Spoiler Alert: the answer is YES! With plenty of published research on the value of doula care and a growing interest on the part of government and private insurers in implementing doula programs, the question really shouldn’t be CAN doulas improve outcomes, but HOW can they do it at scale?
When we look at the research and talk to doulas about the care and services they provide in their communities, it seems pretty clear that the key to success is positive relationships. Doulas provide a much-needed emotional connection during pregnancy, a connection that can translate into timely action for urgent health issues. When a pregnant person has a trusted advisor who can help them navigate a system that can be complex at best and downright antagonistic at worst, this role is critical in a successful pregnancy outcome.
“Pregnant people encounter a range of reasons that can cause concern or anxiety. This is often calmed by providing validation, being an emotional anchor and illustrating options available – there are lot of benefits come from a simple knowing that they can look to someone they trust. It is quite rewarding to witness a birthing family step into greater awareness and ability to steer their experience.”
Myla Flores, Doula and Member Uptown Village Cooperative
So if relationship is the prescription for a good outcome, what is the right dosage and delivery route? This is the challenging question that payers (a term to describe those organizations that “pay” for health care services, primarily Medicaid, commercial insurance, and large self-insured employers) need to answer in order to successfully incorporate doula services into existing maternity benefits packages.
Figuring out which services produce the most benefit is just one part of the complex mechanics of growing and sustaining a new profession. The next big question is what does it cost to deliver those services? This is not just about what doulas should be paid (the answer to that is a living wage!) but really what it costs to grow and manage a doula service that includes all of the indirect expenses such as accounting, HR, intake call center (matching doulas to moms), marketing, and training. In addition, there are costs to the quality assurance insurance providers will need in order to incorporate doulas such as liability insurance and other kinds of oversight.
So, think of it as an algebra equation:
X=Cost savings of having a Doula
Y=Cost of growing and sustaining a Doula
X-Y=Value of Doulas
If we just use pre-term birth (PTB) to try to solve for X, we can use figures from a 2014 study of community-based doulas in the Upper Midwest that provided care to Medicaid recipients that suggest doulas can reduce PTB by 22%. That translates to $50,000 saved per pre-term birth avoided. Definitely seems worth it, but reimbursement for doulas is not currently set at a wage that enables doulas to thrive OR even acknowledges the value they can provide. If we can try to set the reimbursement, or the rate that payers will pay, at a number that comes closer to the VALUE that doulas can bring, we might be able to direct some of that money to actually growing the profession. A feedback loop that serves everyone!