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In the past year, Christian King, a doula based in Kansas City, has supported more than 40 mothers enrolled in Medicaid through their pregnancy, birth and postpartum.

In that role, she helps educate and support families about birth and babies, but her work also takes on a more nontraditional approach.

When one mother鈥檚 water was shut off at four weeks postpartum, King helped her find reconciliation services to turn the utilities back on. When another mom couldn鈥檛 afford car repairs, King found an organization in Raytown that provided financial assistance. She helped one client secure a car seat from the local health department and another fill her closet with baby clothes.

King, 35, hopes that soon, 鈥渏ust like going to the dentist and going to the eye doctor, obtaining a doula and having a doula present is also one of those things that you just have to have on your team as part of services for maternity.鈥�

Doulas do not deliver babies. They advocate for the physical and mental wellbeing of mothers and their families.

For the past 15 months in Missouri, anyone enrolled in Medicaid while pregnant and postpartum can have a doula by their side for free. Now, a group of bipartisan lawmakers are hoping to expand the program in an effort to continue combating the state鈥檚 poor infant and maternal outcomes.

鈥淭he statistics tell a devastating story of the lives lost that could鈥檝e been saved if we put in the proper measures,鈥� said state Sen. Barbara Washington, a Democrat from Kansas City who proposed one iteration of the . 鈥淭here are third-world countries that have better maternal mortality rates than we do.鈥�

The bill is estimated to cost around $300,000. While substantial amid a predicted state budget shortfall, state Rep. also filed legislation to expand the program, said she believes the long-term savings of having fewer Missourians who require medical attention will make up for the cost.

On average, 70 women die each year in Missouri during childbirth or in the first year postpartum. Of those deaths,

In Missouri, than women on private insurance, according to a 2024 report published by the state鈥檚 Pregnancy-Associated Mortality Review that looked at women who gave birth between 2017 and 2021.聽 A 2023 and also pointed to doulas as a solution.

In fall 2024, the Missouri Department of Social Services issued an , citing 鈥渁n immediate danger to the public health, safety or welfare of pregnant women in Missouri.鈥�

Since the program鈥檚 inception, there have been about 625 participants insured through Medicaid who accessed doulas during their pregnancy and postpartum, said Baylee Watts, a spokeswoman for the Department of Social Services. As of this month, 108 doulas were enrolled in the program.

鈥淭he department is encouraged by the level of engagement so far,鈥� Watts said in a statement. 鈥淎nd views the doula benefit as an important component of broader efforts to improve maternal health outcomes across Missouri.鈥�

Legislation filed by state Rep. Tara Peters, a Rolla Republican, has moved the farthest this year, clearing committee in February as part of a 聽Her bill seeks to increase the number of covered doula visits from six to 16.

The average out-of-pocket cost for a doula in Missouri is about $1,500, according to the Missouri Doula Association.

鈥淚鈥檝e just noticed how much extra care a doula can provide, especially for women in high need situations,鈥� said 鈥淒oulas can provide some great education and support for people who maybe don鈥檛 have the extra support.鈥�

This support can also look like serving as an interpreter between medical professionals and pregnant people, navigating insurance, ensuring access to nutritious food or coordinating transportation to medical appointments.

, who previously served as executive director of Monarch Family Resource Center in Farmington, said expanding the number of covered visits can be particularly helpful for women who experience postpartum depression in the year after giving birth.

Her legislation, like Peters鈥�, expands the number of reimbursable visits from six to sixteen, and includes access to doulas for prenatal, birth, postpartum and lactation support.

She said the legislation also hopes to correct some issues doulas have had getting full reimbursement after being in the room for a scheduled c-section, listed as a scheduled surgeries, a classification she said muddled the reimbursement process.

The Department of Social Services previously said the reimbursements could lead to savings for the state in the coming years, including by potentially reducing the Cesarean rate. Watts said it鈥檚 too early to get an accurate look at this result.

said doulas can be a lifesaving set of eyes and ears in homes where women experience domestic violence, a leading cause of pregnancy-associated deaths in Missouri.

鈥淭he doula birth worker can also have a voice in those situations and see what鈥檚 going on outside of that medical office,鈥� she said. 鈥淎nd maybe be able to provide some rescuing relief from dangerous situations for mom.鈥�

To be eligible, and certified through a national or Missouri-based doula training organization. From there, they will be added to a list of eligible doulas overseen by .

Sandra Thornhill, a social justice doula who has advocated in Jefferson City for better legislation for doulas, said it was beautiful to see this policy issue reach across the aisle. And she was happy to see some of the proposals pushing for increased visits, especially in postpartum.

She said it鈥檚 not a question of if doulas should be reimbursed, but of how the state honors the traditional practices and values of doulas in that process. She is wary of any policies that place community health workers under medical or state authority. Instead she hopes to see more collaborative models.

鈥滿y concern is not with recognizing doulas in the Medicaid policy, but with how the bill structures authority and governance over that work,鈥� said Thornill, who describes herself as a womb warrior and policy griot. 鈥淭he question is whether the policy structure strengthens community birth workers or will it place unnecessary burden or medical authority that doesn鈥檛 reflect the roots of the work.鈥�

But she said the progress made in acknowledging and supporting doula鈥檚 work in the past few years is striking, especially as many doulas live 鈥渂irth to birth鈥� as they struggle to pay the bills.

Prior to the state鈥檚 Medicaid reimbursement plan, to help families in need for free as they navigated growing their families.

鈥淭hey do it because they love their people and their community so much that they鈥檙e willing to make this great sacrifice,鈥� Thornhill said. 鈥溾�〩owever, it is not healthy. And it is not fair for the community to have to suffer like that when there are resources available to change that. But again, those resources cannot come with a slap on the wrist. They cannot come with a backlash of 鈥榥ow you鈥檙e under our thumb.鈥欌��

A representative with America鈥檚 Health Insurance Plans voiced opposition to Washington鈥檚 bill in a committee hearing last month.

鈥淲e are very concerned about issues with education, standardization and making sure doulas are all on the same page and we know exactly how they鈥檝e been trained,鈥� he said. 鈥淭here seems to be some resistance out there and a lot of independence within the organizations.鈥�

Washington鈥檚 legislation also seeks to ensure health benefit plans offer coverage for midwifery services. She said this is especially crucial in rural parts of the state, where families don鈥檛 have access to nearby hospitals with maternity wards.

鈥淐urrently, our law does not explicitly require private health plans to cover midwifery. This would close that loophole,鈥� Washington said, adding that this change would shift power back to patients to choose their own provider, especially in rural communities 鈥渨here the hospitals are closing at alarming rates.鈥�

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: [email protected].

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