By Demetria Malloy / For The Herald
In Washington state, the maternal mortality rate was 18 deaths per 100,000 live births in 2024. A staggering 80 percent of these deaths were preventable, often due to factors such as lack of access to care, inadequate screening for risk factors, and systemic racism.
While it may not be the first solution to this crisis that comes to mind, birth doulas can be key to turning these numbers around and beginning to make a meaningful difference in each of the above areas.
Focused on offering comfort, advocacy and guidance, doulas are trained to provide physical, emotional and informational support to individuals throughout every stage of the process: before, during and after birth. Doulas are an extension of support that improves the birthing experience for all, with their presence linked to positive outcomes, including reduced rates of cesarean sections, fewer preterm births and improved birthing experiences.
Recognizing the benefits of doula support, Washington state’s Apple Health (Medicaid) launched a birth doula benefit in January 2025 for the first time, a milestone in addressing birth inequities. Aiming to enhance maternal and infant health outcomes by making doula support more accessible to Medicaid recipients, the birth doula benefit will support increased access, improved maternal health and support for doulas across the state.
More individuals can access essential doula services by reducing financial barriers for patients and widening geographic reach. This personalized support improves maternal health through better birth experiences and outcomes, enhanced postpartum support and service coordination and reduced health disparities, especially for communities of color.
For example, Medicaid members who are American Indian or Alaska Native are less likely to receive a postpartum visit after delivery (48 percent), but initiatives such as Community Health Plan of Washington’s proactive support and education around birth doulas have helped raise this rate to 61 percent. The new benefit also supports doulas through increased reimbursement, with birth doulas now eligible for a $3,500 payment per delivery, the highest Medicaid reimbursement for doulas in the nation.
While the new birth doula benefit is crucial to improving maternal and child health equity, there remain significant challenges in ensuring equitable implementation. In Washington, workforce capacity, regional disparities, cultural representation, and public awareness remain barriers to access. With a limited number of doulas — approximately 338 in Washington and the majority only serving King, Pierce, and Snohomish counties — there is a deep need for increased recruitment and retention. Although the recent changes to state programs have introduced new opportunities, they also include complex certification requirements and administrative challenges, which make it difficult for doulas to enroll. Efforts to ensure the program is truly equitable requires that health care leaders acknowledge existing geographic disparities, especially for those in rural areas who face gaps in availability due to limited resources and fewer trained doulas. Transportation barriers also make it challenging to access these essential services.
Additionally, many Medicaid recipients represent diverse cultural and linguistic communities and often face difficulties finding doulas who are culturally competent and understand their unique needs, which can hinder the effectiveness of doula care. There are still too many lingering misconceptions regarding the role of doulas and how they can benefit from their support. With a lack of resources and education, underutilization of this valuable service could continue without intentional efforts to inform communities of the options available to them; at no cost.
Developing and expanding doula care is essential to improving maternal and infant health outcomes in Washington, particularly for underserved communities. To ensure the new doula benefit is successful, health care leaders must focus on increasing access to training, investing in outreach and education, and promoting cultural competency within the profession.
Health care providers, policymakers and community organizations must work to advocate for the equitable reach of Apple Health’s birth doula benefit program, ensuring all birthing individuals receive safe, inclusive and positive support.
Dr. Demetria Malloy is the chief medical officer and chief health officer for Community Health Plan of Washington.
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