Doula Care Reduces C-sections, Pre-term Birth & Cuts Birthing Costs by a Net $1,000

AHCCCS Actively Working Toward Incorporating Doula Care as a Covered Service but ADHS Still Hasn’t Developed the Certification Regulations

Those of you that attended the health equity conference last week were treated to a terrific late morning panel discussing a range of reproductive health topics including: 1) maternal mortality interventions; 2) local health policies that promote access to care for birthing people and infants; 3) overcoming barriers to care for birthing people and infants in Arizona, and 4) opportunities for cross-sector collaborations.

Several of the speakers (DeShawn Taylor, MD, Jennifer Piatt, JD, Zaida Dedolph Piecoro,, Sara Salek, MD, and Jacqueline Badine) mentioned the role that Doula care can play in improving birth outcomes (especially Ms. Badine). Their discussions inspired me to take a deeper dive into Doula care this week, so here goes.

A doula is a trained professional who provides physical, emotional, and informational support to a woman throughout her pregnancy, childbirth, and postpartum period. Doulas act as a facilitator between the laboring women and her physician by ensuring that the mother gets the required information to make informed decisions.

Several studies have shown that moms who have doula services during their pregnancy and delivery have fewer cesarean sections and epidurals, reduced premature births, higher rates and a longer duration of breastfeeding, while substantially reducing birthing costs

In March 2014, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal medicine issued a consensus statement which explicitly stated that published data has indicated better labor and delivery outcomes when continuous support personnel such as doulas are used. In addition to improving birth outcomes, doula care has a high return on investment.

Doula care reduces healthcare costs by lowering the rate of pre-term and C-section deliveries to the tune of about $1,000 per doula-supported birth

Fortunately, the word that doula care improves health outcomes while reducing healthcare costs has struck a chord- and Arizona policy is slowly moving toward integrating doula care into the network, including AHCCCS coverage.

The strategy for building doula care into the network is much like the model we used for Community Health Workers…  build a professional certification process, followed by amending AHCCCS’ waiver with CMS to provide for reimbursement for the services.

Back in 2021, the legislature passed, and the governor signed a new law [ARS 36-766.01-09] charging the ADHS with developing rules to certify doulas including a scope of practice, qualifications, standards for education and training programs and compliance criteria. The law gave ADHS ‘exempt’ rulemaking authority- which is essentially the diamond lane for writing rules (there’s no excuse for slow-walking them).

While ADHS hasn’t made any tangible progress on that rulemaking yet, they’ve at least published a ‘Notice of Public Information‘ with the Secretary of State.

The slow pace of the rulemaking shows that finishing the rule isn’t a priority for the current ADHS director, but it might be a higher priority for whoever is appointed to that post a few months from now.

At the Health Equity Conference last week, AHCCCS’ Chief Medical Officer (Dr. Sara Salek) mentioned that the agency is in the process of preparing an amendment to their state plan to incorporate doula care as a covered service. Hopefully the next ADHS director will get on the stick and finalize the doula certification rules in time for certification to be available by the time AHCCCS is able to complete their paperwork with CMS. 

Also See:  Doula Coverage to Help Minimize Arizona’s Birth Woes