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Doula care improves health outcomes for pregnant Medicaid patients, new report says

A patient lies down as Midwife Krystal Brown checks her pregnancy.
Yfat Yossifor
Cherish Sims lies down as Krystal Brown, Certified Nurse Midwife, examines her during a prenatal visit Tuesday, Feb. 21, 2023, at Lovers Lane Birth Center in Richardson.

A new report by the Elevance Health Public Policy Institute underlines the positive health impacts of doula access on pregnant patients. Elevance Health provides Medicaid managed care plans nationally, including in Texas through Wellpoint.

The institute found that overall, patients had better birth and postpartum outcomes when accessing doula services. Researchers measured Medicaid patients across the health system’s locations and compared those who had a doula to those who did not.

Patients who used doula care were often Black and lived in communities with a shortage of OBGYN and maternal care. Jennifer Kowalski, the vice president of the public policy institute, said the organization intentionally did outreach to patients who were at higher risk for pregnancy complications.

She said even though these patients were at higher risk, the report still found “better outcomes among those [people]. That’s an important thing to underscore and perhaps somewhat surprising.”

The report found that people who worked with a doula had lower rates of C-sections and lower postpartum anxiety and depression. Patients were also more likely to attend their postpartum visits.

“I think doula services for folks who are pregnant is an important part of [a] whole health approach,” Kowalski said.

The report recommends states lower barriers for doula services to be covered by Medicaid. Midwives and free-standing birth centers are covered under Medicaid in Texas, but doulas are not.

Last year, Texas lawmakers introduced legislation to create a pilot program for doulas to be covered under Medicaid, but the bill stalled in committee.

“Expanding access to doula services more broadly is really the hope,” Kowalski said. “Over time, knowing that we’re seeing such positive results from our study…that this encourages investment in doula workforce and that [patients] who need these services can access them more widespread than they do today.”

Texas did pass and get federal approval for 12 months of postpartum coverage, which goes into effect March 1.

Advocates, birth workers and researchers have said this extended coverage will lower the rates of maternal mortality and morbidity in the state.

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Elena Rivera is the health reporter at KERA. Before moving to Dallas, Elena covered health in Southern Colorado for KRCC and Colorado Public Radio. Her stories covered pandemic mental health support, rural community health access issues and vaccine equity across the region.