Their services and postpartum home visits would be covered under Medicaid in new Illinois proposal
By Alison Bowen
If it hadn’t been for her doula, Marlene Durand might not have realized she was in labor.
Durand, 21, now the mom of a 2-month-old son, knew she wanted someone to help guide her through pregnancy. At the end, when she felt something different, she texted her doula. Later that week, she delivered. She said she might not have thought to reach out to a provider, but weekly sessions with her doula left her feeling supported and connected.
“I would have been lost,” she said. “Every time I needed to know something, or reassurance, she was there.”
A new bill would allow doulas to be covered under Medicaid, something maternal health experts say would help protect women. The bill, which is scheduled to be considered in committee Friday by legislators, would cover weekly prenatal doula services, as well as during labor and delivery, and the year following.
New moms covered under Medicaid are five times more likely to die from pregnancy-related causes; Illinois officials have suggested expanding the time that women are covered after childbirth from 60 days to one year postpartum.
Doulas, trained birth coaches who guide a woman through pregnancy and labor, can help by acting as advocates who stay with women throughout the process and empower patients to ask questions and flag health issues. They are not the same as midwives, health care providers who can deliver babies in hospitals.
It’s time for doula services to be accessible and available to everyone, said state Rep. Mary Flowers, D-Chicago, who co-sponsored the legislation.
“It’s lifesaving to women, specifically African American women,” Flowers said, adding that she has heard from people who experienced health issues and even losses after feeling ignored. “Doulas, they will be the voice of these women.”
The Illinois bill would also cover home visits, another initiative that can improve the health of new moms and their infants. Illinois announced a program in 2019 offering free home visits by registered nurses to new Chicago parents three weeks after a child’s birth.
Right now, 33 states finance home visits, according to EverThrive Illinois, a health equity advocacy group, and in just four states, Medicaid covers doula services.
Durand said the weekly calls with her doula helped her feel supported, especially as a full-time student juggling classes, pregnancy and work.
“She always let me know that she’s proud of me and what I’m doing, and that I’m a very strong woman,” she said. “I really love that, because sometimes you just need to hear that.”
When her baby’s heart was being monitored by doctors, she said, her doula was there to reassure her, and was right that everything did turn out OK.
Because of the pandemic, the hours at the hospital during labor were the first time she and her doula, Mary Calderon, met in person. Calderon’s encouragement, suggestions to try different positions and back rubs kept her calm.
“It was the most peaceful experience that a person could go through,” Durand said.
Calderon and Durand connected through
New Moms, a group that provides free doula services. Calderon said a bill like this would open up services to people who need them — and might not know about doulas or be able to afford one.
“The pandemic has really exposed the health disparities, the health inequities, that have always plagued the marginalized communities,” Calderon said. “Often those who need doula support the most, on the margins, don’t have access. If something like this support could be covered under Medicaid, it would really just improve equity and ultimately improve maternal health.”
In 2018, a state health department report on maternal mortality suggested home visiting programs and expanding doula access during pregnancy and postpartum.
Illinois is facing health disparities that Illinois Department of Public Health Director Ngozi Ezike has called “very dire.” Black women in Illinois are six times more likely to die from pregnancy-related conditions; among deaths reviewed by a state maternal mortality commission, 72% were deemed preventable.
“You would think that we live in a third-world country,” Flowers said. “And the saddest part about it, it doesn’t have anything to do with the income of the mom, it doesn’t have anything to do with the ZIP code.”
Among potentially preventable deaths were issues like blood clots, heart conditions or hemorrhages; weekly meetings with a doula, like those Durand had, or being visited by a nurse at home after childbirth, increases the chances for health issues to be recognized and treated.
And the advocacy a doula can provide can be important for women affected by implicit and explicit bias within the health care industry; Rep. Lauren Underwood, who has introduced maternal health legislation, has said integrating more doulas and midwives will be key to eliminating racial disparities.
The state health department report noted, for example, that a pregnant Black woman was screened for drug use multiple times but killed by a blood clot that was never detected. Her pain, the report noted, appears to have been misinterpreted as drug-seeking behavior, illustrating how bias or prejudice can have an impact on Black women.
It’s been 26 years since her pregnancy, but Jill Lexier still remembers the importance of her doula, who supported her throughout delivery and helped in her healing — all of which improved bonding with her baby.
Decades later, she is struck by how such care can be inaccessible.
“It gave me, as a new mother, and my child the best start I could,” said Lexier, a Naperville resident. “It’s still so memorable and so pivotal and so crucial to my experience as a new parent.”