Been thinking about Doulas

Published June 21, 2023

By Joe Mavretic

A long, long time ago, at 8:30 on a Sunday night, in a shack beside the Currituck Sound near Powells Point, NC, I was delivered by a midwife. Complications from that delivery haunted my mother for the rest of her life; I am an only child.

An article about doulas, written by an eighty-eight year old White guy, who has never been pregnant, and has never birthed a baby, is a bit of a stretch…I get it. But, I want to go on record as an enthusiastic advocate for expanded Medicaid coverage for doula services in North Carolina. A doula initiative can be an excellent opportunity to challenge claims about the efficacy of doulas.

North Carolina’s infant mortality rate is above the national average as is the state’s maternal death rate. Both of these statistics provide an excellent target for the intended outcomes of a doula initiative.

Doulas are not doctors. Doulas are not midwives. Doulas are trained and certified to provide a woman with emotional, physical and informational support during a pregnancy, birth and a postpartum period. Doulas are part of a team that can help deliver healthy babies in North Carolina. To me, delivering healthy babies means fewer babies die and fewer mothers die.

Doulas are not some new Medicaid scam. Doulas have been supporting pregnant women for centuries. They are birthing specialists. Several states have recognized doulas’ contribution to successful pregnancies. As it should be, each state has tailored that recognition in its own statutes, rules and regulations. There are questions about training, certification, experience, and how to compensate for the service. While the devil is always in the details, North Carolina should not allow the bits and pieces to stop recognition. Oregon and Minnesota have recognized doulas for over a decade, and both states have had growing pains with their programs. North Carolina can benefit from their experiences and try not to "reinvent the wheel." Doctors, nurses, hospital administrators, and insurance companies should step aside while the initiative plays out.

Statutory recognition is our first step towards determining how important doulas can be in successful childbirth. Including doula care in Medicaid would require reporting and reporting generates data. That data could answer these  questions: Are doulas important to successful childbirth? Can doulas make a significant difference in infant and maternal death rates?

Whenever possible, legislative action should indicate legislative intent, and some way to measure the effort. For example: If our legislature requires us to wear seat belts in order to reduce accident fatalities and injuries, has that reduction actually happened? To what extent? Do we have supporting data? Data drives our public decisions. In N.C. we put our appropriations where the data is. When the peoples’ money is appropriated to address a problem, there should be a desired result and a way to measure performance.

Our General Assemblies’ Fiscal Research Division is extraordinarily capable of condensing technical information into alternatives or recommendations that the average person can understand.  They are experts in translating data into the justification for appropriations. Other divisions are expert in legislative research and bill-drafting.   If given a chance, the legislature’s staff is well suited to address the public’s questions about doulas.

If doula participation is tracked for about five years, the data should indicate whether doulas have a statistical significance on birthing outcomes or, according to their critics, are they just an "Old wives tale." We should give the doula initiative a chance.