Doula benefit provides support and an advocate

Doulas make a difference

This year, Washington Apple Health began covering birth doula services. Apple Health is Medicaid in Washington state. It has nearly two million people enrolled and covers over 40 percent of births in Washington. With Apple Health’s wide reach, the doula benefit is a step forward for safe births and healthy babies.

Birth doulas are non-medical professionals who provide physical, emotional, and informational support. They help people during pregnancy, labor, and after childbirth — together called the perinatal period.

There’s strong evidence that doulas improve the health of pregnant people and their babies. One of their most important services is being the voice for a pregnant person who can’t speak up — or isn’t heard.

“Doulas are inherently advocates,” says Michelle Madrigal, the doula services program manager at the Health Care Authority (HCA). Before joining us to oversee the doula benefit, Michelle was a practicing licensed midwife. In her career, she’s seen the impact doulas have in preventing death and illness during the perinatal period.

“Doulas provide support in a way that helps patients feel like their voices can be heard,” says Michelle, “If their patients don’t feel heard, then the doula will voice their needs for them. Having that type of support in labor creates a sense of empowerment, which eventually leads to good outcomes.”

Those good outcomes include:

• Fewer unnecessary C-sections
• Fewer early births
• Healthier newborns

Doulas for the people who need them most

This new benefit makes it easier than ever to access doula care. With Apple Health covering the service, people who didn’t have the financial means to hire one in the past can now get a doula.

“Private doula rates are incredibly high. Most people who are accessing doula support are of high socioeconomic status, white, and living in metropolitan areas,” says Michelle.

However, pregnancy and infant outcomes are worse for people of low socioeconomic status and Queer, Trans, Black, Indigenous, and People of Color (QTBIPOC). These groups’ outcomes can improve greatly when they have doulas.

For a long time, these groups have faced systemic barriers to respectful, culturally responsive care. Providing access to doulas is one step toward addressing that harm and building trust in health care systems.

“Everybody deserves to have a doula — and to have a doula who looks like them and lives like them,” says Michelle.

Developed by community

While creating the doula benefit, HCA wanted to make sure it would work for the groups who would see the greatest improvements and benefit the most. “We want to help elevate and center community doulas who are serving the most at-risk populations,” says Michelle.

The leadership and advocacy of community-led groups shaped the doula benefit. One such group was Doulas for All, a coalition led by people in QTBIPOC communities. Doulas for All pushed for laws to recognize doulas as a Department of Health–certified profession in Washington, which led to the Apple Health doula benefit being possible today.

Additionally, we worked with other diverse and justice-oriented groups:

• American Indian Health Commission (AIHC)
• Native American Dialogue on Infant Mortality
• Queer & Trans People of Color (QTPOC)
• Seattle Indian Health Board
• Somali Doulas
• United Indians

Listening to and incorporating community voices helped us make the doula benefit fair and give more people the opportunity to be as healthy as possible.

This next section shows what that opportunity to be healthy looks like for people with Apple Health coverage.

Doula services

If you have Apple Health, you can start using the doula benefit before, during, or after giving birth. Even if you’ve already had a baby, you can see a doula up to 12 months after your baby’s birth.

The Apple Health doula benefit includes:

• One intake visit before birth
• Support during your entire labor and delivery
• Up to 20 hours of visits before and after childbirth.

Six hours of those visits focus on making sure you and your baby are safe after the birth.

Before birth

The visits before birth often focus on educational support. “Doulas are usually going into your home, providing education around childbirth and pregnancy — things you might need to ask your clinical pregnancy provider. Doulas create awareness on your options as a pregnant person,” says Michelle.

Home visits are especially helpful if you can’t easily get in to see a pregnancy provider. A doula can help you get the support you need, exactly when you need it.

During labor

A doula stays by your side during your entire labor and delivery.

“Usually in the hospital you get assigned one nurse, and then you have your delivering provider (whether it’s a midwife or a doctor),” says Michelle. “And they’re in and out of the room, monitoring multiple patients at a time. But with a doula, they’re there the whole time, supporting one person the whole time.”

For many, birth can be a vulnerable or even traumatic experience. Doulas are trained to offer grounded, nonjudgmental presence; helping birthing people feel safe, informed, and in control.

Being in the room the whole time gives doulas a wide perspective. Plus, they’re ready to step in at the right moment to help.

“If someone’s exhausted, they might say, ‘Well, what do you think? Let’s hydrate, let’s eat,’” says Michelle. “Or if things are stalling in labor, they’ll say, ‘Let’s do some position changes.’”

Some of this physical support may sound like common sense, but it’s not easy to do on your own while giving birth. While some might get this help from a family member or friend, not everyone has one by their side during labor.

Doulas give more people the chance for a successful vaginal birth, versus an unnecessary C-section. They also create a more positive birth experience overall.

After birth

Doula visits after birth help fill a gap in support. This is especially important because many pregnancy providers only see their patients a couple of times after childbirth.

“It’s like, ‘Okay, you graduate! You’re an expert,’” says Michelle. “But really, there are challenges at eight, 10, 12 weeks after the birth. A doula is the person who picks up and holds you in those spaces.”

If your baby isn’t sleeping well or if you have breastfeeding or chestfeeding concerns, a doula can answer your questions. They can also help you find other clinical professionals for more help. A doula’s emotional and educational support helps improve your health and your baby’s health in the weeks after birth.

Find an Apple Health–enrolled birth doula

If you’re on Apple Health and need help finding a doula, use the HCA Find-a-Provider tool. In the specialty box, put “Doula.” You’ll find a list of Apple Health–enrolled birth doulas in your area. When you call them, be sure to ask if they’re taking new Washington Apple Health clients.

If you can’t find a doula in your county, search in nearby counties. Michelle says, “Some doulas will travel up to one and a half hours based on where they live and what their clients need.”

The doula benefit advances health equity

At HCA, our mission is to provide equitable, high-quality health care through innovative health policies like the Apple Health birth doula benefit. The doula benefit gives more people the fair and just opportunity to be as healthy as possible.

To learn more and read the latest updates on the doula benefit, visit our doula page.