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.
Did you know that September is Infant Mortality Awareness Month?
Globally, The United States spends more on healthcare than any other country. Yet, it has worse birth outcomes than many other countries globally. Despite recent declines in infant mortality, the United States ranked 26th among the 29 Organization for Economic Co-operation and Development (OECD) countries in 2010, behind most European countries as well as Japan, Korea, Israel, Australia, and New Zealand (1). The U.S. infant mortality rate of 6.1 infant deaths per 1,000 live births was more than twice that for Japan and Finland (both 2.3), the countries with the lowest rates. Twenty-one of the 26 OECD countries studied had infant mortality rates below 5.0.
Overall in the United States, white infants die at a rate of 5-6/1000 births and Hispanic infants have a similar infant mortality rate. African American Infants die at a rate of approximately 11.4/1000 births. I’m here in Texas and our infant mortality rate for white and hispanic infants is 5.5/1000 births while it is 11.4/1000 for African American Infants. In Travis County (the Greater Austin Area where I live), African American Infants have an infant mortality rate of 11.5/1000 births, whereas white infants have an infant mortality rate of 3.7/1000 births and Hispanic infants 6/1000 births.(2) What is the cause of this disparity?
Researchers and public health officials have numerous speculations as to why the IMR for African American infants is so poor,
- Delayed initiation of prenatal care among African American women
- Lack of access to quality prenatal care
- Lack of insurance
- Preterm labor/Prematurity
- Low birth weight
- Birth Defect
- Maternal health complications
However Dr. Michael Lu, an obstetrician and gynecologist at the David Geffen School of Medicine at UCLA and a professor in the Department of Community Health Sciences and the Center for Healthier Children, Families and Communities at UCLA School of Public Health has proposed other reasons for the birth outcome disparities. In his groundbreaking research paper “Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach“ (3) Dr Lu and his colleagues point to systemic racism in American culture as the underlying cause of the birth outcome disparities. Lu and his colleagues point out that racism passed down through generations, as well as repeated racial slights in the daily lives of African American women has created an allostatic load of stress on African American women that is affecting their overall health, but in particular, their reproductive health and causing the negative birth outcomes we see in African American women and infants. To address these social determinants of health, Lu and his colleagues propose a 12 point Life-Course approach to closing the racial gap in birth outcomes.
- Provide Inter-conception care for women with prior adverse pregnancy outcomes
- Increase access to preconception care for African American women
- Improve the quality of prenatal care for African American women
- Expand healthcare access over the life course for African American women
- Strengthen father involvement in African American families
- Enhance systems coordination and integration for family support services
- Create reproductive social capital in African American communities
- Invest in community building and urban renewal
- Close the education gap
- Reduce poverty among African American families
- Support working mothers and families
- Undo Racism
Lu and his colleagues have presented an approach that not only address issues surrounding pregnancy and childbearing, but also addresses the social issues affecting African American families and communities. Lu makes some very bold statements, ones that some people may be loathe to accept and even less likely to act upon. But as Lu says in his publication,
“We will not close the Black-White gap in birth outcomes without political will to do so. Political will is the ability to command resources to make things happen (i.e. implement the 12 points).”
As the saying goes, “Where there is a will, there is a way!” The question now becomes do we the American people have the will, the actual desire to close this gap?
MacDorman MF, Mathews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports; vol 63 no 5. Hyattsville, MD: National Center for Health Statistics. 2014.
Austin Travis County Health and Human Services Department. Infant Mortality Rate Causes of Death for Travis County, 2000-2011. Data Source, Center for Health Statistics, Texas Department of State Health Services. Texas Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012
Lu, M.C., MD, MPH, Kotelchuck, M., PhD, MPH, Hogan, V., DrPH, Jones, L., MA, Wright, K., PhD, MPH, Halfon, N., MD, MPH. “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach” Ethnicity and Disease, Volume 20, Winter 2010.
Father’s Day is this Sunday, June 21st. How are you planning to celebrate the very special man in you and your baby’s life?
Perhaps you are thinking,
“My baby’s father isn’t in our lives!”
I hear you. I am no longer with my children’s father, yet he is an important part of their lives-and mine as we are co-parenting them. But if you have remarried, or there is a “father figure” in your child’s life who has stepped up and stepped in and is fulfilling the role and duties of father, I invite you to celebrate that man this Sunday (and everyday!!)
I know that this website is Mamas on Bedrest & Beyond, and the whole focus is to provide you with the tools and support that you need to have a fantastic pregnancy and a healthy baby. But I would be remiss, and some may even go so far as to say that my actions would be unethical, if I didn’t highlight the important role of fathers-biologic and otherwise-in the lives of birthing women and their babies.
So let’s start with mamas. Fathers/partners provide emotional support throughout the pregnancy. Yeah, sometimes they just don’t get us, but hey, there are times when we don’t get us either! Those who are present are taken on the rollercoaster ride that is pregnancy; full of ups, downs, mood swings, close calls and the joys of labor, delivery and-the baby! As overwhelming as childbearing is for us, imaging how colossal it must be for men? They have to watch the woman that they love (hopefully) grow, change, be uncomfortable (often times sick!!), be on bed rest, endure the endless tests and treatments and then the grand finale-labor and delivery (or a c-section, major surgery) and be able to do very little to make the situation better for her. For many guys, this is this side of insanity! Guys inherently want to fix things and when it comes to childbearing, after insemination, there really isn’t much for them to do but watch and wait. And yes, for some men, this is too much and they leave. So kudos to those who stay, stick it out and hang in when the going is tough and are a solid rock for their women to lean on and rest upon.
The influence of a father, a daddy (a man who provides more than mere sperm donation!) in the lives of children is priceless. According to the National Responsible Fatherhood Clearinghouse,
“When fathers are involved in the lives of their children, especially their education, their children learn more, perform better in school, and exhibit healthier behavior.”
In 2006, Jeffrey Rosenberg and W. Bradford Wilcox, PhD co-authored a manual on fatherhood through the US Department of Health and Human Services, through the Administration for Children and Families, the Administration on Children, Youth and Families and the Children’s Bureau Office on Child Abuse and Neglect called, “The Importance of Fathers in the Healthy Development of Children.” In this publication Rosenberg and Wilcox note that children raised by loving, married parents learn how a man is to treat a woman in the context of a healthy relationship. They also note that even when the parents aren’t married and don’t live together, children who see their fathers speaking to and treating their mothers with respect and courtesy learn that men are supposed to treat women with respect and courtesy (boys) and they learn that behavior that is not respectful and courteous is not acceptable (girls). In summary, Rosenberg and Wilcox found the following characteristics in children who had active fathers in their lives (regardless of the parental relationships)
- Children with involved, caring fathers have better education outcomes that start in preschool and continue throughout their school careers.
- Children who have an involved father are more likely to be emotionally secure, be confident to explore their surroundings, and, as they grow older, have better social connections with peers. These children also are less likely to get in trouble at home, school, or in the neighborhood.
- Fathers spend a much higher percentage of their one-on-one interaction with infants and preschoolers in stimulating, playful activity than do mothers. As such, children whose fathers engage in rough housing are more likely to learn to cope with aggressive behaviors and learn its okay to strike out and explore without being anxious.
- Children with good relationships with their fathers were less likely to experience depression, to exhibit disruptive behavior, or to lie and were more likely to exhibit pro-social behavior.
- Boys with involved fathers had fewer school behavior problems
- Girls had stronger self esteem.
- Children who live with their fathers are more likely to have good physical and emotional health, to achieve academically, and to avoid drugs, violence, and delinquent behavior.
What this study also found and what was also confirmed by a study done by the US Center for Disease Control and Prevention is that lower income fathers are no less involved in their children’s lives than higher earning dads. In fact, many lower income fathers are more “hands on” with their children, especially those who didn’t live with their children all the time; caring for their children on weekends and for other extended periods of time and providing all the care and nurturing that mothers provide in addition to financial support.
I think that fathers are the unsung heroes of families. Yes, we mamas do much to keep that family moving and shaking, but a good dad really holds the family together. So this Sunday, do a little something special for the dads in you and your children’s lives. And Happy Father’s Day to all the dads!!
Child Welfare Information Gateway. (2006). “The Importance of Fathers in the Healthy Development of Children”. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Written By Jeffrey Rosenberg and W. Bradford Wilcox, PhD.
20 Reasons Why Your Child Needs You to Be an Active Father Prepared by Stephen D. Green, Ph.D., Child Development Specialist, Texas A&M AgriLife Extension Service, October 2000.