Doula services and other forms of coordinated maternity healthcare are crucial when it comes to reducing racial and ethnic gaps in maternal health outcomes. California is making it easier to find doulas, licensed midwives, and Certified Nurse Midwives (CNMs). The state has also started offering a community health worker benefit, which is good news for the state’s efforts to improve birth outcomes and give families care after a baby is born.
At a June 4 Ethnic Media Services briefing, advocates discussed how Medi-Cal is expanding maternal healthcare and explored the important role of doula services in the maternal healthcare landscape of California. Doulas help expectant mothers and their families in many ways, including emotionally, physically, and intellectually. People from disadvantaged backgrounds, who encounter more obstacles and dangers during pregnancy and delivery, are especially in need of this assistance.
With the support of a doula, parents and infants of Black, Native American, Latinx, Asian American, and Pacific Islander descent are more likely to have a healthy delivery with fewer complications, including fewer C-sections, epidurals, premature births, low birth weight babies, anxiety, and longer labors.
Medi-Cal access to doula services
The Department of Health Care Services (DHCS) is making it easier for pregnant people, including some who do not qualify for Medi-Cal, to access maternal health services. Through doula services, the DHCS offers a birthing care pathway for members from conception to twelve months after giving birth, parent-child dyadic care, and other programs.
The Medicaid program in California covers one-third of the state’s population which includes 15 million people, including 1.3 million children Expanded services, such as doula visits, are part of Medi-Cal coverage, allowing members to get comprehensive mental and physical health care outside of traditional medical settings.
Maternal healthcare initiatives
Improving maternal health outcomes is a top priority for the California Department of Health Care Services (DHCS). To build a health system that takes the full person into account, Medi-Cal is now undergoing a transition through programs aimed at reducing racial and ethnic inequities and providing coordinated care from pregnancy to twelve months after the baby is born. The programs offer choices for conventional and alternative medical professionals in meeting the demands of people’s physical, mental, and social health.
Medi-Cal’s transformation includes several initiatives to support healthier lives for families and babies:
- Birthing Care Pathway: This initiative supports members from conception to 12 months postpartum.
- Dyadic Care Programs: These programs provide dual care for both parent and child.
- Expanded Benefits: New benefits are available for pregnant members, even those who exceed the income limit for Medi-Cal.
Erica Holmes, Chief, Benefits Division, Department of Health Care Services (DHCS), and Khefri Riley, Medi-Cal doula provider, emphasized doula care and other enhanced maternal health programs for families and infants. Care teams include licensed midwives and certified nurse midwives to offer mothers full assistance from the start of their pregnancies through to the postpartum period, ensuring a well-rounded approach to maternal healthcare.
Improving Maternal Healthcare in California
As of January 2023, doula services are a covered benefit of the Medi-Cal program. This policy shift aims to make delivery more accessible and safer for everyone. California, which has the highest reimbursement rate in the nation, has granted 455 group and individual doula applications. This is in line with a growing movement across the country to include doulas as part of the healthcare delivery team to reduce health inequalities in mother care.
Distinguished Medi-Cal doula Kairis Chiaji who has worked to close access barriers in healthcare facilities, stressed the need for doulas to be part of the healthcare delivery team to ensure everyone giving birth gets the help they need. This integration is essential to reducing health inequalities and boosting maternal health outcomes generally.
A Doula’s Role
The doula serves as a personal trainer for the birthing process, providing constant encouragement and direction. Cultural awareness and bridge-building are crucial in birthing spaces. A doula’s role is multifaceted, including assisting clients with birth preparation, offering emotional support, and understanding and navigating the healthcare system.
A doula’s assistance is critical, especially among Black and Indigenous women who face heightened dangers during pregnancy and delivery. The DHCS has organized a network of doulas to offer emotional and educational assistance to pregnant people in underprivileged areas to support better birth outcomes and equal access to healthcare for all families.
Doulas are essential to postpartum care in providing practical support to new moms. They offer tailored assistance, help moms navigate feeding issues, and connect them to community resources. Doulas ensures that everyone who gives birth gets the care they need by working to eliminate inequalities in the treatment of postpartum depression.
Historical Significance and Empowerment Through Doula Work
There is a long history of community-based assistance for persons giving birth. Medi-Cal doula providers Khefri Riley and Kairis Chiaji shared personal stories about their decision to become doulas. After years of administrative work, Chiaji’s experience working with The Birthing Project spurred her decision to champion underrepresented groups. Over 700 families, mostly from African American neighborhoods, have benefited from Riley’s work with frontline doulas in Los Angeles County, proving the value of doula care.
Increasing access to doulas and other integrated maternal healthcare services in California is a huge win for women of color and their babies’ health. The state’s dedication to equitable care, historical awareness, and collaborative initiatives have improved birth outcomes and assisted families beyond conception.
Photo by Aditya Romansa on Unsplash