effort to cover doulas through Medicaid is one part of a pilot to reduce disparities in maternal mortality.ii

Mandate the coverage of doula services through Medicaid to provide an avenue for women with low incomes to access the support they need and desire throughout pregnancy.

Fiscal Impact
A decrease in cesarean births would result in large savings for Medicaid programs in the U.S. Based on data from 2013:

  • Hospitals billed $126 billion for maternal and newborn care.
  • Cesarean births cost 50% more than vaginal births.
  • Decreasing cesarean births by 28% would result in a $659 million savings per year for Medicaid in the U.S. 

Medicaid coverage of doulas is cost effective.

  • It is estimated that doula services reimbursed at an average of $986 (average across U.S.) has the potential to result in overall Medicaid cost savings as doula supports decrease the rates of preterm and cesarean births.