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Doula Taja Iglesias and her business partner have built a space in Alexandria, Virginia, that’s all things pregnancy, birth, and childcare.
This story also ran on WAMU. It can be republished for free.
Comfortable couches in one area invite expectant parents to settle in for birth education classes. In another, a colorful pile of toys await the babies and toddlers. And there’s a free supply of diapers and food. Years ago, as Iglesias was giving birth and expressing her wish not to have an epidural for pain, she felt isolated and that her preferences were dismissed by the medical staff. Today, she works hard to make sure other parents can have the support of a doula.
“We kind of created this to fill the gaps that we realized existed because we had to go through it,” Iglesias said. She’s the founder of The Momager Co., a doula agency dedicated to giving parents care throughout the perinatal process.
Iglesias said one of the widest gaps is the lack of access to doula care for parents on Medicaid.
Doula care has been associated with improved breastfeeding initiation and less maternal anxiety. The perinatal doula care covers education about pregnancy and birth, advocacy for new parents in the hospital, and help after delivery with lactation and recovery. Doulas often work alongside doctors or midwives who provide medical care.
“The doula is the person that already knows what you want. We know what your dream birth is,” Iglesias explained. “We’re somebody that is standing on the side of the parent.”
In 2022, Virginia became the fourth state to start reimbursing doulas through Medicaid. A push to address the country’s maternal mortality rates, which are higher than in other high-income countries, has been an engine for lawmakers looking to give women on Medicaid the support of doula care. For example, another Virginia law requires hospitals to allow an extra person, other than a family member, in the delivery room.
The services offered and the number of visits covered by Medicaid vary by state, but today doulas are covered in 26 states and Washington, D.C. An additional 20 states have considered proposals or are in the process of implementing similar policies.
In Virginia, doulas say the administrative and logistical challenges they encounter are trickling down to moms. A review of the Virginia Certification Board’s Doula Registry this June found just 19 doulas based in Northern Virginia accept payment from Medicaid.
Doulas say that while Medicaid coverage of their services is a good first step, the amount of paperwork required in the approval process and the low reimbursement rates mean that fewer doulas participate in the Medicaid program, reducing access for beneficiaries.
A 2021 law that extended doula benefits to Medicaid enrollees sought to improve the health of Virginia parents and decrease the number of mothers who die during the time surrounding birth. The state’s maternal mortality rate is among the nation’s highest.
As co-chair of the state’s task force on doula regulations, Iglesias helps shape policies that make it easier for moms on Medicaid to get doula care through the program.
To access doula services in Virginia, parents on Medicaid must have a referral from a doctor, and their doula must be approved by the state to care for Medicaid beneficiaries. Iglesias would like to see that process be quicker and less costly for doulas, who pay $75-$150 for certification.