Doulas can improve health outcomes for women and children. Insurers are taking notice.

Like many first-time mothers, Nathalia Marin Torres was excited when she found out she was pregnant last August, but she was also a little nervous. This 33-year-old Colombian didn’t click with her OB-GYN and felt like she needed more support to navigate the health care system in the United States.

“When you’re away from your family and your culture, it’s a little difficult,” said Torres.

She was referred to Alexia Franco Pettersen, a Mexican American doula in Minneapolis. Pettersen helps guide Torres through prenatal visits and birth preparation. She will be there for all her labor and delivery, whenever and however long, and provide support after the birth.

Torres likened it to the extra support he would receive if he returned to Colombia with his family.

The decision to work with a doula was made easier when she learned that Pettersen’s $2,400 cost would be covered by her insurance.

This year, UnitedHealthcare became the first major insurer to begin adding doula benefits to plans nationwide. Next year, all employer-sponsored company plans will be eligible for the benefit.

Torres’ program is among those that have received doula coverage this year.

Often, doula services were not covered by insurance, leaving many women unable to access them, said Usha Ranji, director of the women’s health policy program at KFF, a nonpartisan research group. United’s decision reflects increased awareness about doulas and how they can improve the lives of pregnant women, she said.

Dr. Denise De Los Santos, an OB-GYN at University Hospital in San Antonio, said insurance coverage for doulas should be the norm.

“I think it’s time we do something to help mothers,” said De Los Santos, adding that anything that can help more women feel supported during pregnancy is important.

In the past 13 years, at least 26 states have begun requiring Medicaid coverage for doulas, according to the National Health Law Program’s Doula Medicaid Project. Four states — Arkansas, Colorado, Louisiana and Rhode Island — require independent programs to do the same.

“We think that doula care is an important step in improving health care outcomes for women during pregnancy, childbirth and the postpartum period, especially for women of color,” said Dr. Margaret-Mary Wilson, chief medical officer of UnitedHealth Group, the parent company of UnitedHealthcare.

‘Health Equity Interventions’

Doulas are not doctors, nurses or midwives, but they can work with women during their pregnancy, birth and postpartum in the role of advocate and coach.

“When health care systems extend to nurses and doctors that maybe they can learn all the details of a person’s life during a 15-minute prenatal appointment, doulas are able to learn more about those things, provide them with more resources, and amplify their voice,” said Pettersen, who has been a doula for 12 years.

There are many organizations that provide doula certification, including DONA International and the National Black Doulas Association, but no single organization oversees the profession.

Doulas often spend hours getting to know their clients, discussing how they would like to give birth and representing those wishes during labor and delivery. During labor, they can help with non-medical pain management by suggesting different positions and breathing techniques. Once women are home with their baby, some doulas can guide them through breastfeeding and help prepare healthy meals.

The US continues to see high maternal mortality rates, and major medical organizations such as the American College of Obstetricians and Gynecologists have noted that continued support provided by doulas can help improve outcomes for women giving birth.

Studies have shown that doulas can reduce rates of premature births, cesarean sections and postpartum depression.

“The state of maternal health in the country has reached a critical level. The number of preventable pregnancy-related deaths, pregnancy-related complications, the increase in mental health among pregnant women is unacceptable,” said United’s Wilson.

Pettersen, a doula who works with Torres, said she was in delivery rooms where doctors dismissed patients’ concerns about certain medical interventions because of language barriers. “Doulas are a health intervention,” she said.

“Sometimes it takes the providers culturally understanding that this is what the patient wants and getting them on board,” said Pettersen, who also speaks fluent Spanish.

Erica Lane decided to become a doula after having a bad birth experience. “I didn’t want women to go through what I went through,” she said. When her second daughter was born, she felt compelled to get the plague and “her birth plan was literally thrown into the trash.”

Lane, president of DONA International, said she’s glad more women will be able to get doulas because of United’s new benefit, but worries its reimbursement model — which requires people to pay first, and insurance will reimburse them later — will be a barrier for some women. “It’s a good start, but there is room for improvement,” he said.