The Role of Doulas in Improving Birth Outcomes for Moms and Babies

Doulas are non-clinical professionals who advocate for pregnant mothers as they navigate their care and the health care system. They provide pregnant mothers with educational, emotional, and physical support to ensure that the mother and baby remain healthy before, during, and after birth. The continuous physical, emotional, and informational support provided to a mother before, during, and shortly after childbirth by a doula is meant to help birthing people achieve the healthiest, most satisfying birthing experience possible.


According to the Centers for Disease Control and Prevention, approximately 700 women die every year in the United States from pregnancy or delivery complications. Black women die at a significantly higher rate from pregnancy-related causes than white women. Between 2007 and 2016, Black women experienced 40.8 pregnancy-related deaths per 100,000 live births, a rate more than three times higher than among white women.


In Ohio, between 2008 and 2016, pregnancy-related deaths occurred at a ratio of 14.7 per 100,000 live births. Over half of these deaths – 57 percent – were considered preventable. Additionally, Black women in Ohio died at a rate of more than two and a half times that of white women, making up 34 percent of pregnancy-related deaths but only 17 percent of births.


When a mother dies as a result of childbirth, it is a tragedy for both families and communities. Healthy moms are the foundation of healthy children. Whether infants are born healthy and with the potential to thrive as they grow greatly depends on their mother’s well-being—not just before birth, but even prior to conception. To have a healthy pregnancy and positive birth outcomes, women and their infants require access to appropriate health care services, before, during, and after birth.


Ohio communities have a history with doula programs across the state that have been successful in improving maternal and infant health outcomes. Many of these programs and services, however, are cost-prohibitive and often not accessible to pregnant women who may benefit the most from additional support. Doula programs serving low-income women have often absorbed the cost of providing care to increase access among our most vulnerable mothers and to support their community.


In 2016, there were 69,683 births by Medicaid recipients and 64,978 births by non-Medicaid recipients in Ohio. Medicaid births thus accounted for 51.8 percent of total births in 2016. Pregnant women in families with income up to 200% of the Federal Poverty Level are eligible for the Medicaid program Healthy Start (also called the State Children’s Health Insurance Plan, or SCHIP). Of the pregnant women served by Medicaid in 2017, only 72.1 percent of white mothers and 69.3 percent of Black mothers received timely prenatal care, having a visit during their first trimester. In order for the state to equitably respond to the maternal and infant health crisis it faces, Ohio must focus on pregnant women and babies served by Medicaid, especially women and babies of color, who face the greatest barriers to accessing quality health care throughout pregnancy and after birth.


During the 133rd Ohio General Assembly, bills were introduced in the House of Representatives (HB 611) as well as the Senate (SB 328) to address the reimbursement of doula services through Medicaid. SB 328 was passed and referred to the House where it did not receive a hearing. HB 611 received multiple committee hearings but was never brought up for a vote. In the 134th Ohio General Assembly, the bill has been updated and reintroduced as HB 142.


This legislation provides certification for doulas, outlines training requirements, and creates a pilot program for the Department of Medicaid to cover doula services as well as a pilot program for the Department of Rehabilitation and Corrections to provide doula services to inmates participating in prison nursery programs.


While doula services are a critical service, they are one of many non-clinical interventions that have demonstrated impact on maternal and child health outcomes. Advancing a more complete vision for pregnant women and young children will be critical to not only the improvement of birth outcomes, but also health and education outcomes that will pay dividends for pregnant women, children, and the state for years to come.