Bill seeking to improve access to, increase funding for doula services heads to hearing

LINDSAY SABADOSA

LINDSAY SABADOSA

By BELLA LEVAVI

Staff Writer

Published: 09-19-2023 11:15 AM

The Legislature’s Joint Committee on Health Care Financing will host a hearing for a bill that could vastly improve access to and increase funding for doula services.

The hearing for bill H 1240/ S 782, “An act relative to Medicaid coverage for doula services,” will take place Wednesday, Sept. 20, from 10 a.m. to 3 p.m. Other bills pertaining to health equity will also be discussed. Advocates in western Massachusetts and beyond are hopeful the bill will be signed into law in the near future.

“With the stars aligning and MassHealth being supportive, it gives a much better chance of getting this bill passed,” said state Rep. Lindsay Sabadosa, D-Northampton, who sponsored the bill with state Sen. Liz Miranda, D-Suffolk. “There has been a lot of progress in a short number of years.”

Doulas are trained, nonclinical professionals that provide education, guidance and support to those giving birth. This occupation ranges in responsibilities from helping families create birth plans to providing natural pain management services through childbirth, and even past childbirth to aid families through the postpartum period.

The role is a distinct difference from midwives, who focus on providing medical care during pregnancy, birth and the postpartum period.

The bill has four goals, which advocates say would change the accessibility to doula services statewide.

The first point of the bill would require MassHealth, the Massachusetts Medicaid program, to cover doula services. Erika Laquer, an Easthampton-based professional birth doula and childbirth educator since 2006, explained that writing these services into law would safeguard them from being taken away and incentivize private health insurance companies to follow suit. Forty percent of births in Massachusetts involve people who are covered by MassHealth.

“That is a large amount of people who could potentially have doulas,” said Martha Hoffman, a doula based out of Northampton.

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Secondly, the bill would expand the workforce and diversity of doulas by providing training assistance. This would improve regional equity, Sabadosa said, by creating trust funds for doula training for people to work with underserved communities.

The bill also amends the Patient Bill of Rights to give patients the right to have a doula in the room at the hospital while giving birth. Finally, the bill creates a Doula Advisory Committee that would be responsible for giving feedback about the bill, making sure “the program actually works,” Sabadosa said.

“I am so excited this bill has come to fruition. It has been many years of collaboration,” said Jacqueline Tuttle, a Deerfield-based birth and postpartum doula. Her company’s name is Yellow Rose Birth Services.

In past legislative sessions when the bill was introduced, “it never makes it to the finish line,” Sabadosa said. She is hopeful it has a better chance of passing this session.

When the bill was first introduced in 2019, MassHealth was in support of the concept, but concerned about the expense of adding doulas as a service covered by insurance. Now, four years later, MassHealth has come out in support of the bill and released a statement that it would pay a flat rate of $700 for labor and delivery support and hourly rates for perinatal visits up to $800.

“This is a huge moment for the history of birth in our state,” Tuttle said.

Doulas typically charge anywhere from $0 to $2,000 for their services depending on the level of experience. Many offer sliding scale pricing, so clients can settle on a price they can afford.

While there are proven positive outcomes to having a doula present at a birth, the service is often inaccessible for people due to the cost.

“We need to make sure the most vulnerable people in our state are able to access services, and providers are willing to provide services at the rate they are paid,” Sabadosa said. “That is across the board and also specific to doulas.”

Western Massachusetts and doulas

The doulas the Recorder spoke with and Sabadosa explained this region is a “hot bed” for doula services.

While Sabadosa thought it was common knowledge that doulas can help cut down on maternal mortality rates, she found while speaking during a public health hearing — and referring to her own birthing experience where doulas often came up in the conversation — that her audience wasn’t as aware as she’d expected. Sabadosa and local doulas say the practice seems to be more common and supported in western Massachusetts.

“It was fascinating to find out in other parts of the state that was not the case,” Sabadosa said.

Doctors in the region are typically pro-doula and know how to work with a doula who is present during labor, according to Tuttle.

Most of the doulas in the area are involved in the networking and community-building platform Green River Doula Network. This network offers training for doulas and can point clients to specialists, as well as people who can help with lactation, doula abortion services and childbirth education, according to Kayla Chatterton, a doula, sexual reproductive health educator and placenta encapsulation specialist through her company Wombans Wellness. The network raises money to support free doula services for low-income families, and has offered two this past year.

The network was inactive during the pandemic and recently relaunched, rebuilding the doula community. Other regions also use doula networks to allow providers to collaborate on one platform.

Hoffman, a board member for the Green River Doula Network, explained one of the biggest problems doulas in the area face is finding clients. Hoffman said there are many people having babies, but some do not know what a doula is. Most doulas in the area have to supplement their career with other jobs.

“Lack of consistency is definitely a little part of the job, but it does seem to be a slower pace out here,” Hoffman said.

Setbacks of the bill

While advocates are rejoicing over the bill’s potential passage, many have spoken out against the rates MassHealth has proposed, referencing the flat rate of $700 for labor and delivery support and hourly rates for perinatal visits up to $800.

“There are two truths,” Sabadosa said. First, “the rate is too low. The second truth is [that the rates MassHealth is proposing are still] higher than any other state.”

The bill itself does not set a rate, because inflation would cause those numbers to change. Instead, MassHealth has set its own rates for doula services, which could change over time.

Tuttle explained she is concerned there is a flat rate for labor and birth services. She said many births, including inductions and first births, can last a long time and there is no overtime offered with the current language of the bill.

Laquer said for people beginning their doula careers in this region, this could be adequate payment, but it is concerning that the same rates across the state do not account for other factors.

“If people are continuously undercharged, they will burn out,” Tuttle said.

She is also concerned this would not pay for travel, which can be a barrier for people living in rural areas, and perinatal visits can only last up to 90 minutes, which she thinks is not enough time.

Bella Levavi can be reached at 413-930-4579 or blevavi@recorder.com.