New York City pilot to cover costs of doulas for low-income families, but is it enough?

New York’s Department of Health is launching a pilot program starting on March 1 to allow Medicaid to help offset the costs of bringing doulas to underserved and low income communities in Brooklyn and Erie County.

Doulas are non-medical but trained professionals who provide physical and emotional support to pregnant women during and after pregnancy. Studies credit doulas with reducing pregnancy and birth-related complications for mothers and babies, according to NBC News.

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Doulas essentially act as birth coaches, not replacing medical practitioners but enhancing the pregnancy and birthing experience for mothers. Doulas are trained in the birthing practice and earn a certificate for their knowledge. Mothers love doulas because they help them to have shorter labors, lower rates of Cesarean sections, fewer pain meds, and newborns that are more likely to be breastfed, according to Choices in Childbirth, a nonprofit that promotes equity in maternal health care.

The pilot program was first announced in November. Since the announcement, doulas in New York have seemed largely excited about the opportunity to serve more clients. However, some doulas and maternal healthcare advocates have also been cautious to praise the initiative, criticizing the program as being inadequately funded and offering a reimbursement rate that is beneath New York’s cost of living. Similar concerns have also been shared in Minnesota and Oregon, the only other states to offer Medicaid coverage for doulas.

“We are committed to continue working with doulas on implementing this pilot program and look forward to expanding these important services to more women throughout the state,” said Caitlin Girouard, the press secretary for the governor, according to NBC News.

New York’s doula pilot program includes coverage of four prenatal and four postpartum visits, plus labor and delivery, for which doulas would be reimbursed a total of $600 by Medicaid. To put that into perspective, in New York City doulas can cost anywhere from $250 to $4,000, based on their experience level, so in the majority of cases, Medicaid would not cover the full cost of the service.

“Even if you do one-hour visits, that’s seven hours right there already. And then most people’s birth is going to be at least 10 hours,” Yael B. Yisrael, the owner of Flatbush Doulas, told NBC News. And that’s just the start. Doulas can be on call for weeks in advance of the birth and spend days without rest supporting clients in active labor. According to Yisrael, failing to pay a livable wage incorrectly “assumes that you don’t have to survive, too.”

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“It’s a business and it’s not that I can’t be passionate and caring and loving, but I have two children and they also deserve to be able to eat,” she said.

The New York governor’s office said that reimbursement rates and covered services are subject to change as the program progresses.

New York chose Brooklyn and Erie County because they represent the state’s highest number of Medicaid births and infant mortality rates per capita.

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