Bridging the gap: Doula services as a solution to WA maternal health crisis

The joy and anticipation of childbirth is often overshadowed by a concerning reality: a maternal health crisis that highlights deep-seated inequities within our health care system. Despite advances in medical technology and health care policies, not all birthing individuals receive the same level of care and support, leading to disparities in maternal mortality rates. Recent data paints a sobering picture of the state’s maternal health, underscoring the urgent need for interventions that can bridge the gap in care and outcomes.

Washington’s maternal mortality rate reflects a broader national issue, with significant racial disparities that cannot be ignored. According to the state Department of Health’s 2023 Maternal Mortality Review Panel Report, Black women are two to three times more likely to die from pregnancy-related causes than white women. This disparity is not just a number; it’s a reflection of systemic inequalities, including access to health care, socioeconomic status and the pervasive effects of systemic racism. Furthermore, Native American and Alaska Native women in Washington experience maternal mortality rates that are similarly elevated, highlighting a crisis that cuts across multiple communities of color.

The Washington Legislature recently made a significant step toward bridging the gap in maternal care and outcomes by beginning the integration of birth doula services into standard maternal care for low-income people. With Gov. Jay Inslee’s signing of the 2024 Supplemental Budget, including Engrossed Substitute Senate Bill 5950, the state commits to implementing a reimbursement for birth doulas through the Washington Apple Health (Medicaid) program. This decision not only recognizes the value of doulas in improving maternal health outcomes but ensures doula services are accessible to more people. Just under half the annual births in Washington are paid for by Apple Health. The Health Care Authority, the state Medicaid agency, estimates the doula benefit will be implemented in early 2025.

Birth doulas are professionals who provide continuous, one-on-one support before, during and after childbirth. Their work encompasses physical and emotional support, evidence-based information on pregnancy and childbirth and advocacy for the mother’s wishes. The doula’s primary responsibility is to the client, not to a doctor, nurse, midwife or hospital administrator. They do not perform clinical tasks, give medical advice or diagnose conditions, and they do not make decisions for their clients. Rather, doulas are a constant presence that help people feel informed, empowered, in-control and safe.

The Evidence Based Birth article, “Evidence on: Doulas,” shows the support of a birth doula can reduce stress, reduce use of pain-relief medications, increase vaginal births and lower rates of medical interventions including Cesarean section. However, despite their proven benefits, access to doula services has historically been limited to those who can afford them.

This policy change is a commendable move toward health care equity. Doulas For All, a coalition mobilized by Surge Reproductive Justice, led and organized the advocacy efforts for the legislation. The policy acknowledges the right of everyone giving birth to receive comprehensive support during one of the most significant moments of their lives, regardless of their financial situation. Making doula services available to those on Apple Health is a crucial step in dismantling the barriers to quality maternal care and addressing the disparities that have long plagued our health care system.

While this legislation represents progress, it also highlights the continuing need for systemic changes in how we support families. The conversation must not stop at Apple Health reimbursement of doula services. We need to ensure all birth workers can earn a living wage and doula support becomes truly integrated in maternal care across all demographics. Our goal should be a health care system where the support of a doula is not an exception but a standard part of the birthing experience for everyone. By valuing and supporting the work of birth doulas, we are investing in a healthier, more equitable future for all.