Katie Schulder-Battis is a Chicago Reporter contributor and student at Northwestern University. This content is made possible through partnership with the Chicago Reporter and the Graduate Science Journalism… More by Katie Schulder-Battis
Chicago women will soon have increased access to quality maternal care. Though implementation of the 2021 Illinois law passed in April 2021 is still in progress, it is expected to begin combatting Chicago’s ongoing maternal healthcare crisis.
The Health Care and Human Services Reform Act, signed into law by Governor J.B. Pritzker nearly two years ago, requires doula services to be covered under medical assistance programs.
“Doulas can be vital to all postpartum moms—it should not be tied to how affluent or poor you are,” said Karie Stewart, a Chicago-based Certified Nurse-Midwife and researcher at University of Illinois Health. “And the state is getting ready to look at insurance paying for Doulas services.”
Chicago’s South Side has been described as a maternal health desert, offering limited birthing options. Doulas provide services similar to midwives, and offer assistance before and after birth with better birth outcomes for women and their babies.
Many doulas have certifications and extensive training, but doulas lack an accreditation body, which has led to difficulty implementing insurance coverage policies. Now the Illinois Healthcare and Family Services department has posted a public comment notice inviting medical experts to offer input and participate in the lawmaking discussion.
“There’s a lot of community doulas and midwives at the table discussing [implementation],” said Stewart. “It’s a good mix of people that are sitting down and making those decisions. Decisions about insurance, specifically Medicaid, and about certifying doulas, are still being discussed.”
The use of a birthing doula has been shown to reduce the likelihood of medical complications prior during and after delivery—issues that have steadily increased in Chicago and disproportionately affect Black mothers.
“Maternity mortality rates are most common postpartum,” said Stewart. “After giving birth, women are so focused on the baby that they don’t always take care of themselves.”
The maternal mortality rate for Black women in Illinois is 142 per 100,000 live births, compared to a national average of just over 17 in 100,000 live births. An Illinois Department of Health committee found that Black women were six times more likely to die of pregnancy-related complications as white women, as of 2018. According to the Illinois Department of Health, as many as 72% of these deaths are preventable.
Doulas can fill in these gaps in care during this vital time.
“There’s a lot of tangible data that show that doulas are reducing cesareans, reducing the use of pain medication, and showing an increase in satisfaction,” said Alexis Robles-Fradet, a health policy analyst for the National Health Law Program. Robles-Fradet specializes in health issues including Medicaid coverage and reproductive health.
Doulas have been shown to spend between six and 11 times as much time with pregnant patients compared with hospital and clinical staff. According to a study involving more than 15,000 women, birthing outcomes for women who use doulas and other forms of continuous labor support include a 31% reduction is reporting a negative experience and a 39% reduction in cesarean procedures, which can lead to life threatening health risks including blood clots and hemorrhaging.
“Using a doula, people feel safer, less traumatized, more respected,” said Robles-Fradet. “And I think that’s really key, and especially with our maternal mortality rates the way they are.”
The use of a doula also improves the health of babies. According to the National Library of Medicine, women who used the assistance of a doula were four times less likely to give birth to a baby with a low birth rate.
The concept of a “birthing companion,” which the World Health Organization officially recommended in 2016, dates back to ancient times, and was even referenced in the Old Testament.
“It’s not a new concept,” said Robles-Fradet. “It’s ancestral work.”