New York to Expand Use of Doulas to Reduce Childbirth Deaths

By LUIS FERRÉ-SADURNÍ APRIL 22, 2018 The New York Times

Gov. Andrew M. Cuomo announced on Sunday a series of initiatives aimed at addressing a disturbingly high rate of maternal mortality among black women, who are four times more likely to die in childbirth than white women in New York State, according to a study released last year.

The plan includes a pilot program that will expand Medicaid coverage for doulas, birth coaches who provide women with physical and emotional support during pregnancy and childbirth.

Studies show the calming presence and supportive reinforcement of doulas can help increase birth outcomes and reduce birth complications for the mother and the baby. Still, only a small percentage of women use doulas nationwide.

Hiring a doula — the word means “servant” in Greek — can be expensive. Doulas can charge up to $1,500 per birth, and studies show there is little diversity in the doula work force.

Black and low-income women are the most likely to want but not have access to doula services, according to one survey. Medicaid coverage for doula services, state officials hope, would help bridge racial disparities and reduce maternal deaths.

“Maternal mortality should not be a fear anyone in New York should have to face in the 21st century,” Mr. Cuomo, a Democrat, said in a statement on Sunday. “We are taking aggressive action to break down barriers that prevent women from getting the prenatal care and information they need.”

The United States’ soaring rates in maternal mortality compared with other wealthy nations have become a cause of concern, but so have the racial disparities, an intractable phenomenon that has not eluded New York. In New York City, the numbers are worse: Black women are 12 times more likely to die from pregnancy-related causes than white women, according to a city study.

The design of the doula pilot program will be finalized by the state’s Health Department within 45 days, and the program will start immediately thereafter. The state will work with health care professionals to determine how many women will be enrolled in the pilot program, state officials said.

If the doula program is successful, New York would join Minnesota and Oregon as the only states that allow Medicaid reimbursements for doula services.

Providing this service, however, has not always been smooth. In Minnesota, not many Medicaid beneficiaries were aware of doula coverage, and reimbursement rates were low, one study found. Additionally, doulas are not licensed in New York, which might be a challenge because Medicaid programs must pay licensed providers to receive matching federal funds.

Molly Deutschbein, a doula and committee member of the Rochester Area Birth Network, was encouraged by a possible Medicaid expansion, but cautioned that it could change the essence of the doula profession because a doula might be required to work for a provider whose interests are not aligned with the mother’s.

“When doulas get paid by someone other than the mother, it gets to the question of, Who does the doula work for?” Ms. Deutschbein said. “I’d have to see more of the details.”

In fact, New York’s Health Department once shied away from the idea of expanding Medicaid coverage for doulas in 2011, saying it was a “complex issue.”

“We see it as this really critical piece of improving outcomes most especially for most at-risk mothers,” said Élan McAllister, a former doula and a co-founder of the New York Coalition for Doula Access.

“There’s something about having a support person who can bring humanity into a situation and who cares that you survive childbirth and get through it.”

The governor is also creating the Task Force on Maternal Mortality and Disparate Racial Outcomes, which will collaborate with the Maternal Mortality Review Board, a new entity composed of health professionals that will review each maternal death in the state.

The board will count all maternal deaths outside the five boroughs, as New York City began a similar program in December to investigate each maternal death in the city and understand its causes and circumstances.

The state is also expanding prenatal education programs for women and reviewing best practices in hospitals to address hemorrhaging, one of the leading causes of pregnancy-related deaths.

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