Alliance forms with $250,000 Walton gift to support doulas, seek coverage

A newly formed group will seek Medicaid and other insurance coverage for doulas, who provide nonmedical support for women going through pregnancy and the birthing process.

The Doula Alliance of Arkansas (DAR) announced Aug. 7 that had it been formed with help from a $250,000 grant from Ingeborg Initiatives, a group seeking to improve maternal health that was founded by Olivia Walton, granddaughter-in-law of Walmart founder Sam Walton. DAR will use that seed money, which will be spread over two years, to hire an executive director.

That part-time position, the search for which was launching that day, will work to gain state recognition of doula certification and work toward coverage of the service by Medicaid and other insurance providers. The grant also will pay for a fall conference, continuing education, and other expenses.

DAR seeks to increase the number of certified doulas in Arkansas and promote their use throughout the pregnancy, birthing process and first year postpartum – particularly in areas with higher mortality rates and a lack of access to maternity care. Doulas provide emotional, physical and informational nonmedical support for pregnant women throughout the birthing process. They bridge the communication gaps between patients and medical providers.

“Doulas provide the personal and continuous support that mainstream medical care just isn’t set up to provide, and this care is an important piece of the puzzle to improve maternal health care in our state,” said Doula Alliance of Arkansas Vice Chairperson Cora Crain.

Crain owns Balanced Mama in Little Rock, which has a staff of three other doulas and also provides massages and other services for pregnant women. A typical doula-client relationship might involve a package that includes four prenatal visits of 45 minutes to an hour, answering phone calls, being present for the birth, and postnatal visits, said Nicolle Fletcher, Doula Alliance of Arkansas chairman and a Conway-based doula who owns Nurturing Arrows Doula Coaching Services.

Fletcher said the standard fee is $800 to $2,000. Another group she directs that trains doulas, Ujima Maternity Network, provided $10,000 this year in scholarships for women who couldn’t afford the service. Fletcher, who is also an apprentice midwife, said 51 doulas are registered with DAR, with many concentrated in central and northwest Arkansas.

Arkansas ranks near the bottom of the nation with regards to maternal and infant mortality rates. Among its 75 counties, it has only 36 licensed labor and delivery providers, one of which is not providing services as it tries to recruit a physician, said Dr. Joe Thompson, president and CEO of the Arkansas Center for Health Improvement.

Other factors contributing to the high mortality rates include the fact that many expectant mothers have risky pre-pregnancy health issues such as hypertension, diabetes and/or obesity. Also, he said the state should do more to monitor mothers after delivery. Gov. Sarah Sanders created the Arkansas Strategic Committee on Maternal Health to develop strategies for addressing the problem.

A review of studies by the National Institutes of Health said the use of doulas was positively associated with reduced cesarean sections, premature deliveries, and length of labor. Doula support in low-income women improved breastfeeding success.

Hajime White of Warren and her daughter, Gwendolyn, said Medicaid coverage would be helpful in their part of the state. Many clients can’t pay them, so the two end up providing the service for free.

“We’re trying to work with pay, but a lot of the moms, they don’t have it,” White said.

Crain, who has been a practicing doula for more than 20 years, first got involved in the profession due to her own impersonal experiences with the health care system as an expectant mother. She said the number of doulas along with families seeking the service has grown. Medical providers see the importance of the role. She said the concept behind doulas is not new.

“Women have been supporting women in all cultures throughout the wonderful and difficult transition to motherhood since the beginning of time,” she said.

DAR came together under the direction and support of Excel by Eight, a group that works to improve outcomes from prenatal through age 8. The Arkansas Community Foundation is DAR’s fiscal agency. The founders have been seeking funding, thinking about policy agendas and talking with partners, said Excel by Eight’s Anna Strong, who is also executive director of the Arkansas Chapter of the American Academy of Pediatrics.

“We’ve been working for about as long as it takes to grow a baby to get to this day. … We’re literally giving birth to the Doula Alliance of Arkansas today,” she said.