Pregnant People - Key Activity 15

KEY ACTIVITY #15:

Doula Programs

 

This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; implement condition-specific registries; proactive patient outreach and engagement; pre-visit planning and care gap reduction; care coordination; behavioral health integration; address social needs.

 

Overview

The Department of Healthcare Services (DHCS) added doula services to the list of preventive services covered under the Medi-Cal program in January 2023. Doulas are birth workers who provide health education, advocacy, and physical, emotional, and nonmedical support for pregnant and postpartum persons before, during and after childbirth, including support during miscarriage, stillbirth and abortion. Doulas are not licensed and they do not require supervision. Doulas also offer various types of support, including health navigation, lactation support, development of a birth plan, and linkages to community-based resources.[1] Pursuant to federal regulations, doula services must be recommended by a physician or other licensed practitioner. In November 2023, DHCS provided a standing recommendation for doula services covering the standard package of doula visits (nine total prenatal and/or postpartum visits and labor support) for all eligible beneficiaries across the state.[2]

Doula services will be available in fee-for-service Medi-Cal and through Medi-Cal managed care plans. Beneficiaries in a Medi-Cal managed care plan will receive doula services from their plan. Your practice can find doulas participating in Medi-Cal in your area using the DHCS directory. These doulas may accept patient referrals from your practice.

Doulas support pregnant individuals and their families with education and advocacy. Doulas, when welcomed into your practice, can be a valuable part of the patient’s care team. As described below, studies in diverse populations have demonstrated that clients who use doula services during pregnancy and the postpartum period experience a variety of positive health outcomes.[3] Encouraging your staff to learn about doula services and doulas practicing in your area can improve the quality of care your practice provides.

Doula programs help address equity when they serve clients and families who are at greater risk of poor birth outcomes, often due to historical marginalization. In these circumstances, doulas – particularly doulas who are culturally concordant to their clients – have been shown to:

  • Reduce the perceived negative impact of interpersonal and institutional racism by birthing people of color.
  • Improve rates of participation in medical, prenatal and postpartum care visits.
  • Improve rates of breastfeeding initiation and continuation among clients.
  • Decrease rates of cesarean birth.
  • Decrease the use of pain medication during labor.
  • Lower self-reported symptoms of depression and anxiety postpartum.

Doula programs address social health by:

  • Helping pregnant individuals navigate the healthcare system and advocate for their needs and preferences.
  • Providing culturally appropriate and person-centered care that respects the diversity and dignity of each individual.
  • Enhancing social support and reducing isolation for pregnant people.
  • Empowering pregnant and birthing people to take charge of their own healthcare needs beyond the perinatal period.[4] [5] [6] [7] [8]

Action steps and roles

1. Ensure your staff and providers are trained on doula scope of work and are connected to doulas who may be serving Medi-Cal beneficiaries in your area.

This may involve using the DHCS doula directory, reaching out to Medi-Cal managed care plans, and connecting with community-based organizations in your area who might be knowledgeable about local doula networks.

 

2. Revise practice policies to welcome doulas to accompany patients to their prenatal visits.

Implement best practices to integrate doulas into the care team (this tool kit may serve as a guide).

 

3. Proactively identify patients in your practice who are eligible to receive doula services and screen them for interest.

A Medi-Cal enrollee who is pregnant, or was pregnant in the past year, and either would benefit from doula services or requests doula services. To receive doula services, Medi-Cal enrollees must have a written recommendation from a physician or other licensed practitioner of the healing arts acting within their scope of practice (the existing standing recommendation from DHCS will suffice). Doula services are preventive services, and a written recommendation approves the following:

  • One initial visit.
  • Up to eight additional visits, which may be provided in any combination of prenatal and postpartum visits.
  • Support during labor and delivery (including labor and delivery resulting in a stillbirth).
  • Up to two extended, three-hour postpartum visits after the end of a pregnancy.

Create a workflow to refer interested patients to local doula providers, and provide recommendations for doula services in alignment with Medi-Cal requirements.

 

4. Find more information visit Doula Services as a Medi-Cal Benefit via DHCS.

 

Evidence base for this activity

Knocke K, Chappel A, Sugar S, De Lew N, Sommers B. December 2022 ISSUE BRIEF 1 Doula Care and Maternal Health: An Evidence Review [Internet]. 2022 Dec. Available from: https://aspe.hhs.gov/sites/default/files/documents/dfcd768f1caf6fabf3d281f762e8d068/ASPE-Doula-Issue-Brief-12-13-22.pdf.