Addressing the maternity care crisis: Nevada triples Medicaid reimbursement for doulas

The story was originally published by the KUNR with support from our 2023 National Fellowship.


On a weekday evening, two Reno doulas interacted with their Spanish teacher on Zoom. Doula Emily Barney practiced her language skills by asking questions in Spanish pertaining to pregnancy with teacher Debora Carlomagno, the CEO of Spanish Classes LA.

“Do you have any questions or worries about having sex during pregnancy?” Barney asked in Spanish and English.

Carlomagno is pregnant and due this month. Barney will be the doula by her side.

“I’m hoping that I’ll be ready to go so that I can support you in Spanish during the labor,” Barney said. “That’s going to be my ask. I want you to speak in Spanish so that you can be in your own language.”

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Doula Emily Barney is the co-founder and executive director of the DOULA CO-OP in Reno, Nev., on Oct. 18, 2023

Kat Fulwider/KUNR Public Radio

This is just a small piece of what a doula can do — it’s a broad caregiver role. Doulas are non-medical birth workers who support their clients spiritually, emotionally, and physically before, during, and after pregnancy. Barney said they can work as advocates and birth educators and help families access other resources they might need.

“What doulas do as community resource generalists, I call us, we have the ability to know who the lactation consultants are in our area, who the pediatric dentists are, the folks who help with WIC, and who can support our teen moms. What are the resources for folks experiencing homelessness? And where do they all fit?” she said.

Barney is a co-founder and executive director of the DOULA CO-OP, a statewide nonprofit based out of Reno formed to support, recruit, and retain doulas. The organization also raises awareness about their availability to expectant parents in Nevada.

“The DOULA CO-OP really came from a need on both sides for doula services to become more accessible and more equitable, especially coming off the heels of the Medicaid legislation, and then also for doulas to come together and step out of our silos,” Barney said.

Nevada began enrolling doulas as Medicaid providers in 2022. Earlier this year, the state legislature increased reimbursement rates from $450 to $1,650.

Medicaid plays a huge role in maternal health care, said Stacie Weeks, director of Nevada Medicaid. She’s no stranger to doulas, having used one herself. Weeks said doulas are crucial players in rural communities where there are gaps in accessing care.

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Public health researcher Joyce Abeng (at table from left), Assemblywoman Shondra Summers-Armstrong, and DOULA CO-OP Executive Director Emily Barney present legislation to increase Medicaid reimbursements for doulas in Carson City, Nev., on March 22, 2023.

Lucia Starbuck/KUNR Public Radio

“There’s comfort in having a doula,” she said. “That may be some of the education early on in pregnancy and helping remind them about the importance of prenatal care. Also helping track behavioral health, and reminding that there are support and services out there for moms.”

So far, just 11 individual doulas have enrolled in Medicaid, with two in rural communities – Fernley and Fallon, according to Nevada Medicaid. But the need is much greater.

“One out of every three Nevadans is on Medicaid. It’s a very large payer. And just one out of every two births, so a lot of pregnant women are on Medicaid, and babies are born on Medicaid,” Weeks said.

Anyone can become a doula. There aren’t standardized certifications one must meet to start taking on clients. Typically, doulas establish the necessary business licenses and go through some kind of online or in-person training to learn about the different stages of labor, how to support hospital and home births, non-clinical pain management, and family bonding, among others, according to the DOULA CO-OP. They may also observe several births with a mentor. In order to enroll with Nevada Medicaid, birth doula providers must be certified through the Nevada Certification Board.

In Northern Nevada, the DOULA CO-OP has also collaborated with Renown for doulas to shadow their maternal health care providers. During the two-day training, doulas follow Labor and Delivery (L&D) and postpartum nurses, as well as lactation consultants, and learn about general hospital safety and operating room (OR) protocols. After completion, doulas can move more freely throughout Renown’s L&D department, including the OR, if their client undergoes a cesarean section. The DOULA CO-OP said the long-term goal of the Doula Access Program is to have doulas regularly available for patients giving birth at Renown.

The pandemic shined a light on the importance of doulas having access in the hospital, said Lora Redmon, the manager of nursing for labor and delivery at Renown.

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Renown’s manager of nursing for labor and delivery, Lora Redmon (left), and manager of nursing for postpartum, newborn nursery lactation, and maternal child education, Jennifer Timmons, in Reno, Nev., on Oct. 18, 2023.

Kat Fulwider/KUNR Public Radio

“I think that one of the biggest changes that we made at the very beginning of COVID was we included them as members of the care team,” Redmon said. “Historically, the doula is one of those visitors, and during COVID, we were only allowing one visitor in labor.”

Pregnant people who utilize doula services are less likely to have birth complications, such as low birth weight and cesarean birth. They are also more likely to initiate breastfeeding. Doula care has been shown to reduce racial disparities and lower rates of maternal mortality and morbidity.

Doulas and medical professionals haven’t always gotten along. When board-certified OB-GYN Veronica Gillispie-Bell began practicing 15 years ago, she didn’t have much exposure to doulas, but that has changed over time.

“I also understand some of the barriers, some of the territorial things that happen sometimes in birthing facilities, that will make both the physicians, nurses, as well as the doulas very defensive. Because of my experiences, I, first of all, always encourage my patients to have doulas, but I also tell my patients, ‘We are your team,’ ” said Gillispie-Bell, who is also a fellow at the American College of Obstetricians and Gynecologists and the Medical Director of the Louisiana Perinatal Quality Collaborative.