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To Reduce Fatal Pregnancies, Some States Look to Doulas

New York is set to become the third state Medicaid program to cover pregnancy and birth coaches for low-income women as a way of lowering the maternal mortality rate.

A doulas shows women how to wrap a 3-month-old.
(TNS/Angela Peterson)
New York will become the third state, starting in March, where some pregnant women can use Medicaid to hire a doula, a nonmedical health coach who provides physical and emotional care throughout pregnancy and after birth.

The change is part of a 10-point plan by New York Gov. Andrew Cuomo to lower the number of women who die from complications associated with pregnancy or birth. The number of these deaths is on the rise in the state -- from 13.2 per 100,000 live births in 2006 to 25 per 100,000 live births in 2015, according to the state's health department.

Maternal mortality rates are particularly high among women of color, who are four times more likely to die this way, according to the Centers for Disease Control and Prevention. There is evidence that doulas reduce the number of unnecessary cesarean sections as well as pregnant women's stress and anxiety, which can cause complications.   

For now, the doula option is only available to Medicaid patients in Erie County and parts of Brooklyn, which have the highest rates of maternal mortality in the state. LuAnne Brown, CEO of the Buffalo Prenatal Perinatal Network, which is taking part in the Erie County pilot, says her doulas will likely take on just five to 10 clients in the first year because of the intimate relationship required between them and expecting mothers.

“The benefits show that it helps with peer-to-peer support, particularly for women who may not have much support around them,” says Brown.

Minnesota and Oregon are the two other states where the Medicaid program covers doulas -- and not just for some counties. In Minnesota, patients with doulas are 22 percent less likely to have a premature birth and 56 percent less likely to have a C-section, compared to Medicaid beneficiaries without a doula.

But some doulas have had some complaints.

Medicaid is reimbursing doulas $411 for six visits and the birth, which is too low, according to Jennifer Almanza, a certified nurse-midwife with the University of Minnesota Physicians. She and other doula advocates would like to see that rate changed to $770. Lawmakers included raised reimbursement rates in a budget bill this year, but it was vetoed by Gov. Mark Dayton.

There are some unanswered questions about how New York’s program will work. Namely, the state doesn’t license doulas, but they must be licensed in order to receive reimbursement from Medicaid.

Brown says the doulas on her staff went through a national certification process, and she’ll likely bill Medicaid through her agency instead of requiring doulas to submit claims themselves.

Doulas are still largely an out-of-pocket expense for mothers who can afford to shell out around a couple of thousand dollars during their pregnancy. But Almanza expects the states' growing use of them to make it a more common health insurance benefit all over.

“If Medicaid starts to freewheel," says Almanza, "then private payers will follow."

Mattie covers all things health for Governing.

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