To address the differences in maternal health, an MN insurer seeks to care for the doula

Natasha Lancour has five children.

Each time she gives birth, Lancour, from Duluth, says she could not feel the need for postpartum care.

“Given it, it can be so fast, everything is so fast. I wanted to know what it was like to breastfeed my baby for the first time. I’ve never breastfed, ”he said.

While pondering her birth, Lancour wonders if having a doula (a non-medical professional who helps clients physically and emotionally during childbirth) was the answer. Especially that doula, Lancour said, as if he were Black, just like him.

“I’ve always experienced birth as a violent way,” Lancour said. “And when I was introduced to the birth of a doula, I felt that every woman had to be available to be a support in the community.”

Lancour recently took part in a four-day doula training in Duluth, where he is from, with the aim of providing customer service.

The training is organized by Everyday Miracles, which helps Minneapolis-based nonprofits connect with doubles. Blue Cross and Blue Shield pay for the program with the largest non-profit health insurance in the state of Minnesota. The training is aimed at hiring more colored doulas, who represent part of the already small doula team.

There is a growing body of research behind the effort, which suggests that doula may have a positive impact on birth outcomes.

Pregnancy care for someone who is not a family member or hospital worker can have positive results in childbirth and then, said Katy Backes Kozhimannil, a public health professor at the University of Minnesota, who has studied the role of doulas in the birth process.

“It’s all about the level of anxiety and agency feelings, such as lower rates of premature births, lower use of pain medications, and lower rates of surgical delivery when not needed,” Backes Kozhimannil said.

But despite these positive results, doulas are economically and logistically excluded for many pregnant women, especially women of color, she said.

Natasha Lancour depicts a portrait at a break while the doula attends a training workshop.

Derek Montgomery for MPR News

‘Someone Like You’

Research shows that women of color and their babies suffer from higher mortality rates and more medical problems during childbirth than the differences associated with generations of institutional racism embedded in the health care system.

Doulas can help improve birth outcomes, especially when doubles share a similar racial and ethnic background to their clients, said Ashley Kidd-Tatge, doula and outreach coordinator at Everyday Miracles.

“Something so important is that someone is arguably entering the most vulnerable space and time,” he said. “Having someone like you can make a difference in the delivery room at all levels medically, emotionally, physically, spiritually.”

Researchers have yet to investigate the doula among women who are pregnant and in childbirth at death rates and medical complications, Backes Kozhimannil said.

But he sees the important role of more color doulas in helping pregnant people who have been marginalized in the health care system for generations.

Backes Kozhimannil, for example, cites his research showing a higher rate of breastfeeding among colored mothers who employed a doula.

Facilitating the path to parenting is even more important for people of color, he said.

“It simply came to our notice then. [from] Structural racism, and we know it produces inadequate results, not only during childbirth, but throughout life, ”said Backes Kozhimannil.

A mess of obstacles

However, access to doula care is uneven, even though the state’s Medicaid program, called Medical Assistance, has been covering the service since 2013.

The program serves a disproportionate number of people of color, but very few of these clients use the doula benefit.

“Something wasn’t working. And we had to try to understand what was going on,” said Amy Bloomquist, director of health design for the Blue Cross population.

Health Insurance partnered with Everyday Miracles to find out what was holding the program together.

What they found was a mixture of challenges and obstacles.

For starters, Medicaid returns doulas for less than $ 500 per pregnancy. Bloomquist said this is roughly a third of what people pay out of pocket for service.

“You only have so many slots in your calendar. And when you can get less than $ 500 for a slot and $ 1500 for a slot,” he said. “It’s not a pillow.”

So Blue Cross doubled the doula payment for Medicaid-covered births – not yet as much as a private patient, but closer.

And it worked with Everyday Miracles to send more claims on a regular basis, so the doulas would be paid for the entire process, instead of making one payment at the beginning of the relationship with the client and another at the birth of the baby.

There are big improvements because babies show up whenever they want, said Debby Prudhom, director of Everyday Miracles.

“Doulas does a very, very valuable job. It’s hard work. It’s a lot of time. It’s about stopping your life,” he said.

But Prudhomme said the return rates are still too low.

“In fact, you can train doulas all day. If they can’t get a decent salary, we won’t remove that barrier,” he said.

Free training doula

In addition to low rates of return, there is too little color doula in Minnesota, especially in rural areas. So, working with the Blue Cross, Everyday Miracles organizes free four-day doula training programs aimed at expanding the work team, as Lancour participated.

Oyate Nixon was in training with Lancour. She had a doula for the birth of her child who knew indigenous traditions. Nixon, who identifies as a Native American, said she has improved her birth experience and wants to share that support with her clients.

“I’m excited to see them go through the door and say, ‘Wow, he’s a native, too.’

A woman poses for a portrait

Oyate Nixon depicts a portrait at a break while the doula attends a training workshop.

Derek Montgomery for MPR News

Kozhimannil, whose research has influenced the state’s decision to extend Medicaid coverage to doula services, said the Blue Cross model is promising.

“I am so pleased to see the focus on increased investment in doula services, the focus on race and geographic equity in the distribution of doula services. I think this is an example of how well things are going.”

At the end of the year, Bloomquist says the Blue Cross will examine its work to see if more Medicaid members used doula. The insurer will tailor the program to what you are learning.

But Bloomquist said one thing will not change: higher doula return rates are sustainable.

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