LANSING, Mich. (Michigan News Source) – The Michigan Department of Health & Human Services (MDHHS) has announced that starting on January 1, 2023, Medicaid is now covering different types of doula services, including community-based doulas, prenatal doulas, labor doulas, birth doulas and postpartum doulas.
Michigan is one of about 15 states that has or is in the process of implementing Medicaid-covered doula programs.
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A doula is a non-clinical person who typically provides physical, emotional and educational support services to pregnant individuals during the prenatal, labor and delivery and postpartum periods.
In the HHS report titled “Doula Care and Maternal Health: An Evidence Review” published in December of 2022, it found “doula-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.”
Doula services include: promoting health literacy and knowledge; assisting with a birth plan; supporting personal and cultural preferences around childbirth; providing emotional support and encouraging self-advocacy; reinforcing breastfeeding; identifying and addressing social determinants of health; coordinating community-based support services; emotional support; educating mothers about newborn care; and more.
Most Medicaid-covered doula services are expected to be given in person but prenatal and postpartum services can be delivered via telehealth. Those utilizing doula services under Medicaid can get a maximum of six total visits during the prenatal and postpartum periods and one visit for attendance at labor and delivery. Doula training programs have to include skill developments including cross-cultural communication. Future efforts with the “MDHHS Doula Initiative” include establishment of a diverse doula advisory council.
In the Michigan Medicaid Policy Bulletin, MDHHS says, “Doula services have been shown to positively impact the social determinants of health, support birth equity, and decrease existing health and racial disparities.”
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The CDC has documented that “non-Hispanic Black women averaged 55.3 deaths per 100,000 live births.”
2019 data from MDHHS reports that black babies in Michigan are three times more likely to die within the first year of life compared to white babies and that black women are nearly two times more likely to die from pregnancy-related causes than white women.
In a Journal of Law, Medicine and Ethics survey titled “Structural Racism and Maternal Health Among Black Women” by Jamila K. Taylor, the report says, “About one in ten women reported being spoken to disrespectfully by hospital personnel. The same women also reported “rough handling” by hospital personnel and being ignored after expressing fears and/or concerns.”
Medicaid-covered doula services are expected to combat inequities in the birthing experiences of people of color.
Farah Hanley, Chief Deputy Director for Health at MDHHS told Bloomberg Law, “We in Michigan have been very focused on addressing existing health and racial disparities and doula services have shown to positively impact social determinants of health and supporting birth equity.”
According to WKAR, Annissa Eddie, a doctoral student in child development at Michigan State University, was part of a group that was responsible for helping to come up with the doula policy at MDHHS. She said, “It (doula service) was more of an exclusive service, typically a self-paid service. And oftentimes, people with lower incomes did not have access to that. And because of systemic issues many of the people that were left out were birthing people of color.”
