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.
I received the following inquiry from a Mama on Bedrest:
“Hi. I’m 24 weeks along and on my last prenatal visit, my OB noted that my cervix was short. After ultrasound evaluation, he determined that a cerclage was needed. I had the cerclage placed, but my OB has not put me on bed rest. I asked if I should limit my activity and he said only if I felt contractions or otherwise uncomfortable.
Most other women that I know who have been in this situation were prescribed bed rest. I’m really nervous that something will go wrong and I will lose my baby. What should I do?”
This is an excellent question!! First and foremost, a Mama should always listen to and follow her health care provider’s recommendations. I say this because you have “contracted” with this person to care for you and your unborn child. It only makes sense that you follow their recommendations. Now, if you find that you disagree with your health care provider on many or at least one major decision, I suggest you first talk with your health care provider and ask why they have chosen the treatment plan that they are implementing. Make sure that you understand the ENTIRE rationale behind their decision, and that you understand and are comfortable with the treatment plan going forward, including potential adverse outcomes.
If you are still uncomfortable after speaking candidly with your health care provider, I suggest getting a second opinion. Sometimes having another assessment of your situation will put your concerns to rest. Also, sometimes another person can explain things differently so that they make more sense to you and ease your mind.
Finally, if you have spoken with your health care provider and not gotten the answers that satisfy you, and you have consulted with another provider and gotten a second opinion-regardless of whether they agree or disagree with your original health care provider, you may want/need to change providers. Now I don’t say this lightly. Changing providers mid-pregnancy is most certainly not optimum, however, if you are really feeling uncomfortable with your current provider, it is in your best interest (and that of your baby’s) to work with a provider in whom you implicitly trust, with whom you feel completely comfortable and who will consult with you every step of the way making sure that you are included in treatment decisions, that you understand all treatment decisions and with whom you can speak to freely and as often as you need. If you don’t feel completely comfortable with your health care provider and feel anxious and uncomfortable with his/her treatment plan, then you may need to consider a change. But again, I highly suggest you do all that you can to work with this person who already knows you and your case.
Now, if it isn’t a conflict with your provider and you are just concerned that you should be on bed rest and they haven’t prescribed it, trust your health care provider as they are doing you a HUGE service not placing you on bed rest if it isn’t medically indicated. In our e-book, “From Mamas to Mamas:The Essential Guide to Surviving Bedrest” I spent an entire chapter discussing how bed rest is not an evidence-based treatment and that many, many obstetricians, maternal-fetal medicine specialists and many of the medical societies caring for pregnant women and their babies are urging providers NOT to prescribe bed rest, but to instead treat the pregnancy complication without the activity restriction. It sounds like this obstetrician is doing just that. What our mama should now do is at her next prenatal visit, ask her health care provider to explain to her EXACTLY why s/he did not prescribe bed rest, what s/he expects to happen with cerclage alone, what other treatments they will implement if the cervix continues to shorten to prevent preterm birth and what she can do to improve her pregnancy outcomes. In this way, Mama will have all the information she needs to take exquisite care of herself and her baby-and hopefully have all her fears and anxieties addressed and “laid to rest.”
What was your response to being put on bed rest or not being prescribed bed rest? Share your experience below in our comments section.
If you want to learn more about Bedrest not being an evidence based treatment for the prevention of preterm labor and preterm birth, read all about it in our e-book, “From Mamas to Mamas: The Essential Guide to Surviving Bedrest” available for immediate download from Amazon.com.
Mamas on Bedrest:Unnecessary Medical Interventions in Labor and Delivery May be Putting Mothers, Babies at RiskJanuary 20th, 2015
I am happy to present to you a podcast interview with Carol Sakala, Director of Childbirth Connection Programs for the National Partnership for Women and Families. She has graciously stopped by today to share with us a landmark comprehensive report put out by Childbirth Connection and National Partnership for Women and Families called, The Hormonal Physiology of Childbearing and Its Implications for Women, Babies and Maternity Care. This report is unlike any other report on maternity care to date. Compiled by Dr. Sarah J. Buckley, the report is a review of over 1100 research papers and reports examining the best practices for maternity care and the best practices that protect and enhance the hormonal systems that are the most essential and influential in pregnancy and childbearing.
The report consists not only of the research and the evidence for each practice recommended, Childbirth Connection has also developed extensive patient and clinician resources that are available for free on the Childbirth Connection website. I am so grateful to Ms. Sakala for taking the time from her busy schedule, on a holiday, to explain the particulars of the report and to share some particular nuances that are beneficial to Mamas on Bedrest.
I apologize in advance for the recording. My microphone is more powerful than I thought picking up background noise from outside despite closed doors and windows. Deleting the noise caused some of the interview to be lost. So bear with the noise, in the beginning as the information is just too good to lose.