Doulas have been shown to improve maternal and infant health, address disparities 

Lansing, MI – On Jan 13th, Governor Gretchen Whitmer announced that Michigan became one of the first states to support expecting mothers by covering doula services, so that they receive the care they need for a healthy pregnancy and support for interventions that are proven to increase health outcomes for women and their children. 

The benefit is part of Governor Whitmer’s Healthy Moms Healthy Babies initiative to help improve maternal and infant health outcomes. The state’s Chief Medical Executive Dr. Natasha Bagdasarian has issued a standing recommendation that doula services are medically necessary and should be offered to families covered by Medicaid insurance. 

“Expecting Michiganders deserve to have the care they need to have a healthy pregnancy,” said Governor Whitmer. “Yet, more than 63% of maternal deaths in Michigan are preventable, and Black women are nearly three times more likely to die from pregnancy-related causes than white women. By providing doula services we are helping address health disparities and ensuring access to high-quality health care that meets their individual needs.” 

The addition of doula services follows the expansion of Medicaid coverage for a full 12-month postpartum period announced in May 2022. Access to high quality health care services is a critical component of statewide efforts in addressing maternal morbidity and mortality rates in Michigan.?Maintaining Medicaid coverage for a full year provides access to critical health and dental services during the first year after pregnancy, which can help to address persistent health disparities. 

Michigan has made strides in improving maternal and infant health yet continues to suffer from one of the highest infant mortality rates in the nation. Between 2019-2021, infant deaths occurred disproportionately among Michigan’s Black and Native American infants, at rates of 14.1 and 10.5 per 1,000 live births, respectively, compared to a rate of 4.6 per 1,000 births among white infants. Disparate rates of infant death have persisted due to systemic inequities.  

“Doulas provide a variety of benefits to expectant parents throughout pregnancy, delivery and even after the birth of a child,” said Dr. Natasha Bagdasarian, chief medical executive. “This includes emotional support, help with a birthing plan, breastfeeding advocacy and education regarding newborn care, nutrition and safety.” 

Doulas are non-clinical birthing professionals who provide physical, emotional and educational services during the prenatal, labor and delivery, and postpartum periods. Doula services have been shown to positively impact social determinants of health, support birth equity, and decrease health and racial disparities. 

By making the standing recommendation, Bagdasarian addresses a federal requirement by the Centers for Medicare and Medicaid Services that doula services are recommended by a licensed health care provider. 

In her recommendation, Bagdasarian stated, “In an effort to improve maternal and infant health outcomes for individuals covered by Medicaid, and consistent with 42 CFR 440.130(c), I have determined based upon my professional experience and the infant and maternal mortality rates in Michigan, that doula services are medically necessary for all pregnant or postpartum Medicaid recipients. Doula services should be explained and offered to this beneficiary population. I hereby recommend that doula services be offered immediately and on an ongoing basis to Medicaid recipients until such time as determined no longer necessary.” 

Doula support may include, but is not limited to:  

Prenatal services, which include:  

• Honoring personal and cultural childbirth preferences. 
• Supporting health literacy and knowledge. 
• Assisting with the development of a birth plan. 
• Providing emotional support and encouraging self-advocacy. 

• Reinforcing practices known to promote positive outcomes, such as breastfeeding. 
• Identifying and addressing social determinants of health. 
• Coordinating referrals to community-based support services (e.g., WIC, behavioral health services, transportation, home visiting services). 

Labor and delivery services, which include:  

• Providing continual physical comfort measures, information and emotional support. 
• Advocating for the needs of the birth person. 
• Being an active member of the birth team.  

Postpartum services, which may include: 

• Sharing education regarding newborn care, nutrition and safety. 
• Supporting breastfeeding. 
• Providing emotional support and encouraging self-care measures. 
• Offering support in attending recommended medical appointments. 
• Identifying and addressing social determinants of health. 

• Coordinating referrals to community-based support services (e.g., WIC, behavioral health services, transportation, home visiting services). 
• Linking families to grief support services, if needed. 

For more information, visit the MDHHS website.