Mississippi needs to integrate doulas into the health system



Historically, pregnant women were generally supported by laypeople during labor and delivery. This custom was particularly widespread among Mississippi black women who relied on grandma midwives and women from their communities, especially during the segregation era when black women were denied access to clinics and hospitals.

Today women who do not provide medical care to working women are known as doulas.

Getty Israel

A doula is a trained obstetrician who provides emotional, physical, and social support during pregnancy, labor, and delivery, and immediately after the baby is born. Typically, doulas develop relationships with pregnant women in the third trimester.

The effectiveness of doulas in reducing medical interventions, especially in caesarean sections, which are often medically unnecessary, and in improving labor outcomes is well understood.

Support for the doula during labor and delivery is associated with lower rates of caesarean sections and fewer obstetric procedures, lower rates of intrapartum analgesia, instrumental vaginal delivery, shorter labor, and higher rates of spontaneous delivery and APGAR scores for infants.

Mothers who received doula support during childbirth were four times less likely to have a low birth weight baby, two times less likely to have a birth complication, and more likely to start breastfeeding.

A study by the University of Minnesota reported that the caesarean section rate was 22% for doula-assisted births and 31.5% for Medicaid recipients nationwide. Medicaid-funded births with doula were 41% less likely to have a caesarean section than Medicaid-funded births with standard care.

In addition, a regional study of 65,000 Medicaid benefit recipients reported that women who were assisted by a doula had lower preterm (4.7% and 6.3%) and caesarean births (20.4% vs. 34.2%). ) had regional births among Medicaid benefit recipients. Doula-assisted births were associated with a 22% lower chance of premature birth. The rates of high blood pressure and diabetes were also lower in the doula-assisted births than in the women in the regional group.

A federally funded Healthy Start Scholar serving a Medicaid population has incorporated doula support services into its program. Participants in the program had premature births and low birth weights nearly 50% lower than women who did not receive doula support.

However, only a few states, Minnesota, Oregon and Illinois, reimburse this very valuable, evidence-based service that could potentially save millions in medical costs for states with high Medicaid enrollments, such as: B. Mississippi which covers about 70% of births and is known for its high premature birth rates, low birth weight babies, caesarean births, infant mortality and very low breastfeeding rates.

It is time to integrate doulas into health and payer systems as the demand for this service continues to grow among pregnant women in Mississippi.

My Jackson clinic receives daily inquiries from Medicaid members who cannot afford the cost. As a result, the service is out of reach for most women in the state. In Mississippi, the cost of a doula can range from $ 400 to $ 1,000 or more, depending on the doula and the level of service received.

The only sustainable solution to ensuring that all pregnant women have access to doulas is to establish government standards and regulations and to impose a fee for reimbursement.

Getty Israel is the founder and managing director of Sisters in Birth Inc. in Jackson.


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