Medicaid coverage for doulas - yay or nay?
Leslie here π
I recently had the chance to sit down with HeHe Stewart from The Birth Lounge Podcast, and we had an absolutely amazing conversation about something that, on the surface, sounds like a great idea, but that I have some serious concerns about.
The topic? Medicaid coverage for doulas.
At first glance, it sounds like a huge win. More access to doula care? Amazing. More families being able to receive support? Absolutely. Getting doulas paid? Hallelujah. We are all for connecting expecting families and doulas, and making birth support more accessible.
But as birth workers who are passionate about women's rights, and who understand that the system is not set up in mothers' and babies' best interests, we also have a responsibility to ask harder questions.
Because if history has taught us anything, it's that when community-based care gets absorbed into large systems, there are often unintended (maybe intended?) consequences.
This is exactly what happened with midwifery.
And if you're not deeply immersed in birth work, policy, or legislation, these conversations usually happen quietly in the background. They do not make national headlines. Most families never hear about them until the effects are already being felt.
One of the biggest questions we explored in the episode was βwhat happens when doulas become accountable to systems instead of families?β
Because historically, doulas have answered to one person: the mother. They are not answering to insurance companies, certification boards, licensing requirements, hospital policies, or reimbursement structures. And all of the research we have about the benefits of doulas come from this community-based model.
When insurance enters the picture, regulation, legal definitions, oversight, and reimbursement slowly start reshaping doula work into something different than what it was meant to be.
Maybe if our maternity care system was already doing a good job, this would not feel like such a big concern. But we are, empirically, NOT doing a good job.
The U.S. spends more on maternity care than many other developed nations and continues to have significantly worse maternal outcomes. We intervene more. We spend more. And despite all of that, our outcomes continue moving in the wrong direction.
This conversation was nuanced, spicy in the best way, and one for both families and doulas.
Go give it a listen and let us know what you think.
Always in your corner,
Kayla & Leslie
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