The United States continues to grapple with high rates of maternal morbidity and mortality that disproportionately affect Black and American Indian/Alaska Native women.^1,2,3 Expectant mothers and their support systems, policymakers, advocates, and public health and medical professionals are looking for ways to improve maternal and infant health outcomes.

The presence of a doula, a non-clinical professional who provides continuous physical, emotional, and informational support to people before, during, and shortly after childbirth, is one option.^5,6 The concept of a doula spans centuries and originates from “woman-to-woman” birth support provided by family members, friends, or community members and later childbirth educators.⁷

Research shows⁸ that people who use doulas during childbirth can:

• Spend fewer hours in labor

• Have more positive feelings about their childbirth experience

• Be less likely to use an intrapartum analgesia (i.e. epidural)

• Be more likely to experience spontaneous vaginal births

Among low-income populations, Black populations, and other communities of color, researchers found^9,10,11 that individuals who received doula support were more likely to:

• Begin prenatal care in their first trimester of pregnancy

• Have lower rates of preterm birth

• Have fewer low birthweight (LBW) infants

• Report higher rates of breastfeeding initiation

In an effort to expand access to doulas and improve birth outcomes for Medicaid patients, Oregon and Minnesota passed legislation to reimburse doulas through Medicaid in 2012 and 2013, respectively.¹² In 2019, New Jersey and Indiana followed suit.^13,14

Oregon offers birthing individuals up to four support visits and labor support, and birth doulas can be reimbursed up to $350. Minnesota offers birthing individuals up to six support visits and labor support, and birth doulas can be reimbursed up to $770. Doulas and birthing individuals in Oregon and Minnesota have encountered several barriers to Medicaid reimbursement for doula services, including low reimbursement rates, difficulty establishing relationships with providers, complicated billing structures, lack of awareness about doulas among the Medicaid population, and lack of accessible and affordable trauma-informed trainings and pathways to certification.^15,16,17

Washington state is also exploring ways to reimburse doulas through Medicaid in order to reduce health inequities.¹⁸

The Health Care Authority (HCA), which runs Washington state’s Medicaid program, and the Department of Health are consulting a group of stakeholders to develop methods to reimburse doulas through Medicaid. The HCA will “report the group’s recommendations to the appropriate committees of the legislature by December 1, 2020.”¹⁹