Quatia Osorio had never heard of a doula before 2011.
But after two miscarriages, the Rhode Island resident started looking into services to support her during pregnancy and delivery of her fourth child. Having a doula was a lifechanging experience, Osorio said. The certified, non-medical provider acted as a coach before, during and after childbirth, staying with her amid an ever-rotating onslaught of doctors and nurses.
That’s what led Osorio to become a doula herself, completing the requisite certification and opening her own doula business, Our Journ3i, in 2015. In the intervening years, she’s seen growth in the number of doulas across the state – including doulas of color like herself – and increased demand for their services.
But that rising demand has been largely limited to a very specific type of client: those who can afford to fork over the out-of-pocket costs for doula services, which are not covered through health insurance.
“You can access a doula in Rhode Island, but can you actually pay for it?” Osorio said. “If people can’t afford it, that’s not access. And it’s also not equity.”
But efforts to change that are gaining traction. Gov. Gina M. Raimondo’s proposed fiscal 2021 budget proposal contains $226,750 for Medicaid reimbursement for doula services, including $94,802 in general revenue funds. A pair of bills introduced in the House and Senate would extend that measure to private insurers.
‘If people can’t afford it, that’s not access. And it’s also not equity.’
QUATIA OSORIO, Our Journ3i owner
Advocates say the proposal is a matter of ensuring equity – both health and socioeconomic. Research indicates that continuous support for women during childbirth, such as that provided by doulas, can lead to better outcomes for mothers and their babies, including reducing cesarean section rates by up to 40%. Doula services are also cited as a part of the solution to reducing the maternal morbidity rate among black women, which is three to four times as high as their white peers nationwide and twice as high in Rhode Island, according to the Centers for Disease Control and Prevention.
“The physical, emotional and informational support that doulas provide before, during and shortly after childbirth can be absolutely invaluable, both at the individual and community level,” said Dr. Nicole Alexander-Scott, director for the R.I. Department of Health.
Members of communities of color are less likely to be able to afford doula services, which cost approximately $1,200 for a basic package of three prenatal visits, labor and delivery, and two follow-up visits. Osorio offers discounted rates – usually $850 but sometimes as low as $250 – as part of her mission to serve exclusively women of color, but even her prices are too high for some prospective clients.
“A lot of times I get requests, and as soon as I give them the fee, they just say thank you,” Osorio said.
Susie Finnerty, co-president of Doulas of Rhode Island, also cited cost as a prohibiting factor for her services and those of the other 60 members of the organization. Despite that, demand for doula services has surpassed the supply; Finnerty said she frequently gets requests from clinics and hospitals asking for volunteer doulas to offer perinatal services.
Doula services complement, rather than compete with, clinical perinatal offerings, according to Peg Miller, chief of women’s services for Lifespan Physician Group Inc. Asked if there was ever a time when a doula’s advocacy or advice conflicted with a medical recommendation during labor and delivery, she could not recall any examples.
Establishing insurance coverage for doula services would not only open access for a broader racial and socioeconomic demographic, it would also make doula services more financially viable for those in the industry.
Osorio’s discount prices, for example, may help clients but aren’t helpful to her business’s bottom line, she said.
“Women who are doulas need to be adequately compensated,” said Rep. Marcia Ranglin-Vassell, D-Providence, who sponsored the House bill.
Ranglin-Vassell also cited the cost-saving benefits of her bill, not only in reducing C-section births but also limiting the money spent on babies in intensive care and other costs. She framed it as advantageous for the state, for doulas and for mothers and babies.
Raimondo’s budget proposal is based on a Medicaid reimbursement rate of $850 per birth, though doulas say they are pushing for a $1,500 reimbursement rate for private insurance. Assuming 10% of pregnant women use doulas and there is a 40% decrease in C-sections, the governor’s budget projects $81,000 in general revenue fund savings in fiscal 2021.
Blue Cross & Blue Shield of Rhode Island declined to comment on the impact of the bill on its insurance offerings. Terrance Martiesian, a lobbyist representing America’s Health Insurance Plans, a trade association of health insurers, who submitted written testimony on the Senate bill, did not return multiple calls and emails for comment.
Nancy Lavin is a PBN staff writer. Contact her at Lavin@PBN.com.
