Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”January 14th, 2016
As we roll into 2016 one thing is certain: We are on the brink of change in the maternity world! At no time in history have there been so many groups and so many initiatives determined to improve maternity care and birth outcomes. Below is a press release put out by two leading maternity advocacy groups, Choices in Childbirth and Childbirth Connection (a program of the National Partnership for Women and Families) to raise awareness not only of the cost benefit of doula care, but also the tremendous benefit doulas provide to mamas and infants in improving birth outcomes. A doula is “a trained birth attendant who provides non-medical emotional, physical and informational support before, during and after childbirth.” Here is more from the press release:
“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”
“Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”
The brief provides key recommendations to expand insurance coverage for doula care across the country. They have also provided an informative infographic which also summarized the major points (see below).
- Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
- The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
- State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
- The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
- Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
- State legislatures should mandate private insurance coverage of doula services.
Seldom do I revert to childish gloating, but occasionally I just have to go there. Such is the case as I am gleefully reading the report put out by the US Centers for Disease Control and Prevention utilizing data from the National Center for Health Statistics which shows that Black fathers are just as engaged-if not more so-in the rearing and support of their children than fathers of other races.
Excuse me while I take a moment to gloat.
“Ha! Told yaaaaaaa!!”
“Na na na na na, you were wrong!!!!!”
Now you may be wondering why I am so over the moon about this research? Well, there are several reasons.
1. I am sick to death of hearing how black men are no good, they “hit it and quit it” and don’t take responsibility for the children that they help create.
2. I am sick and tired of hearing that all the ills of the world are because of black men.
3. I am thoroughly done with the portrayal of black men-black people actually-as uncivilized and bringing down the status of US culture globally.
4. And I am beyond through with this nation feeling that it is okay to kill a black male simply because he is present in time and space!
Now you all may be wondering, “What in God’s name does any of this have to do with high risk pregnancy and bed rest??” Well, it has everything to do with it. As I have often reported, African American women and infants have the worst birth outcomes of any other race or ethnicity in the US, with 2-4 times the morbidity and mortality of women and infants of other races and ethnicities. An African American infant is more than twice as likely to die before its first birthday than infants of other races and ethnicities and this is due primarily to preterm birth!!!
Are you following me yet?
Let me continue. Ever since I can remember and at least for my adult professional life “the party line” regarding the black family has been,
“It’s the breakdown of the black family, and the absence of black fathers in particular, that is the cause of the high maternal and infant morbidity and mortality that exists amongst African Americans.”
As an African American, and now as a divorced single mama, I knew that isn’t at all the case but had no way of substantiating what I knew to be true. Now there is concrete data obtained by one of the most reputable scientific bodies in the United States that has shown what many of us African Americans already knew. Yes, many more African American children are born to and/or raised by “single” mothers, but what this study has shown is that while the parents of a child may not be married, they may in fact be together (co-habitating) and even if they are not living together, African American fathers are intricately involved in the rearing of and support (and here I do mean financially) of their children, in many cases more than White or Latino fathers.
So again you may be asking, “What does this have to do with preterm labor and infant mortality?” Stay with me.
There is a lot going on in the United States as regards race and quite frankly none of it is good. We have all seen and heard the news reports of police shooting unarmed African American men, racial profiling of both African American men and women, disparities in discipline for African American School Children and so on and so on and so on. These are daily facts of life, daily stressors for African American women, and daily stressors for the infants they are carrying. Additionally, poverty for all families is reaching heights not seen since the great depression and other times in our history. The unemployment rate is still teetering on the high side and looms highest amongst African American men. More depressing is the fact that people of any race with higher educations are now just as likely as those with little to no education to endure a prolonged time of unemployment, and those numbers are again higher for African American men. This amounts to markedly elevated stress for African American men and African American women, their partners. Stress, as well as poverty, is not good for anyone, but particularly not good for pregnant African American women and the infants that they are carrying. We know that stress is an independent risk factor for preterm labor, prematurity and low birth weight all areas in which African Americans have the highest rates. So I think that it is safe to say that poverty, unemployment and racism are far strong predictors and stressors on maternal and infant morbidity and mortality in African Americans than “absentee dads”.
Now I know that many of you are going to come right back at me and say, “But what about black on black violence? What about the crime rates in predominantly black neighborhoods? And we know that many African American men abandon their family responsibilities.” Agreed. But the data from this study, which was broad and the study well constructed, shows that despite all these negative influences, African American men continue to be hands on fathers, and at greater rates than white or Latino fathers.
I wholeheartedly admit that there is much that needs to be done within my culture to heal it. But let’s not look astray too much to lay blame. Much of what we see in these urban, depressed areas is poverty; boarded up buildings, non-existent stores and services, poorer schools and no revenue coming into these areas. Add to that no jobs, no way for people in these areas to support themselves and their families, no money, leads to crime and yes, homicides. Is it okay? No. Is it an excuse? Of course not. But let’s consider the fact that if people in these areas had jobs, income and ways in which to support and sustain their families, then, according to data from the CDC again, crime rates would in fact go down and quality of life would go up.
But I myself have veered a bit off topic. The bottom line is this-even in depressed economic times, even in economically depressed communities, even when jobless, even with the threats to their lives black men are taking care of their children. Contrary to the sensationalized news reports and the stereotypic depictions on television and in movies, black men are taking care of their children-their families. The question now becomes, how can we as a culture, as a nation give them a hand so that this can continue? What are we as a nation, as a culture doing to reduce poverty, increase jobs, increase opportunities for education so that not just black men, but all men, can have the means to raise and support their children?
Finally, we have to ask the question, “Have we too narrowly defined “family”? We know from this work that there are men and women living together and raising their children but not married, or married and helping to raise their spouse’s children. Aren’t they still a family? What about blended families? Large extended families? This is all data that is yet to be analyzed-or even obtained. We know that African Americans being of the African diaspora are a “tribal” people. Migration and dispersion-both voluntary and involuntary-has also played a role in the depressed socioeconomic status of African Americans resulting in decreased community support for families. How are we as African Americans going to re-establish our communities and our families going forward?
There are many unanswered questions and I am sure that many more studies will come about, but what we do know is this: African American men are supporting their children and its time to toss out the stereotypes of them as “absentee fathers” and do what we can to support their efforts and the efforts of all men who want to be active parents to their children.
Jo Jones, Ph.D., and William D. Mosher, Ph.D., “Father’s Involvement With Their Children: United States, 2006–2010”. National Health Statistics Report, Number 71, December 20, 2013
The Causes of Infant Mortality-The US Centers for Disease Control and Prevention
African-American Women and Their Babies at a Higher Risk for Pregnancy and Birth Complications–The US Centers for Disease Control and Prevention
Black Unemployment Rate 2015: In Better Economy, African-Americans See Minimal Gains–International Business Times.
Murry, V. M., Brown, P. A., Brody, G. H., Cutrona, C. E. and Simons, R. L. (2001), “Racial Discrimination as a Moderator of the Links Among Stress, Maternal Psychological Functioning, and Family Relationships.” Journal of Marriage and Family, 63: 915–926. doi: 10.1111/j.1741-3737.2001.00915. x
The Absent Black Father Myth Debunked-by CDC–The Daily Kos
Researchers at the Center for Perinatal Research at the Nationwide Children’s Hospital in Ohio have identified a Urine test that detects proteins in pregnant mamas’ urine that indicate pre-eclampsia. Pre-Eclampsia is one of the most common reasons mamas are prescribed bed rest, and one of the leading causes of preterm labor, prematurity and even death in mamas globally. This new finding is significant because this current research shows that pre-eclampsia, more specifically the proteins found in the urine of pregnant women with pre-eclampsia, are also associated with diseases of neurodegenerative diseases of aging such as Parkinson’s Disease, Mad Cow Disease and Alzheimers Disease.
Dr. Irina Buhimschi, director of the Center for Perinatal Research at Nationwide Children’s Hospital in Ohio and lead author of the paper. While Dr. Buhimschi admits that this is definitely a huge breakthrough in pre-eclampsia research, she admits that physicians and researchers are still no closer to knowing why some women develop pre-eclampsia and why others don’t. Pre-eclampsia is still responsible for some 75,000 deaths annually, mostly in poorer, developing nations. The proteins noted in mamas’ urine are now easily identified with a simple and inexpensive urine test called the Congo Red Dot Test. This simple test merely requires that clinicians place a small amount of urine on a test paper and if a large red dot develops, they know that the urine contains proteins indicative of pre-eclampsia.While we have reported on the Congo Red Dot test previously, a simple test like the Congo Red Dot test could really be a breakthough in treatment in these areas and significantly lower maternal mortality.
Pre-Eclampsia is diagnosed when a mama has high blood pressure and protein in the urine. Mamas will also often experience facial and extremity swelling. Left untreated, pre-eclampsia leads to dizziness, visual changes, seizures, stroke, swelling and weight gain, organ (kidney) failure and death. Pre-Eclampsia is a leading cause of preterm delivery, yet once the baby and placenta are delivered, mama’s symptoms resolve.
The connection between pre-eclampsia and other neurodegenerative diseases such as Alzheimers has yet to be determined. Additionally, no one yet knows if women who develop pre-eclampsia are at greater risk for developing Alzheimers or Parkinson’s Diseases or have some sort of protection. These questions will definitely have to be answered in subsequent research. In the meantime, having a low technology, easy to perform and inexpensive test to screen for pre-eclampsia may well reduce the maternal mortality associated with it tremendously worldwide. Even here in the US, this low lost, low tech test, performed early, may enable obstetricians to begin treating women early with antihypertensive medications and ward off the more serious signs and symptoms of pre-eclampsia. The next step-or perhaps leap-is that perhaps them mamas who have pre-eclampsia may not need to be placed on bed rest-so long as their blood pressures are stabilized on medications, they are no longer spilling proteins into their urine and they are not having any signs of seizure, stroke or organ failure. Finally, combining these findings with the Pluristem Technology, and yes, we may in fact be on the way to eradicating pre-eclampsia!!
Reference: MacLean’s Digital Magazine
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