May 19, 2023. By Uma Gaddamanugu.
The maternal health landscape in our country is grim. An American woman today is 50% more likely to die in childbirth than her own mother. Black women are three to four times more likely than white women to die from pregnancy-related complications. And recently, the CDC found that 84% of maternal deaths in our country are preventable. Think about that for a second. Childbirth is often considered a joyous time, but for many women in our country, it is a time riddled with fear and frustration.
Inequities like this motivated me to start a volunteer doula program at ECU Hospitals, where I am currently a second-year medical student and a 2022-23 NC Schweitzer Fellow. Our volunteers provide continuous support to laboring mothers at no cost; we teach them to use breathing techniques during contractions, advocate for their preferences with medical professionals, and ensure they feel informed and empowered every step of the way. Doulas are particularly valuable in rural communities, where moms often travel hours to receive prenatal care or deliver their baby. At our hospital, it isn’t uncommon for patients to give birth alone, as transportation barriers and geographical distance often prevent the patients’ support network from reaching the hospital in time. Therefore, the continuous, one-on-one support that doulas provide to laboring patients can be particularly impactful in rural communities. However, there are many more laboring mothers throughout the state than our volunteer program cannot serve.
Doulas are a valuable yet underused resource in attaining maternal health equity. This is partly because in North Carolina, Medicaid and most private insurers do not cover doula services, and out-of-pocket costs can reach around $1500. For many families in eastern NC, where 1 in 4 mothers lives in poverty, doulas are rarely affordable.
As the risk of dying from pregnancy and childbirth in the US continues to escalate, doulas provide desperately needed emotional support and reinforcement for pregnant patients in a healthcare system riddled with barriers and inequities. Therefore, the NC legislature must move forward with their bill to include coverage for community-based doulas under the state’s Medicaid program. Numerous studies demonstrate that doula care is associated with lower epidural and cesarean section rates, higher levels of maternal satisfaction, and higher birth weights. In NC, where we rank 41 out of 50 for infant deaths and 30 out of 50 for maternal deaths, doulas can help transform the maternal health landscape. Currently, very few doulas are available in eastern NC, mainly because the high costs for doula services limit the demand. However, providing Medicaid coverage for doula services could help attract doulas to rural communities and bolster the local workforce.
As the state works to implement Medicaid coverage for doula services, we must ensure that doulas’ voices are included when crafting the bill. Doulas should be paid a fair living wage, have autonomy over their work, and practice without unnecessary barriers to reimbursement and certification.
The utility of doula care in the fight to combat maternal health disparities is unquestionable. Then why are they only accessible to people who can afford to pay a premium for their services? This country is long overdue in addressing the shameful maternal health crisis in our country. By expanding access to doula services with Medicaid coverage, the state can take a desperately needed step towards improving the wellbeing of women and babies across North Carolina.
2022-23 NC Schweitzer Fellow
ECU Brody School of Medicine, Class of 2025