Arkansas trails much of the nation in maternal mortality rates and in birth outcomes. Could doulas be a small part of the solution? What would be the other parts?
Doulas provide emotional, physical and informational nonmedical support for women during childbirth. They bridge the communication gaps between the mother and the medical staff.
They also support the mother before and afterwards. Nicolle Fletcher, who owns Nurturing Arrows Doula Coaching Services in Conway, said a typical relationship also includes prenatal and postnatal visits.
According to the KFF health research organization, the maternal mortality rate in Arkansas from 2018 to 2022 was 38 deaths per 100,000 births – the deaths occurring within 42 days of the pregnancy’s end. That ranks among the worst in the country.
Meanwhile, the March of Dimes says one in nine Arkansas babies was born preterm in 2022. The rate is one in 10 nationally. It says 309 babies died before their first birthday for a rate of 8.6 per 1,000 live births. Nationally, the rate is 5.4. Arkansas’ rate of cesarian sections, 33.7%, is slightly higher than the 32.1% national rate.
Research has shown that doulas can lead to better birth outcomes. A review of studies on the National Institutes of Health website states doulas were positively associated with reduced cesarean sections, premature deliveries, and lengths of labor. Doula support in low-income women improved breastfeeding success.
Cora Crain of Little Rock became a doula after her own impersonal childbirth experience with the medical system. She said a culture of fear regarding childbirth is being handed down to American women. Doulas help women gain confidence in their body’s ability.
Doulas must be paid for their work like anyone else. Fletcher said a typical relationship might cost between $800 and $2,000. Some of the mothers who most need the services can’t afford them. Hajime White of Warren and her daughter, Gwendolyn, often provide their services for free.
“We’re trying to work with pay, but a lot of the moms, they don’t have it,” White said.
On Wednesday, doulas announced they were forming the Doula Alliance of Arkansas. Fletcher is the chair and Crain the co-chair.
The group is forming with the help of a $250,000 grant from Ingeborg Initiatives, whose mission includes improving maternal health. Olivia Walton, granddaughter-in-law of Walmart founder Sam Walton, founded it.
The Alliance (www.doulaallianceofar.org) will use part of that money to hire a part-time executive director who will organize a conference, help provide continuing education, and lobby legislators and policymakers for Medicaid funding and insurance reimbursements for doula services.
This will be an interesting discussion. Gov. Sarah Huckabee Sanders and state lawmakers recently cut $500 million in state income taxes and probably aren’t done, so the money is not unlimited. At the same time, Arkansas is not in a Medicaid-expanding mood at the moment. It’s one of only four states that provide new mothers with port-partum Medicaid coverage for only 60 days after birth rather than a year, and two of the others are planning to extend to a year.
But the state is considering how to address the state’s poor maternal health outcomes. Sanders created a commission to study the issue. Instead of extending Medicaid coverage, those mothers could be enrolled in the state’s ARHOME health insurance program.
Arkansas has a lot of challenges in this area. In a state with 75 counties, there are only 36 licensed birthing services providers, and one of those is currently inactive because it’s trying to recruit a physician. In Searcy County, the median travel time for birthing services in 2022 was 73 minutes, according to the Arkansas Center for Health Improvement. ACHI President and CEO Dr. Joe Thompson said many women have pre-pregnancy health issues such as hypertension, diabetes and obesity. Care is also lacking for women post birth.
These are huge systemic challenges. Having more doulas alone would not solve them.
But it would be a simple, achievable, concrete step that doesn’t require any wheel reinventing. We’ve done this before. In fact, we’ve always done it.
“Women have been supporting women in all cultures throughout the wonderful and difficult transition to motherhood since the beginning of time,” Crain said.
The big question that will come before lawmakers is, should Medicaid pay for it? And whether or not that’s so, what else should be done?
Steve Brawner is a syndicated columnist published in 17 outlets in Arkansas. Email him at brawnersteve@mac.com.
