Stephaine Courtney: State has opportunity to help Black mothers with new doula guidelines

Stephaine Courtney

Across Washington state, maternal health outcomes are driven by race and ethnicity. Black women are three to four times more likely to die of pregnancy-related issues than white women. We are more likely to suffer from pregnancy-related complications such as preterm birth, pre-eclampsia, gestational diabetes and postpartum depression. Black women face barriers in accessing quality health care, including limited prenatal care, insurance coverage and few health care providers who understand and can address our specific needs.

To help close these health equity gaps, the Washington Legislature passed House Bill 1881, which created a professional licensing category for doulas. This laid an important foundation of systemic support for birthing professionals to support communities of color. Our state’s Health Care Authority will be tasked with determining the reimbursement schedule and rules that will accompany the new certification. During the implementation process HCA must ensure its rulemaking outcomes address the needs of the communities HB 1881 was intended to serve.

Here in Spokane, the Shades of Motherhood Network fills the existing maternal care gap by providing resources like community support doulas, peer groups and educational workshops for doulas. We are developing the workforce of doulas by helping people of from the African diaspora become independent doulas in our community. Community organizations like ours can offer culturally appropriate teachings for doulas with a specific focus on the needs of mothers in Spokane and provide an alternate route to obtaining a doula license. As an unlimited community-based training program, Shades of Motherhood combines the ancestral knowledge around maternal health with evidence-based education. These practices ensure certification on an even playing field with white-led institutions that are expensive to attend and more difficult to access, particularly for people in rural areas.

Creating many credentialing pathways for doulas eliminates a barrier to entry that otherwise may deter other Black and Brown doulas from entering the field, “unbundling” their work from hospital reimbursements.

There are currently two ways that bundling restricts doulas. First, including doulas in bundled care payments for pregnancy puts them in direct competition with the rest of the medical care provided unless payment is increased. Second, if doula payments are bundled with the hospital, it ties doulas to hospital births and to hospitals for funding. This discounts the value of postpartum doulas.

Our overburdened medical system struggles to make space for individualized care, and Black mothers are often the first to fall through the cracks. Doulas address this gap in care. They serve both as an intermediary to medical staff for new mothers as well as a socio-emotional support to new families during a time of transition. They help Black families navigate a complex medical system that was not built with their needs in mind, improving the coordination of medical care and ultimately reducing birth complications.

Washington State’s Health Care Authority is also tasked with creating guidelines to decide how doula services are paid for by Medicaid in Washington state. At this critical moment in the policymaking process, the agency has an opportunity to create equitable access for low-income families who would benefit from doula services. For more people of color to become licensed doulas, these services must be reimbursed as an “unbundled” service – meaning doulas can receive dedicated resources to practice care both inside and outside traditional clinical settings in addition to other medically necessary treatment.

Addressing Black maternal health disparities in Washington requires a multifaceted approach: Improving access to quality prenatal care, promoting culturally competent health care providers, addressing systemic racism within health care systems, and supporting legislation that prioritizes maternal health equity. Part of the legislative change that must become standard practice in Washington includes expansion of licensure options for doulas, who have become a critical part of the birth process.

By recognizing and addressing the unique challenges faced by Black women during pregnancy and childbirth, it is possible to improve Black maternal health outcomes and promote equity in maternal care. Black women deserve culturally relevant care throughout their childbirth experience to address the current maternal health disparities and to ensure that both mother and child are well taken care of.

Stephaine Courtney is an art activist, educator and creative influencer in social justice who uplifts voices in creative ways to highlight problems and solutions that are impacting communities. She is the owner of the Learning Project Network and the Shades of Motherhood Network, a new nonprofit creating solutions for women of color and women who have children of color through creative peer groups.