Massachusetts is launching a new certification process for birth doulas this spring that’s intended to create clear standards for education or experience, setting the stage for private and commercial insurers to cover their services.
It feeds into the state’s broader goal of making more birth doulas available to more parents to reduce maternal health disparities. Few — if any — private health insurance plans currently cover doulas in Massachusetts.
“This is hopefully a step in that direction, in that — at the very least — these insurance plans would know where to go and would be able to verify that doulas have the education or the pathway and they’ve been certified by the commonwealth,” said Deu Almeida, who founded the doula collective Doulas of the Diaspora.
The state’s urgency to address maternal health is growing. Health outcomes worsened for birthing parents across the board between 2010 and 2020, with Black parents seeing the worst outcomes. As of 2022, Black parents were about 2.5 times more likely to have a severe complication during childbirth than white parents.
Birth doulas are one way the commonwealth is trying to step in. They don’t have medical training: their job is to provide emotional, physical and informational support throughout pregnancy and labor. Doula support has been linked to better health outcomes, fewer unnecessary C-sections, fewer preterm births and higher parental satisfaction.
But until the last couple of years, families typically paid out-of-pocket for their services, or else doulas would volunteer their time. That changed when the state’s Medicaid, MassHealth, started reimbursing doulas for their services in late 2023.
Now, doulas are paid up to $1,700 for eight perinatal visits and accompanying a parent through labor.
About 4,500 families have worked with doulas through the state’s Medicaid since then, a MassHealth spokesperson told GBH News.
A spokesperson for the state’s Department of Public Health says the new program creates clear, consistent and publicly accountable standards for doulas. Certification will not be required for doulas to work in Massachusetts.
“The Department of Public Health’s (DPH) Doula Certification Program builds on Massachusetts’ ongoing commitment to birth equity and to strengthening the maternal health workforce,” the spokesperson told GBH News in a statement.
As the state tries to grow the doula workforce, it’s also bringing in the nonprofit HealthLeads to bring together small groups of doulas, where they can share the challenges they’ve encountered and get direct help. HealthLeads plans to bring those overarching concerns to the state.
Steph Campbell, a program director with HealthLeads, wants to bring together Massachusetts doulas from different backgrounds who can also support each other.
“We really have doulas who might be in the western part of the state — with expertise in supporting birthing families with substance use disorder — connect with those who are serving similar families that may feel isolated,” Campbell said. “We recognize there’s kinks in any systems that we’re designing, but we have — with the support of this cohort — really identified an agenda that’s uplifting their unique perspective in the larger system.”
Leaders at HealthLeads said that when they’ve run similar groups in New York, they’ve heard about problems with too-low wages and difficulties with being accepted by hospital staff — issues that doulas have raised in Massachusetts, too.
More than half of state Medicaid insurances now reimburse for doula services, according to the Doula Medicaid Project. But far fewer states require private insurers to cover doula services.
Almeida points to a bill on Beacon Hill that would require private insurers to cover doula services in Massachusetts. It has been reported favorably out of committee in the House and the Senate.
This new certification process, she says, is “demonstrating to the commercial and private insurers that the commonwealth is serious about supporting doula services and really wants ... that reimbursement.”
About 400 doulas are already enrolled through MassHealth and will be effectively grandfathered in when the state’s public health department launches the certification process this spring.
