The Fight for Doula Coverage by MassHealth and Why it Matters.

Massachusetts has historically been known as a place where healthcare innovation takes place, as home to some of the best hospitals and doctors in the nation. So why is it that we can’t get maternal health care right? Massachusetts maternal mortality data shows that “black, non-Hispanic birthing people were 1.9 times as likely to die during pregnancy or within one year postpartum compared to white non-Hispanic birthing people” (Expanding doula support services in Massachusetts 2022). When we look at other data around birth Massachusetts ranks 19th in the nation for cesarean births, 44th in preterm birth weight, and 35th in low birthweight (National Center for Health Statistics Massachusetts 2022). So what is it that we can do to address these numbers?

The answer is simple, a doula. Doulas are non-clinical support people who offer physical, emotional, and informational support during pregnancy, birth, and the postpartum period. Data show that when doulas (or other continuous support) are present at births the rates for spontaneous vaginal birth increase, labor is seen to be shorter, less pain medication is used, APGAR scores are higher, cesarean rates drop, and overall birther satisfaction is significantly improved. (Levy, G, B, R, & Karakashian, A.R.B 2018). These data points are even more significant when we examine doulas in low-income and BIPOC communities. So why is it that insurance won’t cover them, especially MassHealth?

Beginning in March 2021 legislation was proposed to require Medicaid (MassHealth) to cover services that doulas provide. By covering these services under MassHealth the access to doula care is improved greatly, making this once out-of-pocket service reserved for those who could afford it now available to all who desire it. Through this bill, Massachusetts is making a huge leap in addressing and mitigating racial and ethnic disparities within birth by encouraging the creation of more community-based doula programs, as well as encouraging people to join the doula workforce, and improving doula care accessibility. 

For starters, this bill addresses specifically the plan for expanded access to “doula support services as a means to improve birth outcomes in the state.” (Expanding doula support services in Massachusetts 2022). Policies are currently underway to provide access through MassHealth, and additionally, receive “funding from a health policy commission investment program (Birth Equity and Support through the Inclusion of Doula Expertise; BESIDE)  to provide $500,000 in grant support” (Expanding doula support services in Massachusetts 2022). This grant would greatly improve doula services provided at hospitals with primarily black birthers. Steps that have been taken in moving these proposals along include a request for information report, lobbying, and other surveys sent out to Massachusetts doulas, as well as those who have received doula care. 

The Betsey Lehman Center recently released a report on considerations that should be taken into place for the successful implementation of this bill and the various benefits for all people involved in this bill. 

For birthers, it provides numerous benefits including emotional support, stability, and guidance for all. Doulas also provide benefits in addressing the racism, and bias taking place within the medical system. People often choose doulas who identify with their language, and cultural/ethnic background allowing for a deeper understanding. Doulas also serve as buffers for birthing people by advocating for the birther and their needs and pointing out racism and bias’ as seen. Doulas also help by challenging the ‘strong black woman script’ allowing black women to come out and identify that they don’t have to be strong for it all they can ask for help (Collins, C. C. et al, 2021). This report concludes the benefits of a doula by saying they “create a birthing process over the long term that is based in love and care that could create a positive ripple effect for future generations” (Expanding doula support services in Massachusetts 2022). 

For doulas it creates opportunities to be paid in full for work that is currently offered at low or no cost,  it increases the likelihood they’ll be seen as members of the care team in hospital settings, expands the doula workforce culturally and physically, creates a code of ethics, responsibility, and knowledge, and lastly provides a standard for certifying organizations. Overall this bill would provide a framework for doulas to work in a stable, supportive system that begins to recognize their importance. Massachusetts already has a strong doula workforce who is dedicated to working in this field, over 60% of the doulas surveyed have been serving for over 4 years (Expanding doula support services in Massachusetts 2022). This bill would support this network even more by creating systematic support. 

The biggest benefit is for society as a whole, coverage would reduce disparities in health outcomes due to racism, lower the number of unnecessary procedures, and provide cost savings for the healthcare system. It truly is a win-win-win bill. 

The latest legislative update from February 3rd, 2022 states that the “committee recommended the bill ought to pass” and it was then referred to the committee on “House ways and means” (MA H2372 | 2021-2022 | 192nd General Court | LegiScan). No further action has been reported. 

Looking to support this bill? Here’s what to do.

Send a letter or email to your representative ( search here) and share your support for bill H.2372. If you’ve used a doula share your experience if you want to use a doula share why (and share any barriers you’ve faced) if you are a doula share how this would benefit you! The list goes on but voice your support for this bill, legislatures love to hear from their constituents.

Wanna read more? Check my sources out!  

Centers for Disease Control and Prevention. (2022, February 16). National Center for Health Statistics Massachusetts. Centers for Disease Control and Prevention. Retrieved February 20, 2023, from https://www.cdc.gov/nchs/pressroom/states/massachusetts/ma.htm

Collins, C. C., Brown, P. L., Rice, H., Bronson, C., Cherney, E., Farmer, C., & DeRigne, L. A. (2021). Experiences of black women during pregnancy: The meaning of perinatal support. American Journal of Orthopsychiatry, 91(5), 589–597. https://doi.org/10.1037/ort0000557

Expanding doula support services in Massachusetts. Betsey Lehman Center. (2022). Retrieved February 21, 2023, from https://betsylehmancenterma.gov/assets/uploads/DoulaSupportMA_Report.pdf

Levy, G. B. R., & Karakashian, A. R. B. (2018). Doula Support During Labor and Childbirth: Outcomes. CINAHL Nursing Guide. 

Massachusetts H2372: 2021-2022: 192nd general court. LegiScan. (n.d.). Retrieved February 20, 2023, from https://legiscan.com/MA/bill/H2372/2021