This story comes to you from MPR News, through a partnership with Sahan Journal.

Natasha Lancour is the mother of five children.

Each time she gave birth, Lancour, of Duluth, says she felt unable to seek the postpartum help she needed.

“During work it can be so rushed, everything is so fast. I wanted to know what it is like to breastfeed my child for the first time. I’ve never breastfed before,” she said.

As she reflects on her births, Lancour now wonders if having a doula — a non-medically trained professional who supports clients physically and emotionally through the birthing process — might have been the answer. Especially if this doula, says Lancour, was black, like her.

“I’ve always experienced birth as a kind of violence,” Lancour said. “And when I was introduced to doula birth, it was something that I thought every woman should have access to, to have support in the community.”

Lancour recently participated in a free four-day doula training in hopes of bringing the service to clients in Duluth, where she is from.

The training is hosted by Everyday Miracles, a Minneapolis-based nonprofit that helps clients connect with doulas. Blue Cross and Minnesota’s Blue Shield, the state’s largest nonprofit health insurer, pay for the program. The training aims to recruit more doulas of color — who represent a slice of the already small doula workforce.

Behind this effort is a growing body of research that suggests doulas can have a positive impact on birth outcomes.

Pregnancy support for someone who is not a family member or hospital employee can have positive results during and after birth, said Katy Backes Kozhimannil, professor of public health at the University of Minnesota, which studied the role of doulas in the birthing process.

“Everything from higher levels of satisfaction and sense of agency to things like lower rates of preterm births, lower use of painkillers, and lower rates of surgical deliveries when not needed “, said Backes Kozhimannil.

But despite these positive results, doulas remain financially and logistically out of reach for many pregnant women — especially women of color, she said.

Natasha Lancour portrays a portrait during a break from a doula training workshop. Credit: Derek Montgomery | MPR News

‘Someone who looks like you’

Research shows that women of color and their babies face higher death rates and more medical issues during childbirth — disparities tied to generations of institutional racism embedded in the healthcare system.

Doulas could help improve birth outcomes, especially when doulas share similar racial and ethnic backgrounds with their clients, said Ashley Kidd-Tatge, doula and outreach coordinator for Everyday Miracles.

There is something so important about bringing someone into arguably the most vulnerable space and time… Having someone like you in the birthing room can make a difference medically, emotionally, physically, spiritually, at all levels.

Ashley Kidd-Tatge, doula and outreach coordinator for Everyday Miracles

“There’s something so important about someone stepping into arguably the most vulnerable space and time,” she said. “Having someone like you in the birthing room can make a difference medically, emotionally, physically, spiritually, on every level.”

Researchers have not yet investigated whether doulas have an impact on death rates and medical complications among pregnant women and women giving birth, Backes Kozhimannil said.

But she sees an important role specifically for more doulas of color to help pregnant women of color who have been marginalized within the healthcare system for generations.

Backes Kozhimannil points, for example, to his own research that shows a higher breastfeeding rate among mothers of color who employed a doula.

Easing the path to parenthood is even more important for people of color, she said.

“It is important, especially for black and indigenous people who are born into a system that we know is suffering [from] structural racism, and which we know produces inequitable outcomes, not just in childbirth, but throughout life,” Backes Kozhimannil said.

A tangle of barriers

Yet access to doula care is uneven, even though the state’s Medicaid program, called Medical Assistance, has covered the service since 2013.

The program serves a disproportionate number of people of color, but very few of those clients use the doula benefit.

“Something was wrong. And we had to try to figure out what was going on,” said Amy Bloomquist, director of population health design at Blue Cross.

The health insurer partnered with Everyday Miracles to find out what was holding the program back.

What they discovered was a tangle of challenges and obstacles.

To start, Medicaid reimburses doulas $47 for each visit and less than $500 for each birth. Bloomquist said that’s about a third of what people pay out of pocket for the service.

“You only have a limited number of slots in your schedule. And when you can get less than $500 slot versus $1,500 slot,” she said. It’s obvious.”

So Blue Cross doubled the doula payment for Medicaid-covered births — still not as much as a private paying patient, but closer.

And it worked with Everyday Miracles to submit more claims at regular intervals, so doulas get paid throughout the process, instead of one payment at the start of the relationship with their client and another at birth. of the baby.

These are big improvements because babies show up when they want to, said Debby Prudhomme, director of Everyday Miracles.

“Doulas do very, very valuable work. This is a difficult work. It’s a lot of time. It puts your life on hold,” she said.

But Prudhomme said reimbursement rates are still too low.

“The fact remains, you can train doulas all day. If they can’t earn a living wage, we don’t remove that barrier,” she said.

Free doula training

In addition to low reimbursement rates, there are too few doulas of color in Minnesota, especially in rural areas. So, in conjunction with Blue Cross, Everyday Miracles runs free four-day doula training programs aimed at expanding the workforce — like the one Lancour attended.

Joining Lancour in the lineup was Oyate Nixon. She had a doula for the birth of her child who was knowledgeable about Native traditions. Nixon, who identifies as Native American, said it improved her birth experience and she wants to share that support with her clients.

“I’m thrilled to have that sigh of relief when they see me walk through the door and they’re like, ‘Wow, she’s Native too.’ You know, it’s like, it’s this automatic sense of relativity between us that I think is very important for them to feel comfortable and supported.

Oyate Nixon portrays a portrait during a break from a doula training workshop.
Oyate Nixon portrays a portrait during a break from a doula training workshop. Credit: Derek Montgomery | MPR News

Kozhimannil, whose research influenced the state’s decision to extend Medicaid coverage to doula services, said the Blue Cross model holds promise.

“I am so happy to see the attention to greater investment in doula services, the attention to racial and geographic equity in the distribution of doula services. I think that’s an example of things going well.

At the end of the year, Bloomquist says Blue Cross will analyze its work to find out if more of its Medicaid members have used doulas. The insurer will modify the program based on what they learn.

But Bloomquist said one thing won’t change: These higher reimbursement rates for doulas are permanent.

Correction (June 16, 2022): This story has been updated to correct the amount reimbursed by Medicaid for doula work.