To address differences in maternal health, an insurer at MN seeks care for doulas

Natasha Lancourt is the mother of five children.

Every time she gave birth, Lankour of Duluth said she felt unable to ask for the postpartum care she needed.

“It can be so hasty at birth, it’s so fast. I wanted to know what it was like to breastfeed my baby for the first time. “I’ve never breastfed before,” she said.

As he ponders his birth, Lankour is now wondering if having a doula – a non-medically trained professional who supports clients physically and emotionally throughout the birth process – may be the answer. Especially if that doula, Lancourt said, was Black, like her.

“I’ve always seen childbirth as violent,” Lancourt said. “And when I was introduced to the birth of the doula, it was something I felt every woman should have access to, support in the community.”

Lancour recently participated in a free, four-day doula training in hopes of offering customer service in Duluth, where it comes from.

The training is organized by Everyday Miracles, a non-profit organization based in Minneapolis that helps clients connect with doulas. Blue Cross and Blue Shield of Minnesota, the state’s largest nonprofit health insurer, are paying for the program. The training is aimed at recruiting more colored barrels – which are part of the already small workforce of the barrel.

Behind the efforts is a growing number of studies that suggest that doulas may have a positive effect on birth outcomes.

Support for pregnancy from someone who is not a family member or hospital employee can have positive results during and after birth, said University of Minnesota Public Health Professor Katie Becks Kozhimannil, who studied the role of doulas in the process. birth.

“Everything from higher levels of satisfaction and freedom to things like lower levels of premature birth, lower use of painkillers and lower levels of surgical birth when it’s not needed,” said Bakes Kozymannil.

But despite these positive results, doulas remain financially and logistically inaccessible to many pregnant women – especially colored women, she said.

Natasha Lancourt presents a portrait during a break while attending a doula training seminar.

Derek Montgomery for MPR News

“Someone who looks like you”

Research shows that black women and their babies face higher mortality rates and more medical problems during childbirth – differences that are linked to generations of institutional racism embedded in the health care system.

Doulas could help improve birth outcomes, especially when doulas share racial and ethnic backgrounds that are similar to their clients, said Ashley Kid-Tege, doula and coordinator for daily miracles.

“There is something so important about someone entering perhaps the most vulnerable space and time,” she said. “Having someone who looks like you in the delivery room can make a difference in medical, emotional, physical, spiritual at all levels. “

Researchers have not yet studied whether doulas affect mortality and medical complications in pregnant and postpartum women, said Backes Kozhimannil.

But she sees an important role especially for more colored figs in helping colored pregnant women who have been marginalized within the health care system for generations.

Becks Kozhimannil points out, for example, his own study, which shows a higher rate of breastfeeding among colored mothers who have used a doula.

Ease of parenting is even more important for people of color, she said.

“This is important, especially for blacks and local people who give birth in a system that we know suffers. [from] structural racism and what we know leads to unfair results not only at birth but throughout life, ”said Bucks Kozymannil.

Braid of partitions

However, access to doula care is uneven, although the state-run Medicaid program, called Health Care, has covered the service since 2013.

The program serves a disproportionate number of people of color, but very few of these customers take advantage of the doula.

“Something was wrong. And we had to try to figure out what was going on, “said Amy Bloomquist, director of public health design at Blue Cross.

The health insurer is partnering with Everyday Miracles to find out what is stopping the program.

What they found was a tangle of challenges and barriers.

For starters, Medicaid reimburses doulas for less than $ 500 per pregnancy. Bloomquist said that’s about a third of what people pay out of pocket for the service.

“You only have so many slots on your calendar. And when you can get less than $ 500 per slot for $ 1,500 per slot,” she said. “That’s nonsense.”

So Blue Cross has doubled the doula’s payment for Medicaid-covered births – still not as much as a private paid patient, but closer.

And he worked with Everyday Miracles to file more claims at regular intervals so that the doulas would be paid throughout the process, instead of one payment at the beginning of the relationship with their client and another when the baby is born.

These are big improvements because babies show up whenever they want, said Debbie Prudom, director of Everyday Miracles

“Dooley is doing a very, very valuable job. This is hard work. That’s a long time. That stops your life, “she said.

But Prudhomme said recovery rates are still too low.

“The fact remains, you can train doulas all day. “If they can’t make a decent wage, we won’t remove that barrier,” she said.

Free doula training

In addition to low levels of cost recovery, there are too few colored figs in Minnesota, especially in rural areas. So working with Blue Cross, Everyday Miracles organizes free four-day doula training programs aimed at expanding the workforce – like the one Lancourt attends.

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

“I’m excited to sigh with relief when they see me walk in the door and say, ‘Wow, she’s born, too.’ You know, it’s that automatic sense of relativity between us that I think is very important for them to feel comfortable and supported. “

A woman poses for a portrait

Oyate Nixon means a portrait during a break while attending a doula training seminar.

Derek Montgomery for MPR News

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

“I am so happy to see the focus on greater investment in doula services, the focus on racial and geographical justice in the distribution of doula services. I think this is an example that things are going well. “

At the end of the year, Bloomquist said Blue Cross would analyze its work to see if more Medicaid members used doulas. The insurer will adjust the program based on what he learns.

But Bloomquist said one thing will not change: these higher recovery rates for doulas are constant.

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