Natalia Marin Torres, a first-time mom from Colombia, felt a mix of excitement and anxiety when she learned she was pregnant last August. She had a disagreement with her OB-GYN and realized she needed additional assistance to cope with the U.S. healthcare system.
“Being away from family and familiar culture can, I think, be quite overwhelming,” Torres shared.
Then, she met Alexia Franco Pettersen, a Mexican-American doula based in Minneapolis. Pettersen has been invaluable, guiding Torres through prenatal visits and preparations for after the baby arrives. She’s there for labor and delivery, no matter how long it takes, and continues to offer support once the baby arrives.
Torres found this support similar to what she would expect if she were back in Colombia with her family.
When Pettersen learned that her $2,400 fee would be covered by insurance, it made the choice to work with a doula much easier.
This year marked a significant shift as UnitedHealthcare became the first major insurance provider to include doula benefits in its plans nationwide. By next year, all employer-sponsored plans will offer this feature.
Torres’s plan is among those receiving coverage for doula services this year.
According to Usha Ranji, an associate director at KFF, which is a nonpartisan research organization, doula services typically aren’t covered by insurance, making them unaffordable for many women. The recent decision by UnitedHealthcare highlights a growing acknowledgment of doulas and the positive impact they can have on the health of pregnant women, she noted.
Dr. Dennis de los Santos, an obstetrician-gynecologist from San Antonio University Hospital, supports insurance coverage for doulas, believing it should be the standard practice. “It’s about time we do something beneficial for mothers,” he remarked, emphasizing the importance of support during pregnancy.
Over the last 13 years, at least 26 states have started mandating Medicaid coverage for doulas, as reported by the Doula Medicaid Project. Four additional states require similar measures for private plans—those being Arkansas, Colorado, Louisiana, and Rhode Island.
Dr. Margaret Mary Wilson, the chief medical officer at UnitedHealthcare’s parent company, stated that doula care is crucial for enhancing health outcomes for pregnant women, particularly women of color.
“Health Equity Interventions”
Though not medical professionals, doulas play a vital role in advocating for and coaching women during pregnancy, childbirth, and the postpartum phase.
Pettersen, who has been a doula for 12 years, explained that while healthcare providers may be limited by time during appointments, doulas take the time to understand their clients better, providing resources and elevating their voices.
While various organizations offer doula certifications, no central authority oversees the profession as a whole.
Doulas invest significant time in getting to know their clients, discussing birth preferences, and advocating for them during labor. They can also offer techniques to manage pain naturally and provide breastfeeding tips after the baby comes home.
The United States is grappling with high maternal mortality rates, and major institutions like the American College of Obstetricians and Gynecologists acknowledge that ongoing support from doulas may enhance childbirth outcomes.
Research suggests that doulas can help lower preterm births, reduce the likelihood of cesarean sections, and lessen postpartum depression.
Wilson emphasized, “Maternal health is at a critical juncture in this country. The number of preventable pregnancy-related deaths and complications is simply unacceptable.”
Pettersen noted that she has witnessed instances where doctors overlooked patients’ concerns due to language barriers, showcasing the importance of doulas as health equity advocates.
She remarked that this support can help providers understand the cultural context and align patient needs more closely.
Erica Lane became a doula influenced by her own negative birthing experience. “I didn’t want other women to endure what I went through,” she expressed. During her second daughter’s birth, she felt pressured into unwanted interventions, which led to her birth plan being disregarded.
As president of DONA International, Lane welcomes the potential for broader access to doulas due to United’s new policy, yet she cautions that the reimbursement model requiring upfront payment can be a significant barrier. “It’s a commendable step forward, but there’s definitely more to address,” she concluded.
