Like many first-time moms, Nathalia Marin Torres was excited when she found out she was pregnant last August, but she was also a bit nervous. The 33-year-old Colombia native didn’t click with her OB-GYN and felt like she needed more support navigating the health care system in the United States.
“When you’re kind of far away from family and from your culture, it’s a little bit overwhelming,” Torres said.
She was referred to Alexia Franco Pettersen, a Mexican American doula in Minneapolis. Pettersen is helping guide Torres through prenatal visits and preparing for postpartum. She’ll be there for the entirety of her labor and delivery, whenever and however long that may be, and provide support after the birth as well.
Torres likened it to the extra support she would get if she were back in Colombia with her family.
The decision to work with a doula was made easier when she learned that Pettersen’s $2,400 cost would be covered by her insurance.
This year, UnitedHealthcare became the first major insurer to start adding a doula benefit to plans across the country. By next year, all of the company’s employer-sponsored plans will have access to the benefit.
Torres’ plan is among those that got doula coverage this year.
Typically, doula services have not been covered by insurance, putting them out of reach for many women, said Usha Ranji, an associate director of the women’s health policy program at KFF, a nonpartisan research group. United’s decision reflects a growing awareness about doulas and how they can improve pregnant women’s health, she said.
Dr. Denise De Los Santos, an OB-GYN at University Hospital in San Antonio, said insurance coverage for doulas should be the norm.
“I think it’s about time we do something to help moms,” said De Los Santos, adding that anything that could help more women feel supported during pregnancy is important.
Over the past 13 years, at least 26 states have begun requiring Medicaid coverage for doulas, according to the National Health Law Program’s Doula Medicaid Project. Four states — Arkansas, Colorado, Louisiana and Rhode Island — require some private plans to do the same.
“We think that doula care is an important step in improving health care outcomes for women going through pregnancy and delivery and postpartum, especially for women of color,” said Dr. Margaret-Mary Wilson, the chief medical officer for UnitedHealth Group, the parent company of UnitedHealthcare.
‘A health equity intervention’
Doulas aren’t doctors, nurses or midwives, but can work with women during their pregnancy, birth and postpartum in the role of an advocate and coach.
“When health care systems are stretching nurses and doctors to maybe not be able to learn all the details of someone’s life during a 15-minute prenatal appointment, then doulas are able to learn more about those things, provide them extra resources, amplify their voice,” said Pettersen, who has been a doula for 12 years.
There are multiple organizations that offer doula certifications, including DONA International and the National Black Doulas Association, but no single body oversees the profession.
Doulas typically spend hours getting to know their clients, discussing how they would like to give birth and advocating for those wishes during labor and delivery. During the birth, they can help with nonmedical pain management by suggesting different positions and breathing techniques. Once women are home with their baby, some doulas can guide them through breastfeeding and even help prepare healthy meals.
The U.S. continues to see high levels of maternal mortality, and major medical organizations like the American College of Obstetricians and Gynecologists have noted that the continuous support doulas provide can help improve outcomes for women in labor.
Studies have shown doulas can decrease the rates of preterm births, cesarean sections and postpartum depression.
“The state of maternal health in the country has reached a critical point. The number of preventable pregnancy-related deaths, pregnancy-related complications, the mental health prevalence in women who are pregnant is unacceptable,” United’s Wilson said.
Pettersen, the doula working with Torres, said she’s been in delivery rooms where doctors have dismissed patients’ concerns about certain medical interventions because of language barriers. “Doulas are a health equity intervention,” she said.
“Sometimes it’s even having the providers understand culturally this is what the patient is wanting and getting them on board,” said Pettersen, who is also fluent in Spanish.
Erica Lane decided to become a doula after having a bad birth experience. “I didn’t want women to go through what I went through,” she said. During the birth of her second daughter, she felt coerced into getting an epidural and her “birth plan was literally thrown in the trash.”
Lane, who is president of DONA International, said she’s glad more women will potentially have access to doulas because of United’s new benefit, but worries its reimbursement model — which requires people to pay upfront, and the insurer will later reimburse them — will be a barrier for some women. “It is a good start, but there’s definitely room for improvement,” she said.
Leave a Reply