Pennsylvania House legislators have come out in strong support of maternal doula care with a package of bills affectionately called the “Momnibus.” Unfortunately, the next stop will be the Senate, where, despite bipartisan support, another measure to fairly compensate doulas has languished for over a year.

It’s time for the upper chamber to join the universal push to properly compensate, accredit and recognize doulas. They are the non-medical personnel who help new parents through pregnancy, childbirth and breastfeeding. A 2023 meta-analysis of birth outcomes showed that care from doulas effectively reduced rates of cesarean sections, low birth weights in babies and premature labor — all investments that reduce medical costs for both mother and child, with benefits that may last through their lifetimes. But without the proper compensation and best practices mandated by these bills, the doula community won’t be able to expand in the state.

The biggest boost that the bills provide for doula services is coverage under Medicaid. Right now, new mothers on the low-income health care benefit had to pay for doula care out-of-pocket or with the help of grants. Opening up options to Medicaid recipients will expand doula access for hundreds of thousands of Pennsylvanians: Between 2017 and 2021, a third of all births were covered by Medicaid.

Supporting supportive maternal care is of particular importance for women of color. Pregnant and postpartum Black women in Allegheny County face a death rate two and a half times higher than their white counterparts, so establishing proven practices that focus on cultural sensitivity is vital.

The bills also establish a Doula Advisory Board to gather overall expertise, establish accreditation and education best practices, and highlight the biggest areas of need. It’s a proper supplement to the state accreditation system meant to meet Medicaid guidelines launched two years ago.

The accreditation process juggles the sensitivity of regulating a practice often built from passed-down expertise and experience with the necessity of preventing incompetent providers from causing harm. To that end, the mandatory training remains minimal, while in-depth, detailed letters of recommendation from experts and a review of maternal outcomes play a much larger factor. This careful construction of the regulation has brought in numbers of applications that surpassed expectations multiple times, and the new advisory board should take note.

Maternal care is also a hot topic as rural hospital systems close labor and delivery, postpartum and neonatal units across the state. Six Pennsylvania counties currently offer no maternal medical care at all, leaving expectant mothers with no choice but to travel. While doulas can’t (and shouldn’t be expected to) replace medical providers, their role in creating positive maternal outcomes is vital for addressing larger shortcomings across the traditional medical establishment.

In all, the Pennsylvania Department of Health, nonprofits like the Doula Commission and the state House have all laid the groundwork for the launch of a successful alternative maternal care system. Now, the Senate needs to place the capstone.

First Published: May 13, 2024, 9:30 a.m.