WASHINGTON — Jo Ann Bishop calls being a doula her “final chapter.” She had other careers but wanted her last one to be serving women.
“It's really who I am, not just what I do,” she said.
Doulas provide non-medical support to women before, during, and after childbirth. Research shows such care improves outcomes for women and their babies.
“Increased confidence for the mother, improved mental health postpartum, decreasing anxiety,” Bishop explained.
Congresswoman Gwen Moore, D-Milwaukee, has reintroduced legislation to allow Medicaid to pay for doulas and midwife services. Moore said expanding access to such care would have an immediate, positive impact on the most vulnerable women, especially Black women.
“While maternal mortality is not restricted by income or by race, you can bet your bottom dollar that if you're poor, and if you're a woman of color, that you are in a higher risk category,” Moore said.
Maternal mortality rates have increased across the U.S. In Wisconsin, as in most of the country, maternal deaths are highest among Black women.
“Bringing new life into the world should not be a death sentence,” Moore said.
Black women experienced 40.4 deaths per 100,000 live births from 2010-2019, according to a study published in the Journal of the American Medical Association. Maternal death rates for that decade for other groups in Wisconsin were 32.5 for American Indian and Alaskan Native mothers, 24.2 for white mothers, 18.5 for Hispanic mothers, and 18.4 for Asian, Native Hawaiian or other Pacific Islander mothers.
“For our black populations, data shows and women's voices tell us that they feel like they're not heard within the labor process. They're not heard in maternal care, like leading up to labor. Their levels of pain are not responded to in the same way that a white woman is responded to,” said Briana Rockler, an assistant professor of public health and UW-Eau Claire. “So if you have a doula there that is going to speak for that woman and is not going to say no [or] back down… [it] can make all the difference.”
Bishop praised the legislation but said she’s concerned about the reimbursement rates some states might set for doula care. If the rate is too low, some doulas may not accept patients with Medicaid. Bishop said she’s seen doula fees that range from $800-$3,500.
“This is a complicated issue that we want to make sure people have coverage,” Bishop said. “But we also want to make sure that doulas are able to accept the coverage, and that it can be commensurate with the work that they're doing. As a nation, if we say we believe in life and we believe in childbirth, we need to be able to invest in this and provide excellent support for the best birth outcome possible, for both the mother and the baby.”
The legislation has been introduced before, but never made it out of Congress. Moore said she’s hopeful a “disturbing” increase in maternal mortality rates will create impetus for passage this time. Sen. Elizabeth Warren, D-Massachusetts, is sponsoring the bill in the Senate.