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Senate Health Committee hears testimony on providing Medicaid coverage for doulas



The Senate Committee on Health and Human Services heard testimony on Senate Bill 0678 that upon passage will provide medical assistance health care for expectant mothers and establishes medical assistance coverage and reimbursement rates for perinatal doula services through Medicaid.

I covered the introduction of this legislation here.

Doulas are trained professionals who provide continuous physical, emotional and informational support to women during pregnancy, childbirth and the first few postpartum weeks. They assist in making women as comfortable as possible during birth, providing help with breathing techniques, massage and advice, and can help advocate for the woman during the birth.

Below is all the oral testimony presented to the committee.

“Providing Medicaid dollars for doula services can actually lower health care costs,” said the bill’s sponsor, Senator Ana Quezada (Democrat, District 2, Providence). “It will prevent many women from going to the emergency [room] because sometimes, when you are pregnant for the first time, you don’t know… What a doula does is… teach [expectant mothers], help them, educate them.”

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“If we reimburse doulas that means women will get low-cost health care that will not only support them in their pregnancies but it will give them support throughout the whole pregnancy and after the baby’s born,” said Gail Harvey, representing Rhode Island NOW. “So by having doulas you are cutting the cost of what it would be if I had to go to the emergency room because I had no health care, because I had nobody to help me. You’re cutting the cost of perhaps postpartum depression. So what is it going to cost? It’s going to cost the health care companies less because I’m not using expensive services…”

“Although I was a nurse with medical knowledge and about pregnancy and childbirth I still wasn’t able to be my own advocate during a very complicated delivery for my second child. I actually really don’t remember very much except being hooked hooked up to IVs monitors and having people hover around me but I was very fortunate because I received adequate care. However, not every woman receives appropriate timely care and that’s especially dire for black women and women who live in poverty who experience a maternal mortality rate and delivery complications and negative birth outcomes at significantly higher rates than privately insured white women.,” said Rachel Jarosz.

“It’s a misconception that life-threatening complications related to pregnancy are rare. They are not and there are huge opportunities to improve care. A study in the Journal of prenatal education demonstrated that expectant mothers matched with a doula had much better outcomes. Doula assisted mothers were four times less likely to have a low birth weight baby, two times less likely to experience a birth complication and continuous doula support was also associated with higher Apgar scores….”

“The data is clear, however many women are unable to take advantage of doula services during pregnancy because they are not covered by Medicaid or private insurance and cannot afford to pay out of pocket. In addition, many doulas are unable to provide care to pregnant women because they cannot be reimbursed through Medicaid or private insurance,” said Kavelle Christie of Planned Parenthood.

Planned Parenthood of Southern New England and the Rhode Island Coalition for Reproductive Freedom believe that carrying a pregnancy to term should not put women’s lives at risk. Maternal mortality and morbidity in the United States is a public health crisis and its severe impact on black woman is simply unacceptable. Access to reproductive health care including culturally competent perinatal and postpartum care is an essential human right. Planned Parenthood of Southern New England also believes that health care providers including doulas deserve fair compensation for the work they provide.”

Ellen Cynar, director of the City of Providence’s Healthy Communities Office delivered a packet in support of the bill and expressed the support of Providence Mayor Jorge Elorza.

“Doula support during labor and birth is a service that, as you’ve been hearing, has been consistently shown to measurably improve outcomes for mothers and infants with zero risk and no side effects. So it is an unusual health care service in that regard,” said Camille Williams, speaking on behalf of the Rhode Island Affiliate of Nurse Midwives.

“One 2016 study modeling the cost-effectiveness of Medicaid coverage for doula services found in average cost savings of $976 per per birth. The situation we have in Rhode Island is that despite the well-documented health and cost benefits of the continuous support that doulas provide, doula support in Rhode Island is essentially a boutique service that’s only available to people who have the financial means to pay many hundreds of dollars out-of-pocket and that of course creates inequity and it may means that doula care is inaccessible to those who arguably need it the most.”

“I’m here for two reasons because as a woman who gave birth in the state of Rhode Island, what I experienced during birth and I want some of the women that come to the United States as immigrants who don’t speak English to have a better outcome than what I experienced.,” said Aniece Germain, assistant executive director of Hope and Change for Haiti.

“The second reason is because of the research and the report I read maternal mortality and morbidity has become a public health crisis in the United States and this unfortunately affects black women particularly. Black women unfortunately, are three to four times more likely to die during birth than white women. This really stunned me. This is really unacceptable in the 21st century to see how black women continue to die during labor because of pregnancy-related complications. And most of the time it’s because their voice is not heard because there’s no one to understand what they need…”

“I have been practicing as a doula since 2014 and I am co-president of the Doulas of Rhode Island, which is our local professional organization for our state,” said doula Susan Finnerty. “The foundation of this bill has rested on the widely accepted data that when people have access to a doula they are less likely to have a surgical birth, less likely to require medication for pain or to speed labor along, an increase in satisfaction with their birth experience and an overall shorter labor. There is a well-documented decrease in premature births and newborn illness. These are important when discussing the cost saving in maternity care and in saving lives.”

“In 2011 we found ourselves in San Diego California and a pregnancy followed that fall,” said Middletown resident Ellen Sullivan-Washburn. “

“In 2011 we found ourselves in San Diego California and a pregnancy followed that fall. Due to escalating situations overseas my husband received orders to deploy to Afghanistan. He was scheduled to leave in February, 2012 which was the month of my expected delivery. This is when I began to research doula for support of my son’s birth. Due to the cost and lack of available doulas during my birth month, and being in an unfamiliar City without family I did secure a doula in training and was happy to support her as she pursued her training in this needed caregiver profession.

“With the risk of my husband not being present for our son’s birth the presence of a doula helped me to emotionally ready myself. My doula also helped me both in pre and post birth preparations. Her support during delivery assisted me in adhering to my birth plan and not having pain medications. I did end up having complications during labor and the doula assisted both my husband and myself during that trial of time. Through the marathon of labor and then ultimately a c-section, having a doula during this rollercoaster time is something that I’m sincerely grateful for.

“After my son’s birth I was told that he had a tongue tie which made breastfeeding very difficult. She assisted me through this added trial. We were fortunate to have my husband present at Emmett’s birth, however he was deployed four days later. The emotional and physical support of a doula during my pregnancy, labor and postpartum was unsurmountable.”

“Above all the defining experience of my labor and delivery with a doula was feeling supported and heard when I was unable to even say that I needed help.,” said Sarah Byrnes.

“I was admitted to the Hospital on January 7th in triage at Women and Infants. With me at the same time my neighbor was a woman LaShonda Hazard who died that day while I was waiting in triage and I certainly can’t speak to any of the details of her story only to what I heard – Which was a woman who, for those of you who don’t know the story of a black woman, a pregnant woman who was repeatedly saying things like ‘I need help’ and ‘Why won’t anyone help me?’ and ‘I think I might die.’ Whereas with the help of my doula I was able anytime I needed any help to have lots and lots of support the comments that I heard in response to LaShonda pleas for help were very dismissive. ‘I think she’s just constipated,’ – ‘ Well, maybe we can get a nurse in a minute,’ – that sort of thing.

“I came away from that experience thinking that everyone needs the help that I had and certainly low-income women, women on Medicaid who are more likely to have challenges in childbirth, and women who are women of color who are more likely to experience complications and face discrimination. I feel so lucky that I had the help that I needed and I hope that we can make that happen for everyone.”

“In a broad sense of scale throughout the entire world and everywhere is a civilization [where], when a woman was pregnant, naturally her mother was around, her aunts were around other siblings were around [and] the woman was always cared for,” said Alyse Wilkie. “She would have meals prepped for her she would have someone doting on her to some extent. We don’t live in that type of society any longer and we need to adapt. We need to enter the modern-day. Doulas are that network there, that mom there to hold your hand and comb your hair and get you a cup of tea and put your feet up, because otherwise women are working full-time jobs and also other have other children. It’s comical to try to tell them, ‘oh, just rest the next two weeks before you give birth.’ That can’t happen in this kind of world.”

“I was literally dying,” said Jennifer Rourke. “I was drowning in my own fluids. I was sent for an EKG. I had an MRI, CAT Scan. I just kept saying, ‘Something’s not right, something’s not right.’ No one listened to me and finally I found out sometime later that I had postpartum preeclampsia. However, the signs were being seen prior to giving birth, so when my blood pressure hit 135, someone should have said something’s wrong.

“If I had a doula by my side to advocate for me it would have been something completely different. The minute that she saw that my blood pressure was elevated she would have done something, but my doctor completely ignored me. The nurses completely ignored me.

“Doulas provide emotional support. They provide that perinatal, the antepartum, the postpartum support that women need. Especially women like me, because I don’t get listened to when I tell them something’s wrong. They brushed it off. I have private insurance. I didn’t think I needed a doula. I have a good doctor. I have been nurses but apparently I didn’t have a voice because no one was hearing me.”

“I’m a doula also and I just wanted to talk a little bit about some of the reasons that this bill is so important for mothers in Rhode Island and hopefully it sets a precedent for other states as well. I think Jen has really just talked about one of the most important reasons to have a doula and one of the biggest differences between a health care provider and a doula, which is that our sole focus is on the mother, whereas a midwife and OB a nurse is focused on the progression of labor and the baby and making sure that drugs are being administered properly, exams are happening – But we are doulas are hyper focused on the experience that the mother is having… Our sole focus is tuning into what mom needs…”

“I have a doula practice that is strictly postpartum care due to some of the barriers that were previously discussed. I do have a full-time job. I do have children so I can’t afford childcare to be with your child so I do just postpartum, mostly group setting to recreate the village

“I trained last year with a culturally competent doula training… “

“I began my doula journey in 2015 after I had my fourth child. I had a doula for the first time and it was a wonderful experience. It was such an integral change in my life that I decided to become a doula. I trained in Brooklyn, New York with Ancient Song Doula Services, specifically to service my community.

“I had a grant through the Department of Health in order to provide this service due to socio-economic barriers and most of my clients which I serve are primarily black and people of color who cannot afford doula services. There is no such thing as too much support. I’m a doula to the entire family. I’m a doula to the mom and the baby. I’m a doula to the dad.

“Eventually you have to get something to eat, eventually you have to go to the bathroom, eventually you have to go to sleep and so you can never have too much support…”

“I had a doula myself 16 years ago and I have been working for 14 years in perinatal health education and advocacy for families during pregnancy, birth and postpartum. I follow families before the baby is being born into the four years afterward. My colleagues and families have done an amazing job drawing attention to many of the benefits of doula support.

“I want to focus on a specific area this sort of stats or information that say doulas, ‘increased satisfaction’ with the birth experience and I want to nail that down because that can sound a bit watery and it is extremely impactful. When we’re talking about improving satisfaction, what we’re talking about is preventing trauma which is incredibly prevalent in childbirth… We have a ton of information over many many years about how incredibly important the mental health of both parents is to supporting bonding with their baby which will impact that child’s development for the rest of their life.

“Our families are also the building blocks of our society and a family that is not receiving support to be physically healthy but also mentally and psychologically healthy is a broken link in the health of our society…”

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Steve Ahlquist is a frontline reporter in Rhode Island. He has covered human rights, social justice, progressive politics and environmental news for nearly a decade.