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Many people see the word 鈥渄oula鈥� and think, 鈥淎h, yes. A midwife.鈥� Though the two words describe important roles in the birth experience, the jobs are dramatically different. Midwives are medical professionals trained to deliver babies, providing individualized healthcare throughout pregnancy, childbirth and postpartum. A doula is a non-medical childbirth assistant whose number one job is to focus on the physical and emotional needs of the mother and their families during pregnancy, childbirth and the postpartum period. Doulas don鈥檛 deliver babies but can help mothers develop a birth plan and have the support they need throughout labor and delivery, and advocate on her behalf with medical personnel 鈥� all factors that contribute to safer and healthier births.

The service is growing in popularity because it has been shown to make a dramatic difference in the birth experience for mothers, babies and families. A U.S. Department of Health and Human Services report published in December found that doula services drastically improved maternal health outcomes.聽 鈥淒oula-assisted mothers were four times less likely to give birth to a baby with low birth weight, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding,鈥� the report states. According to the , the one-on-one emotional support provided by doulas has been shown to reduce cesarean births, help shorten the duration of labor and improve the rate of spontaneous vaginal birth.

American mothers need all the help they can get. Though rates of maternal deaths have been declining in most countries, the U.S. has the of any industrialized country in the world, and the Centers for Disease Control and Prevention reports that 鈥渟tark and unacceptable鈥� racial and ethnic disparities persist in this maternity crisis. A large body of research suggests that doula support is a promising strategy to mitigate these disparities.

Medicaid each year 鈥� roughly 1.5 million births 鈥� and among the CDC鈥檚 policy recommendations to address America鈥檚 maternity crisis is to extend Medicaid coverage to make sure that no one in this country dies because of pregnancy. Because states have some discretion in how to use their Medicaid funding, some have begun following the evidence and offering doula services as a benefit to their enrollees.

Michigan has now become the latest state to reimburse doula services for individuals covered by or eligible for Medicaid insurance, joining 15 other states that have done so or are in the process of providing this benefit. In taking this step, the Great Lake State has made it possible for the approximately 45,000 Michigan Medicaid enrollees who give birth each year to access the gift of childbirth assistance that for years has been a luxury enjoyed by those who could pay for the service out of pocket or had great insurance.

Though Michigan has made strides recently in improving maternal and infant health, it still suffers from one of the nation鈥檚 highest infant mortality rates, with infant deaths among its Black and Native American communities more than double those among white infants. Black women in Michigan are three times more likely to die from pregnancy-related causes than white women 鈥� in keeping with similar national disparities.

To address these inequities, Gov. Gretchen Whitmer launched her initiative, allocating millions of dollars to improve birth outcomes and support birth equity. As part of this initiative, Michigan expanded Medicaid coverage for a full 12-month postpartum period, providing access to critical physical and behavioral health services, dental care, treatment for substance abuse, and more throughout the first year after pregnancy.

In January 2023, Gov. Whitmer announced that announced that Michigan would begin supporting expecting mothers by covering doula services for Medicaid enrollees. In making the announcement, Gov. Whitmer stated that a whopping 63 percent of maternal deaths in Michigan are preventable. (Michigan is by no means an outlier in these numbers: The in 2020 that more than 80 percent of pregnancy-related deaths from 2017 to 2019 in the U.S. were preventable.) To powerfully impact that situation, the state has put together a comprehensive program, a sort of one-stop shop that will spread the word about doula services, build the workforce, and provide ongoing resources and support for Michigan鈥檚 doulas.

A Solid Platform for Success

Doulas practiced in Michigan before the launch of the initiative, says Dawn Shanafelt, director of the Michigan Department of Health and Human Services Division of Maternal & Infant Health, who is leading the . 鈥淏ut with the program, Michigan will have a central location where families that have Medicaid insurance can find doulas available in their communities.鈥�

The initiative also provides a registry for doulas that offers webinars, training and continuing education, as well as for enrolling as a Medicaid provider and guidance on billing for doula services through Medicaid. To become a provider, individuals must have completed Michigan Department of Health and Human Services-approved (MDHHS) training, and they can find these approved programs on the website. The initiative provides scholarships for those who want to take the training and become professional doulas 鈥� a strategy that both builds the workforce and offers economic opportunity within local communities.

A key component of the program is the Doula Advisory Council comprising 29 individuals, all doulas from across the state who represent the diversity of Michigan鈥檚 communities, Shanafelt says. The council will work to promote advancement of doula services statewide and advise the MDHHS on policies, applications and resources, as well as providing advice on content for continuing education and reviewing training programs to ensure they meet Medicaid requirements.

The health department is hiring two doula specialists to work with Shanafelt鈥檚 division to serve different geographic areas of the state. She says one of these specialists has been hired 鈥� a doula with 22 years鈥� experience 鈥� and a second is on the way.

Medicaid policy includes a maximum of six doula visits during the prenatal and postpartum period, plus one visit for labor and delivery in a hospital setting. The flat reimbursement rate is $75 for each of the six visits, plus $700 for attendance through labor and delivery.

A stumbling block for states accessing Medicaid funding for doula services has been the requirement by the federal Centers for Medicare and Medicaid Services that doula services must be recommended by a licensed healthcare provider. To address this, Michigan鈥檚 chief medical executive Dr. Natasha Bagdasarian has issued a standing recommendation that doula services are medically necessary and should be offered to families covered by Medicaid insurance.聽In her recommendation, Bagdasarian wrote that doula services should be offered 鈥渋mmediately and on an ongoing basis to Medicaid recipients until such time as determined no longer necessary.鈥�

Results Speak Volumes

Since professional doula services were first offered in 1970s, friction has existed with the medical community, with some doctors and nurses viewing doulas as encroaching on their territory, or just one more body to get in the way of their efficiency during labor and delivery.

鈥淭he way to change the mindset regarding who鈥檚 a part of the care team is by seeing excellent outcomes,鈥� Shanafelt says. 鈥淏y seeing that the patient or birthing person鈥檚 well-being improved by having a doula as part of their care team, attitudes change.

鈥淗aving the American College of Obstetrics and Gynecology recommend having an emotional support person such as a doula present because it is associated with better outcomes for women in labor makes a difference,鈥� she says. 鈥淒oulas have been serving birthing persons for decades, even hundreds of years, so this isn鈥檛 a new concept. The difference is the recognition of the value and importance of the doula profession.

鈥淭he shift is partly a result of the research that鈥檚 been published (about the benefit of doulas), but most importantly, it鈥檚 come from listening to families. Families tell us what works best for them. They鈥檙e the experts. So, if you listen to the experts, you鈥檙e going to hear time and time again that doulas make the difference.鈥�

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RESOURCES

• , a nonprofit organization connecting Black families to certified Black doulas throughout the U.S. The maternal mortality rate among Black women聽, according to the Centers for Disease Control and Prevention (CDC).
• Survey of medical literature demonstrating significant benefit for birthing parents and their infants, notably for Black patients

FACT CHECK

• (Journal of Law, Medicine & Ethics)

This story originally published on Early Learning Nation and is now archived on 麻豆精品. Learn more here.