Doula Support in Black Maternal Health

The U.S. currently faces a crisis in Black maternal health. 黑人妇女死于妊娠并发症的比率是白人妇女的2到4倍, and they are more likely to have life-threatening complications of delivery, also called severe maternal morbidity. The Black maternal health crisis reflects many factors, including structural racism and discrimination in health care and society.

Doula Care as Part of the Solution

改善对黑人孕妇护理的一种方法是增加获得助产师的机会. Doulas are trained to provide physical, emotional, and informational support before, during, and after people give birth. 他们不是护士或医生，而是与卫生保健提供者一起工作，以获得安全和积极的分娩体验. For example, doulas help pregnant women understand their options in making birth plans, give encouragement during labor, and ensure their wishes and concerns are heard by the medical team.

In some cases, doulas work in the same communities in which they live. 这些以社区为基础的助产师尤其重要，因为她们往往与她们所帮助的人有着相似的背景. 研究表明，助产师提供的个性化支持改善了母亲和婴儿的分娩体验和结果, 在使用以社区为基础的助产师服务的家庭中观察到更大的好处.

Increasing Access to Doula Care in Medicaid

Medicaid plays a critical role in maternal health, covering 65% of all births to Black women in the U.S. 增加参加医疗补助计划的人获得助产师的机会是医疗保险中心的主要重点 & Medicaid Services (CMS) upcoming Transforming Maternal Health Model (TMaH). 各州有几个实施方案来为助产师提供医疗补助:

• States can submit an amendment to their Medicaid State Plan to CMS for approval.
• 医疗补助管理医疗机构(MCOs)可以选择为所有患者或符合特定标准的患者报销助产师服务.
• 各州可以使用第五章母婴健康服务整笔补助金来支持为医疗补助计划涵盖的孕妇提供助产师服务的社区组织.

州医疗补助机构必须解决两个关键问题，以增加医疗补助患者获得社区助产师的机会:

• Training. 国家要求的培训和执照费用由医疗补助计划报销，可能会很昂贵. When states limit credentialing to select organizations, 他们排除了可能最接近黑人医疗补助人群的地方和社区组织. Solutions include:
  • Provide financial help in the form of waivers, grants, or sliding scale adjustments to make doula training more affordable.
  • 不再要求助产师资格标准获得特定组织的认证，而是允许当地的机构, 培训助产师照顾她们所服务的特定社区的低成本项目. 
  • 为那些有丰富经验但没有接受过正式培训的助产师创建一个“传统途径”或“经验途径”. This means that instead of needing a certificate from a training group, 这些经验丰富的助产师可以使用他们所支持的分娩数量的证据来获得认证.
• Reimbursement. 尽管对助产师来说，医疗补助计划的财政可持续性很重要, 报销率过低将限制参加的助产师人数. Solutions include:
  • Determine a rate or fee that pays a fair wage to doulas, taking into account the cost of living where doulas live, the scope of services they provide, and the number of clients they can serve each month.
  • Reimburse travel time for doulas serving in rural areas, where access to maternity care is often limited.

Partnering with the Community

趣赢平台’s experience of supporting federally funded maternal health programs, 包括CMS孕产妇阿片类药物滥用(MOM)模型和美国国立卫生研究院(NIH)孕产妇健康社区实施计划(MH-CIP), 强调必须采取以社区为中心的办法，解决黑人妇女面临的孕产妇保健不平等问题. By integrating community perspectives and resources into care delivery models, initiatives can be more effective, sustainable, and responsive to the diverse needs of women and families.

To integrate doula care into Medicaid, 我们建议各州与以社区为基础的助产师组织合作，或组建包括助产师和社区成员在内的工作组. By including community input from the start, 各州将有最大的机会增加获得美元和支持公平, respectful care for Black women.

Doulas are not the sole solution to the Black maternal health crisis. 我们需要继续寻找更广泛地支持黑人妇女及其家庭的方法. 这包括倡导促进怀孕期间良好健康的环境, such as ensuring access to affordable healthy food, transportation, and safe, stable housing. These efforts must be undertaken in collaboration with the Black community.

Note from the authors: In this Issue Brief, “妇女”和“产妇”这两个词用来指怀孕或分娩的人. However, 我们承认并肯定，并非所有经历怀孕或分娩的人都认为自己是妇女或母亲. 我们承认并尊重性别认同和表达的多样性，并努力包容和尊重所有个体, regardless of their gender identity or expression.

Contributed by 趣赢平台 experts Rachel Neenan, a Research Associate, Behavioral Health and Health Policy; Dominick Esposito, PhD, a Vice President, Behavioral Health and Health Policy; and Nicole Harlaar, PhD, a Principal Research Associate, Public Health.