Natasha Lancourt is the mother of five children.

Every time she gave birth, Lancourt of Duluth says she felt unable to ask for the postpartum care she needed.

“It can be so hurried in childbirth, everything is so fast. I wanted to know what it’s like to breastfeed a baby for the first time. I have never breastfed before,” she said.

Reflecting on her birth, Lancourt wonders if having a doula, a non-medical professional who supports clients physically and emotionally during the birth process, could be the answer. Especially if that doula, according to Lancourt, was black, like her.

“I always perceived childbirth as something violent,” Lancourt said. “And when I was introduced to doula childbirth, I felt that every woman should have access to this in order to have support in society.”

Lancourt recently took part in a free four-day doula training in hopes of offering services to clients in Duluth, where she hails from.

The training is hosted by Everyday Miracles, a Minneapolis-based non-profit organization that helps clients connect with doulas. The program is paid for by Blue Cross and Blue Shield of Minnesota, the state’s largest non-profit insurance company. The training aims to recruit more doulas of color who are part of an already small doula workforce.

Behind these efforts is a growing body of research showing that doulas can have a positive impact on birth outcomes.

Support during pregnancy from someone who is not a family member or a hospital employee can have positive outcomes during and after childbirth, said University of Minnesota public health professor Cathy Backes Kojimanneel, who has studied the role of doulas in the birth process.

“Everything from higher levels of satisfaction and free will to things like lower rates of preterm birth, less use of painkillers, and lower rates of surgical births when they are not needed,” Bakes Kojimannil said.

But despite these positive results, doulas remain financially and logistically out of reach for many pregnant women, especially women of color, she said.

Woman posing for a portrait

Natasha Lancourt poses for a portrait during a break from a doula training workshop.

Derek Montgomery for MPR News

“Someone who looks like you”

Research shows that women of color and their children face higher death rates and more medical problems during childbirth—inequalities that are linked to generations of institutional racism ingrained in the healthcare system.

Doulas can help improve birth outcomes, especially when doulas are of the same racial and ethnic background as their clients, says Ashley Kidd-Tutj, doula and public relations coordinator for Everyday Miracles.

“There is something very important about having someone enter what is possibly the most vulnerable space and time,” she said. “The presence of someone like you in the delivery room can make a difference medically, emotionally, physically, spiritually, on all levels. “

According to Backes Kojimannil, researchers have not yet investigated whether doulas affect mortality and medical complications in pregnant women and women in childbirth.

But she sees an important role for more doulas of color in helping pregnancies of color who have been marginalized in the healthcare system for generations.

Backes Kojimannil points out, for example, her own research this shows a higher rate of breastfeeding among mothers of color who hired doulas.

Easing the path to fatherhood is even more important for people of color, she says.

“This is important, especially for blacks and indigenous people who are born into a system that we know is suffering. [from] structural racism, which, as we know, leads to unfair consequences, not only during childbirth, but throughout life, ”said Backes Kojimannil.

A tangle of barriers

However, access to doula services is uneven, although the state Medicaid program called Medical Assistance has covered this service since 2013.

The program serves a disproportionate number of people of color, but very few of these clients use doulas.

“Something didn’t work. And we needed to try to understand what was going on,” said Amy Blomkvist, director of population health design at Blue Cross.

The health insurance company partnered with Everyday Miracles to find out what’s holding back the program.

What they found was a tangle of problems and barriers.

First, Medicaid reimburses doulas for less than $500 per pregnancy. Blomkvist said that’s about a third of what people pay out of pocket for the service.

“You have a limited number of calendar slots. And when you can get under $500 per slot versus $1,500 per slot,” she said. “It’s not a problem”.

So Blue Cross has doubled doula fees for Medicaid-covered deliveries—still not as much as a paying patient, but closer.

And it worked with Everyday Miracles to submit more applications at regular intervals so that doulas get paid throughout the process rather than one payment at the start of their relationship and another when the baby is born.

It’s a big improvement because kids show up when they want to, says Debbie Prudhomme, director of Everyday Miracles.

“The barrels are doing a very, very valuable job. This is hard work. It takes a lot of time. It puts your life on pause,” she said.

But Prudhomme said reimbursement rates are still too low.

“The fact remains that you can train a doula all day long. If they cannot receive a decent wage, we do not remove this barrier,” she said.

Free doula training

In addition to low reimbursement rates, there are too few doulas of color in Minnesota, especially in rural areas. So, working with Blue Cross, Everyday Miracles organizes free, four-day workforce-expanding doula training programs like the one Lancourt participated in.

Lancourt was joined in training by Oyate Nixon. At the birth of her child, she had a doula familiar with the traditions of the indigenous peoples. Nixon, who identifies as a Native American, said it has improved her birth experience and she wants to share that support with her clients.

“I breathed a sigh of relief when they saw me walk in the door and said, ‘Wow, she’s an indigenous too.’ You know, it’s like that automatic sense of relativity between us that I think is very important for them to feel comfortable and supportive.”

Woman posing for a portrait

Oyate Nixon draws a portrait during a break from a doula training workshop.

Derek Montgomery for MPR News

Kojimannil, whose research influenced the state’s decision to expand Medicaid doula coverage, said the Blue Cross model holds promise.

“I am so happy to see the attention to increased investment in doula services, attention to racial and geographic equality in the distribution of doula services. I think it’s an example that things are going well.”

Blomkvist says that at the end of the year, Blue Cross will review its work to see if more Medicaid members have used doulas. The insurer will customize the program based on what it learns.

But Blomkvist said one thing won’t change: These higher doula reimbursement rates are permanent.

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