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In a move to improve access for mothers and families, congressional legislation would broaden Medicaid payouts available for doulas and midwives.
U.S. Rep. Gwen Moore originally introduced the “Mamas First Act” in 2019. The bill would require state Medicaid programs to cover doula and midwife services for expecting families, including care before, after and during the baby’s birth.
Currently, doula services are not fully covered by Wisconsin’s Medicaid programs. Doulas are certified birth workers who provide support services before, during and after birth for mothers and their families.
Medicaid is a state-provided insurance program that provides low-income residents with coverage for medical costs.
Lyanne Jordan, executive director and visionary steward for Maroon Calabash, a local maternal health organization, explained that the difference between doulas and other birth workers is often the deeper relationship between the mother and the birth worker.
“Whereas when you go to a doctor’s office and they may know your name, they may know your personal history and information, but they may not know that your kid is taking piano or that your grandma just died,” Jordan said. “They may not sit with you and ask you, ‘Truly, how was your birth experience?’”
Midwives support clinical services for expecting mothers in addition to counseling and support. A certified midwife can perform medical tasks such as delivery and diagnostic testing, which distinguishes them from doulas.
The bill would provide funding for doulas and midwives across the country, but Moore said this presents a significant opportunity for Milwaukee, where maternal and infant health have been a consistent concern.
According to a recently released maternal mortality report, charting the years 2016 to 2017 from the state Department of Health Services, 85% of the state’s pregnancy-associated deaths occurred in urban settings. About 58% of those who died were enrolled in Medicaid at the time. A total of 80 deaths occurred from 2016 to 2017, the report said.
Roughly 52% of deaths in that time period were attributable to mental health issues, including substance abuse and overdoses. The report identified 97% of these deaths as preventable.
Moore said the legislation would help increase care to reduce maternal mortality. Moore, who used midwives during some of her own pregnancies, said that birth workers could provide a “support system” for mothers by helping to ensure they go to the doctor’s office and serving an advocate in the exam room.
Moore said since some women of color are not taken seriously in medical settings, having someone there to navigate is critical.
“There are so many women who are not assertive with health care professionals, and it has cost women their lives,” Moore said. “This is a real barrier – especially for women of color – to be taken seriously by some health-care institutions.”
Nicole Miles, manager of the Milwaukee Health Department’s Birth Outcomes Made Better Doula program, which provides doula services in the city, said imperfections within the current Medicaid payout system will need to be addressed for the legislation to be effective.
Midwifery services in the state currently have some coverage from Medicaid, but Miles said many midwives don’t receive the maximum allowable payment from the state for services. Certain requirements may need to be met to get payment and costs for services can vary, making it hard to ensure a livable wage for providers.
“Yes, it’s important that Medicaid is covering it, but at what cost?” Miles said. “You say this is valuable, but how much are you willing to give to this? … It has to be explicit.”
Miles emphasized the importance of training midwives and doulas in how to submit payment codes for Medicaid reimbursement and the specific requirements to receive the maximum allowances.
Miles said the legislation was a step in the right direction, especially since many private insurers change policies after Medicaid does.
Jordan said the need for financial support among doulas and midwives is great, especially since the onset of the COVID-19 pandemic.
“There’s so many Black and brown midwives I know who are juggling their own personal practice, their family life and fundraising for their clients,” Jordan said. “They’re out there hunting for dollars, asking their friends and families and communities to support families in birthing because the finances just aren’t there.”
Jordan said she wanted to see the legislation be more ambitious in its goals and felt more was needed to support birth workers in Milwaukee.
“Economic equity is a crucial part of ensuring that BIPOC middle-birth workers are being asked to care for the community at rates that are not exploitative, that are not harmful – rates that don’t lack equity and sustainability,” Jordan said.
If done correctly, Jordan said the legislation could be a great addition for a group of medical professionals who needs support. Providing more sustainable options for expecting families, including doula and midwife services, could lead to better outcomes she said.
“If people can mix and match and create the kind of experience that they want, that would be incredible,” Jordan said. “And then they’re doing so with birth workers that aren’t going to be burnt out in three years because they’re literally gifting their profession to the community and there’s no system of reciprocity.”
The bill was referred to the House Committee on Energy and Commerce on April 7. If it passes through the committee, it will get a vote on the House floor, inching another step closer to becoming law.
In case you missed it: NNS Spotlight: How Maroon Calabash is addressing Black maternal deaths by building on a history of midwifery
As an end-of-life doula, the passing of this bill is essential to providing equitable care to people of color—particularly mothers, caregivers, and individuals suffering from terminal illnesses and diseases. Unfortunately, because healthcare is based on timed performance and the mindset to “fix” the condition, we give more attention to caring for pets than honoring human lives. As a result, people get ignored or pushed through the system as if they are on a manufacturer’s assembly line. If you need more convincing to pass the bill, I suggest setting in on a couple of birthing sessions or going through the dying process where doulas and midwives are holding their own in supporting their clients as they give life and lose a life.