As numerous Maine hospitals have closed their birthing units in recent years, there’s a movement to increase access to doula services across the state.
Sen. Denise Tepler, a Democrat representing Sagadahoc County, introduced a bill this session requiring MaineCare to cover doula services, and she said another colleague has plans to introduce a similar measure.
During a maternal and child health fellowship with the National Conference of State Legislatures, Tepler said she was given a list of things states can do to improve health equity and the only measure Maine had not yet done was increasing access to doulas for Mainers of all income.
That’s why she introduced L.D. 376: An Act to Improve Maternal and Infant Health Outcomes Through Doula Care.
“In many parts of Maine, women do not have good access to maternity care, particularly in the northern and rim county area,” she said. “Their nearest maternity care center may be two to three hours away from them.”
This is where doulas can step in, said Sarah Tewhey, chair of the Maine Doula Coalition and a doula herself on Mount Desert Island.
Doulas are nonmedical, perinatal care workers who provide ongoing educational, physical and emotional support to pregnant, birthing and postpartum people and their families. However, there is no national standardized training, certification or exam requirement, and standards can vary widely between training organizations, according to the report.
Tewhey said research has found doulas can help reduce the rate of C-sections, make labor shorter and reduce maternal depression and anxiety. They also can improve infant care, such as increasing safe car seat use and safe sleep.
Currently 12 states and Washington D.C. have implemented Medicaid coverage for doula services, according to the National Health Law Program. (MaineCare is the state’s version of Medicaid.)
There are at least 53 doulas in Maine, according to a 2023 perinatal health disparities needs assessment, however the report acknowledged at the time that data was lacking and that the estimate came from internet searches.
The first ever survey of the state’s doula workforce, published last fall by the Maine Doula Coalition, reached 45 doulas and found that they were overwhelmingly white and highly concentrated in southern Maine. The average age was 39, ranging between 23 and 68. About 91 percent of respondents identified as female, 6.7 percent as queer or non-binary and 91 percent identified as white.
None of the respondents said they lived in Somerset, Aroostook or Piscataquis counties. There was one respondent from Washington County and four from Oxford County, “meaning that a large rural area with the state’s highest rates of poverty is not adequately covered by doula services,” according to the report.
More than half of surveyed doulas said they had supported Medicaid recipients and more than half had clients who were completely uninsured. Nearly 70 percent said they had supported a client for free at one point in their career.
In addition, nearly 90 percent of survey respondents said English was their only fluent language. Tewhey said a priority of the coalition is to expand and diversify the workforce because people deserve to have access to a doula who speaks their language and has a shared lived experience.
A recent report by the Maine Permanent Commission on Racial, Tribal and Indigenous Populations found that culturally specific doula programs are one way to address disparities in access to prenatal care across Maine’s racial, indigenous and tribal populations. It recommended Maine consider doula services as eligible under MaineCare.
Tewhey said there are already initiatives to increase access to culturally sensitive care. In Her Presence, an organization in southern Maine that works with the New Mainer community, trained more than a dozen doulas last year to support other immigrants, she said. And the New England Arab American Organization is training more than a dozen doulas to serve Maine’s Arab population.
Tepler said it might be difficult to pass her bill this session given the contentious debate around the budget and MaineCare spending, but she said it’s an important start to the conversation.
Tewhey was more optimistic. The Maine Department of Health and Human Services last year was awarded a $17 million 10-year grant from the federal government to improve maternal healthcare, which requires the state to cover doula services within the first three years of the grant, she said.
“In the context of that grant, it lays more favorable groundwork for legislation to be passed in the next few years,” she said.
