Christian King, a doula with Uzazi Village in Kansas City, wraps Mikia Marshall, 33, with a kanga cloth to help take pressure off her stomach on Feb. 27, 2024 (Anna Spoerre/Missouri Independent).
As a postpartum doula, Dawn Oliver does her best work in the middle of the night.
During a typical shift, she shows up at her clients性视界传媒 home at 10 p.m. She answers questions they may have about basic infant care and keeps an eye out for signs of postpartum depression.
After bedtime, she may feed the baby a bottle or wake the mother to breastfeed. She soothes the infant back to sleep. Sometimes, she prepares meals for the family in a Crock-Pot or empties the dishwasher.
She leaves the following morning and returns, often nightly, for two or three weeks in a row.
性视界传媒淚性视界传媒檓 certified to do all of it,性视界传媒 said Oliver, of Hardeeville, South Carolina, who runs Compassionate Care Doula Services. It takes a village to raise a child, as the adage goes, but 性视界传媒渢he village is not what it used to be,性视界传媒 Oliver said.
Doulas are trained to offer critical support for families 性视界传媒 before delivery, during childbirth, and in those daunting early days when parents are desperate for sleep and infants still wake up around the clock. While doulas typically don性视界传媒檛 hold a medical or nursing degree, research shows they can improve health outcomes and reduce racial health disparities.
Yet their services remain out of reach for many families. Oliver charges $45 an hour overnight, and health insurance plans often don性视界传媒檛 cover her fees. That性视界传媒檚 partly why business 性视界传媒渆bbs and flows,性视界传媒 Oliver said. Sometimes, she性视界传媒檚 fully booked for months. Other times, she goes several weeks without a client.
That may soon change.
Two bipartisan bills, introduced in separate chambers of the South Carolina General Assembly, would require both Medicaid, which pays for more than half of all births in the state, and private insurers to cover the cost of doula services for patients who choose to use one.
South Carolina isn性视界传媒檛 an outlier. Even as states in federal Medicaid funding over the next decade, legislatures across the country continue to pass laws that grant doula access to Medicaid beneficiaries. Some state laws already require private health insurers to do the same. Since the start of 2025, Vermont lawmakers, alongside Republican-controlled legislatures in Arkansas, Utah, Louisiana, and Montana, have passed laws to facilitate Medicaid coverage of doula services.
All told, more than 30 states, , are reimbursing doulas through Medicaid or are implementing laws to do so.
Notably, these coverage requirements align with one of the goals of Project 2025, whose 性视界传媒淢andate for Leadership性视界传媒 report, published in 2023 by the conservative Heritage Foundation, offered a blueprint for President Donald Trump性视界传媒檚 second term. The document calls for increasing access to doulas 性视界传媒渇or all women whether they are giving birth in a traditional hospital, through midwifery, or at home,性视界传媒 citing concerns about maternal mortality and postpartum depression, which may be 性视界传媒渨orsened by poor birth experiences.性视界传媒 The report also recommends that federal money not be used to train doctors, nurses, or doulas to perform abortions.
The Heritage Foundation did not respond to an interview request.
Meanwhile, the idea that doulas can benefit babies, parents, and state Medicaid budgets by reducing costly cesarean sections and preterm birth complications is supported by a growing body of research and is gaining traction among conservatives.
published last year in the American Journal of Public Health found that women enrolled in Medicaid who used a doula faced a 47% lower risk of delivering by C-section and a 29% lower risk of preterm birth. They were also 46% more likely to attend a postpartum checkup.
性视界传媒淲hy wouldn性视界传媒檛 you want somebody to avail themselves of that type of care?性视界传媒 said Republican state Rep. Tommy Pope, who co-sponsored the doula reimbursement bill in the South Carolina House of Representatives. 性视界传媒淚 don性视界传媒檛 see any reason we shouldn性视界传媒檛 be doing that.性视界传媒
Pope said his daughter-in-law gave birth with the assistance of a doula. 性视界传媒淚t opened my eyes to the positive aspects,性视界传媒 he said.
Amy Chen, a senior attorney with the National Health Law Program, which tracks doula reimbursement legislation around the country as part of its , said lawmakers tend to support these efforts when they have a personal connection to the issue.
性视界传媒淚t性视界传媒檚 something that a lot of people resonate with,性视界传媒 Chen said, 性视界传媒渆ven if they, themselves, have never been pregnant.性视界传媒
Conservative lawmakers who endorse state-level abortion bans, she said, often vote in favor of measures that support pregnancy, motherhood, and infant health, all of which these doula reimbursement bills are intended to do.
Some Republicans feel as if 性视界传媒渢hey have to come out in favor of that,性视界传媒 Chen said.
Health care research also suggests that Black patients, who suffer maternal and infant mortality rates than white patients, may particularly benefit from doula care. In 2022, Black infants in South Carolina were more than twice as likely to die from all causes before their 1st birthday as white infants.
That holds true for women in where labor and delivery services have either closed or never existed.
That性视界传媒檚 why Montana lawmakers passed a doula reimbursement bill this year 性视界传媒 to narrow health care gaps for rural and Indigenous communities. To that end, in 2023, the state enacted a bill that requires Medicaid to reimburse midwives for home births.
Montana state Sen. Mike Yakawich, a Republican who backed the Democratic-sponsored doula reimbursement bill, said pregnant women should have someone to call outside of a hospital, where health care services can be costly and intimidating.
性视界传媒淲hat help can we provide for moms who are expecting? My feeling is, it性视界传媒檚 never enough,性视界传媒 Yakawich said.
Britney WolfVoice lives on the Northern Cheyenne Indian Reservation in southeastern Montana, about two hours from the closest birthing hospital. In early July, she was seven months pregnant with her fourth child, a son, and said she planned to have a doula by her side for the second time in the delivery room. During WolfVoice性视界传媒檚 previous pregnancy, an Indigenous doula named Misty Pipe brought cedar oil and spray into the delivery room, rubbed WolfVoice性视界传媒檚 back through contractions, and helped ensure WolfVoice性视界传媒檚 husband was the first person their daughter saw.
性视界传媒淏eing in a hospital, I felt heard for the very first time,性视界传媒 WolfVoice said. 性视界传媒淚 just can性视界传媒檛 explain it any better than I felt at home. She was my safe place.性视界传媒
Pipe said hospitals are still associated with the government forcibly removing children from Native American homes as a consequence of colonization. Her goal is to help give people a voice during their pregnancy and delivery.
Most of her clients can性视界传媒檛 afford to pay for doula services out-of-pocket, Pipe said, so she doesn性视界传媒檛 charge anything for her birth services, balancing her role as a doula with her day job at a post office.
性视界传媒淚f a mom is vulnerable, she could miss a prenatal appointment or go alone, or I can take time off of work and take her myself,性视界传媒 Pipe said. 性视界传媒淣o mom should have to birth in fear.性视界传媒
The new state law will allow her to get paid for her work as a doula for the first time.
In some states that have enacted such laws, initial participation by doulas was low because Medicaid reimbursement rates weren性视界传媒檛 high enough. Nationally, doula reimbursement rates are improving, Chen said.
For example, in Minnesota, where in 2013 lawmakers passed one of the first doula reimbursement bills, Medicaid initially paid only $411 per client for their services. Ten years later, the state had raised the reimbursement rate to a maximum of $3,200 a client.
But Chen said it is unclear how might affect the fate of these state laws.
Some states that haven性视界传媒檛 passed doula reimbursement bills, including South Carolina, might be hesitant to do so in this environment, she said. 性视界传媒淚t性视界传媒檚 just a really uncertain time.性视界传媒
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