So being passed around on social media in birth professional groups is this new article on NPR.org about the cost saving benefits of doula support. At first glance, it's neat to have doulas being talked about in a major news outlet, and I'm thrilled if this piece will introduce the concept of doula care to folks who've never heard of us. I appreciate the research that's been done to solidify and confirm what doulas already know:
Women can benefit from another woman (or man! There is a growing group of male doulas...) providing professional support during her pregnancy, labor, delivery, and postpartum period.
But as I read on further into the article, I have some questions. I'll be exploring those questions in the next few blog posts. The first question I have is in regards to compensation for the doulas providing care in the Medicaid system. I have heard frustrating stories from obstetrical care providers that have become unable to sustain their practice's acceptance of Medicaid patients due to the low reimbursment rate for care when compared with self-pay or private insurance patients. We read in the NPR article that doulas save state Medicaid programs money by reducing cesarean section rates and pre-term births. Does that cost savings go away when doulas are paid a living wage? I'm curious how much Medicaid would reimburse doulas for care, especially given the terms of the study - four prenatal visits, labor and delivery hours, and two postpartum visits. That's a lot of hours! In Minnesota, where the Medicaid-provided doula program exists and was studied, the doulas received $300-$400 per client. I know that for most doulas who do this work full-time, as their career and profession, that level of compensation would not provide the doula with sustainable income. Interestingly, the Minnesota program found that they could break even between paying the doula and the cost savings for Medicaid if they paid the doula almost $1,000! Now that comes much closer to a real income.
I'm not sure I'd sign up to be a Medicaid-provided doula - no matter what the cost-savings to the state programs, even if I could be helping reduce my clients' chances of pre-term or cesarean birth - if I couldn't make a living wage while doing it. We can't expect doulas to support women if we don't support the doulas with fair pay.
Other questions I'll be exploring:
1. Is there a really a scope of practice for all doulas, and how does that affect Medicaid compensation?
2. Does this mean the role of the doula in the pregnancy care team has additional legitimacy? Will this lead to some type of standardized national certification?