Doula Taja Iglesias and her business partner have built a space in Alexandria, Virginia, that’s all things pregnancy, birth, and childcare. The space includes comfortable couches for birth education classes, a colorful pile of toys for babies and toddlers, and a free supply of diapers and food. Iglesias, the founder of The Momager Co., a doula agency, works hard to make sure other parents can have the support of a doula.
Years ago, Iglesias was giving birth and expressed her wish not to have an epidural for pain, but she felt isolated and that her preferences were dismissed by the medical staff. This experience led Iglesias to create The Momager Co. to fill the gaps that existed in the perinatal process.
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.
Iglesias explained that doulas know what parents want and are somebody that is standing on the side of the parent. She said, “We’re somebody that already knows what your dream birth is.”
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In 2022, Virginia became the fourth state to start reimbursing doulas through Medicaid. This push to address the country’s maternal mortality rates has been an engine for lawmakers looking to give women on Medicaid the support of doula care.
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. However, the services offered and the number of visits covered by Medicaid vary by state.
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.
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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.
Iglesias has decided not to get certified to care for parents on Medicaid. Instead, she raises money to provide doula care for parents on Medicaid outside the system. Iglesias said, “I don’t want to be state-certified with a training that I feel is not full and complete, a training that doesn’t touch on that community aspect of work.”
The services covered are too limited and Medicaid does not allow Iglesias to work with clients as she sees fit. Virginia’s payment covers up to eight doula visits. All but the first visit are limited to one hour, which Iglesias said isn’t enough time.
Private-pay doulas in Virginia commonly charge $1,200 to $3,000 per pregnancy. For families wanting more extensive prenatal or postpartum services, the fee can be as much as $6,000. Virginia’s Medicaid program reimburses doulas $859 per pregnancy.
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Kenda Denia, executive director of Birth in Color, a statewide doula collective in Virginia, welcomed the law at first. “But now we’re looking at certain logistics that are not working,” Denia said.
Denia said the pay is too low and does not reflect the value of the services they provide. “Midwives don’t get paid this. Doctors don’t get paid this,” she explained.
Despite the barriers, Denia applauded parts of the policy. Medicaid coverage of doulas means that more parents can have a “birthing bestie,” she said. For some parents, like Juliana Navia, having a doula made a significant difference in their birth experience. Navia connected with Iglesias at a free clinic and later had Iglesias as her doula. Navia said, “I was stressed giving birth, but my doula helped me. I was advocated for.”
