What Ohio rules should a doula follow? Medicaid regulations raise concerns

When Alicia Warner was pregnant with her daughter, Parma, Ohio, the woman received support from a doula, a trained professional who helps women during pregnancy and after childbirth.

She said the doula supported her by taking her to most doctor’s appointments, and she remembers a scary time during her pregnancy.

“I remember going to hospital because I had symptoms of a severe headache and high blood pressure. She was there, giving advice, asking questions and never leaving me alone,” said the 30-year-old mother of two children.

Warner’s doula, Marie McCausland, has been working in the Cleveland area for three years. She became a doula because she also had a difficult pregnancy.

“I almost died when I gave birth to my son, and that led me to gravitate into the maternal health advocacy space and feel like there was a need for better support in the Cleveland area,” McCausland said.

McCausland also serves as chairwoman of the Ohio Doula Advisory Group, which falls under the Ohio Board of Nursing, and is working to expand access to doula services in the state.

Starting this fall, doulas will be able to receive up to $1,200 per birth under Ohio Medicaid, thanks to rule changes passed in the 2023 state budget.

More than half of all births in Ohio are covered by Ohio Medicaid, so changing the law could dramatically increase access to birth support.

A new system for paying and certifying doulas is being created by the Ohio Board of Nursing.

But doulas on the advisory group question the rules being developed by the nursing board and fear their concerns will not be heard.

Why Medicaid?

Ohio ranks among the highest in the nation for maternal and infant mortality rates. According to the CDC, black women in the U.S., like Warner, are three times more likely to die during or shortly after childbirth than white women.

Studies, such as one published in the Journal of Perinatal Education, have shown that access to a doula can help eliminate these disparities. The study also found that mothers who used doula support were less likely to experience complications during and after childbirth.

Medicaid insurance would make doula services more accessible to low-income families, said Natasha Takyi-Micah, who has researched the topic for the Cleveland-based Center for Community Solutions.

“With the help of doulas, we can reduce maternal mortality, especially for black women and also infants,” Takyi-Micah said.

The Role of the Ohio Doula Advisory Group

In October, doulas will be able to formally become Medicaid providers.

However, McCausland said there are still some serious concerns about title protection and disciplinary action against doulas.

“The Board of Nursing wants to be able to protect the designation of a certified doula and penalize any doula who claims to be a certified doula if they do not obtain that certification through the board of nursing,” McCausland said.

However, she said doula certification organizations, such as Doulas of North America (DONA International), already exist. Other certifying organizations in the state include ROOTT in Columbus and Birthing Beautiful Communities in the Cleveland area.

In a statement to WYSO, the Board of Nursing said the issue of title protection should be considered by the Ohio Legislature. The role of the council is to enforce the law made by the legislator.

“Our work is progressing quickly because the legislator has tasked our team with introducing the regulations by October 3, 2024.” – we read in the statement.

In a recent letter to the Board of Nursing, doulas from the advisory group also cited rigid rules that they say are punitive. This includes a policy that states that the board “may impose one or more of the following sanctions on a person seeking or holding a doula certification: deny, revoke, suspend or impose restrictions on a doula certification, a reprimand, or otherwise discipline a doula certificate holder.”

Sunday Tortelli, another member of the Doula Advisory Group, stated that disciplinary action against doulas is excessive because doulas provide non-clinical counseling services.

“The rules are tailored to the case of a nurse, who has much more clinical responsibility than a doula,” Tortelli said.

Road to the fall deadline

Medicaid requires certification approval by the state’s board of nursing for a doula to qualify for coverage.

Maureen Corcoran, director of the Ohio Department of Medicaid, said some regulations are needed.

“You need to create this type of regulatory oversight mechanism to work with one of the boards that has similar clinical experience,” Corcoran said. – You don’t want doulas to be under the management of plumbers and pipefitters, for example, do you?

Brandy Davis, another researcher at the Center for Social Solutions, said it’s important to involve doulas and ensure the new rules are fair.

“We don’t want a situation where they just say, OK, I don’t even want to practice anymore because this process has been harder than it’s worth,” Davis said.

A spokesperson for the Board of Nursing told WYSO that while the policy-setting process may be difficult, authorities are making progress.

“Providing doulas with Medicaid provider status is an extraordinary and necessary opportunity to support babies and mothers in Ohio,” they said.

As the October due date approaches, mothers and birthing women like Warner will continue to need doula services.

“She explained to me the severity of preeclampsia,” Warner said of her experience with a doula. “I’m grateful she showed me how serious your health is when you’re pregnant.”

The doulas and the advisory group hope that a fair compromise will be reached.

“I’m concerned that if we start something that has glaring problems that are already visible, we could be dooming this program to failure,” Tortelli said.