Lauren Sausser and Katheryn Houghton
As a postpartum doula, Dawn Oliver does her finest work in the course of the night time.
During a typical shift, she exhibits up at her shoppers’ dwelling at 10 p.m. She solutions questions they might have about fundamental toddler care and retains a watch out for indicators of postpartum melancholy.
After bedtime, she might feed the newborn a bottle or wake the mom to breastfeed. She soothes the toddler again to sleep. Sometimes, she prepares meals for the household in a Crock-Pot or empties the dishwasher.
She leaves the next morning and returns, usually nightly, for 2 or three weeks in a row.
“I’m certified to do all of it,” stated Oliver, of Hardeeville, South Carolina, who runs Compassionate Care Doula Services. It takes a village to boost a baby, because the adage goes, however “the village is not what it used to be,” Oliver stated.
Doulas are educated to supply vital assist for households — earlier than supply, throughout childbirth, and in these daunting early days when mother and father are determined for sleep and infants nonetheless get up across the clock. While doulas usually don’t maintain a medical or nursing diploma, analysis exhibits they will enhance well being outcomes and cut back racial well being disparities.
Yet their providers stay out of attain for a lot of households. Oliver fees $45 an hour in a single day, and medical insurance plans usually don’t cowl her charges. That’s partly why enterprise “ebbs and flows,” Oliver stated. Sometimes, she’s totally booked for months. Other occasions, she goes a number of weeks with no consumer.
That might quickly change.
Two bipartisan payments, launched in separate chambers of the South Carolina General Assembly, would require each Medicaid, which pays for greater than half of all births within the state, and personal insurers to cowl the price of doula providers for sufferers who select to make use of one.
South Carolina isn’t an outlier. Even as states brace for significant reductions in federal Medicaid funding over the subsequent decade, legislatures throughout the nation proceed to move legal guidelines that grant doula entry to Medicaid beneficiaries. Some state legal guidelines already require personal well being insurers to do the identical. Since the beginning of 2025, Vermont lawmakers, alongside Republican-controlled legislatures in Arkansas, Utah, Louisiana, and Montana, have handed legal guidelines to facilitate Medicaid protection of doula providers.
All instructed, greater than 30 states are reimbursing doulas by way of Medicaid or are implementing legal guidelines to take action.
Notably, these protection necessities align with one of many targets of Project 2025, whose “Mandate for Leadership” report, revealed in 2023 by the conservative Heritage Foundation, provided a blueprint for President Donald Trump’s second time period. The doc requires rising entry to doulas “for all women whether they are giving birth in a traditional hospital, through midwifery, or at home,” citing issues about maternal mortality and postpartum melancholy, which can be “worsened by poor birth experiences.” The report additionally recommends that federal cash not be used to coach docs, nurses, or doulas to carry out abortions.
The Heritage Foundation didn’t reply to an interview request.
Meanwhile, the concept doulas can profit infants, mother and father, and state Medicaid budgets by decreasing pricey cesarean sections and preterm delivery issues is supported by a rising physique of analysis and is gaining traction amongst conservatives.
A study revealed final 12 months within the American Journal of Public Health discovered that ladies enrolled in Medicaid who used a doula confronted a 47% decrease threat of delivering by C-section and a 29% decrease threat of preterm delivery. They had been additionally 46% extra more likely to attend a postpartum checkup.
“Why wouldn’t you want somebody to avail themselves of that type of care?” stated Republican state Rep. Tommy Pope, who co-sponsored the doula reimbursement invoice within the South Carolina House of Representatives. “I don’t see any reason we shouldn’t be doing that.”
Pope stated his daughter-in-law gave delivery with the help of a doula. “It opened my eyes to the positive aspects,” he stated.
Amy Chen, a senior legal professional with the National Health Law Program, which tracks doula reimbursement laws across the nation as a part of its Doula Medicaid Project, stated lawmakers are likely to assist these efforts once they have a private connection to the difficulty.
“It’s something that a lot of people resonate with,” Chen stated, “even if they, themselves, have never been pregnant.”
Conservative lawmakers who endorse state-level abortion bans, she stated, usually vote in favor of measures that assist being pregnant, motherhood, and toddler well being, all of which these doula reimbursement payments are meant to do.
Some Republicans really feel as if “they have to come out in favor of that,” Chen stated.
Health care analysis additionally means that Black sufferers, that suffer significantly higher maternal and toddler mortality charges than white sufferers, might significantly profit from doula care. In 2022, Black infants in South Carolina had been greater than twice as more likely to die from all causes earlier than their 1st birthday as white infants.
That holds true for ladies in rural parts of the country the place labor and supply providers have both closed or by no means existed.
That’s why Montana lawmakers handed a doula reimbursement invoice this 12 months — to slender well being care gaps for rural and Indigenous communities. To that finish, in 2023, the state enacted a invoice that requires Medicaid to reimburse midwives for dwelling births.
Montana state Sen. Mike Yakawich, a Republican who backed the Democratic-sponsored doula reimbursement invoice, stated pregnant girls ought to have somebody to name exterior of a hospital, the place well being care providers may be pricey and intimidating.
“What help can we provide for moms who are expecting? My feeling is, it’s never enough,” Yakawich stated.
Britney WolfVoice lives on the Northern Cheyenne Indian Reservation in southeastern Montana, about two hours from the closest birthing hospital. In early July, she was seven months pregnant along with her fourth youngster, a son, and stated she deliberate to have a doula by her facet for the second time within the supply room. During WolfVoice’s earlier being pregnant, an Indigenous doula named Misty Pipe introduced cedar oil and spray into the supply room, rubbed WolfVoice’s again by way of contractions, and helped guarantee WolfVoice’s husband was the primary individual their daughter noticed.
“Being in a hospital, I felt heard for the very first time,” WolfVoice stated. “I just can’t explain it any better than I felt at home. She was my safe place.”
Pipe stated hospitals are nonetheless related to the federal government forcibly eradicating kids from Native American properties as a consequence of colonization. Her objective is to assist in giving folks a voice throughout their being pregnant and supply.
Most of her shoppers can’t afford to pay for doula providers out-of-pocket, Pipe stated, so she doesn’t cost something for her delivery providers, balancing her position as a doula along with her day job at a put up workplace.
“If a mom is vulnerable, she could miss a prenatal appointment or go alone, or I can take time off of work and take her myself,” Pipe stated. “No mom should have to birth in fear.”
The new state legislation will permit her to receives a commission for her work as a doula for the primary time.
In some states which have enacted such legal guidelines, preliminary participation by doulas was low as a result of Medicaid reimbursement charges weren’t excessive sufficient. Nationally, doula reimbursement charges are bettering, Chen stated.
For instance, in Minnesota, the place in 2013 lawmakers handed one of many first doula reimbursement payments, Medicaid initially paid solely $411 per consumer for his or her providers. Ten years later, the state had raised the reimbursement price to a most of $3,200 a consumer.
But Chen stated it’s unclear how federal Medicaid cuts may have an effect on the destiny of those state legal guidelines.
Some states that haven’t handed doula reimbursement payments, together with South Carolina, may be hesitant to take action on this surroundings, she stated. “It’s just a really uncertain time.”
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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