A nonprofit collaborating with state agencies and lawmakers is trying to expand doula services. The goal is to reduce the state’s maternal mortality rate, especially in communities of color, where that rate tends to be higher.
Doulas, who are non-medical professionals who provide emotional, physical and educational support to patients during pregnancy, are not part of the state Medicaid network, which is the health insurance plan that many low-income people rely on.
The Pennsylvania Doula Commission, founded in 2021, wants to prepare doulas to eventually join the state Medicaid system. It is offering a scholarship to pay the $50 application fee for perinatal doula certifications.
While a perinatal doula certification is not required to practice as a doula, it sets a pathway to get Medicaid reimbursement, said Gerria Coffee, president of PADC. Certification could help create a standard for the state Department of Human Services to recognize doulas as providers.
“Very few organizations or doulas throughout Pennsylvania are actually working with managed care organizations,” Coffee said. “There are a few, but very few and not all doulas have received the education necessary or the support necessary to be able to fill out claims for reimbursement.”
Because of not being able to get reimbursements, doulas often do not make enough money to live off that profession, regardless of how many hours they spend with their patients. Doulas often pay for their own gas and supplies, so, in the end, their take-home pay is reduced. That is why some doulas approach the job as a “side hustle,” Coffee said.
Pennsylvania ranks 37th out of 50 in the United States for doula salaries, according to ZipRecruiter.
Sharee Lynn Livingston, an OB-GYN physician and co-founder of Diversifying Doulas in Lancaster County, said doula state certification could improve doula interaction with hospitals and doctors
“As long as we’re centering the doula, then it’s a win-win,” Livingston said. “I know that you can provide excellent doula care, without certification, without these name badges, if you will.”
But there are other ways of integrating doulas in the healthcare system. For example, a “fee-for- service” system.
“If there’s a patient that comes in who I think would benefit from a doula, then I know in the chart that this patient would benefit from doula care, and the insurance then pays a fee for service for that doula,” Livingston said.
PADC’s stipends come from the Jewish Healthcare Foundation, which is acting as a fiscal agent for federal Coronavirus State Fiscal Recovery Funds provided through the Pennsylvania Department of Human Services.
Earlier in the year, Democratic state House lawmakers pledged to address the state’s maternal mortality crisis. A 2022 report from the Pennsylvania Maternal Mortality Review Committee found the state has a pregnancy-associated mortality ratio (PAMR) of 82 deaths per 100,000 live births. Black women in the United States are three times more likely to die in childbirth, according to the CDC.
State Sen. Judy Schwank, D-Berks State and Rep. Morgan Cephas, D-Philadelphia re-introduced companions bills to extend Medicaid coverage to doulas.
Increased access to doulas is seen as one of the solutions for improving birth outcomes in the state. Multiple studies have shown that having a doula reduces the risk of maternal death. Patients who give birth with a doula are more likely to have a shorter labor, according to a report from the National Institutes of Health. Doula-assisted mothers were also less likely to have a baby born with a low birth rate.
Doulas also help patients with language barriers. The Pennsylvania Doula Commission will have an equity commission in July that will target bilingual doulas.
“Having someone, especially when you’re in a situation where you may not have that much family around, that’s speaking to you in your native tongue and that understands your needs culturally and is there with a mindset of providing and protecting you – that lowers stress levels and improves health outcomes, not just for the mother or birthing parent, but also for the baby,” Coffee said.
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