Doulas make birth better — Louisiana is expanding access to them

A young woman sits and feeds her baby on her lap.
Callie Ardoin feeds her 4-month-old daughter hope at her grandmother’s house in Basile, La., on Friday, March 22, 2024. Photo by Alena Maschke

Callie Ardoin was getting ready for a double shift at a Eunice sports bar when she found herself staring at the two solid lines. She was pregnant. The pregnancy was unexpected but easy, she said. Still, when it came time to deliver the baby, she was happy her doula, who also happened to be her aunt, was there with her.

“I couldn’t understand half of what they were saying,” Ardoin said of the nurses throwing medical terms at her. “She translated it for me, basically.”

Her boyfriend was glad to have the support too. “I was an emotional wreck,” the 24-year-old said of the night his daughter was born. But working with the doula, he felt prepared to support Ardoin in the delivery room and beyond.

Numerous studies have shown that doulas — non-medical professionals trained to provide guidance and support during pregnancy and childbirth — improve maternal health outcomes, but so far, they have been out of reach for many expecting mothers. Providers have been scarce, many hospitals were skeptical and insurance rarely covered the cost of the services. Now, that’s changing.

In January, a law went into effect requiring private insurers to cover doula services in Louisiana. The state’s Medicaid program offers reimbursement for the services and at least three managed care organizations — the providers of local Medicaid plans — now cover several appointments throughout the pregnancy, during delivery and after birth as a result.

It reflects a significant shift from when Emily Bergeron, Ardoin’s aunt and doula, first started providing services in Acadiana in 2008.

“They thought my name was Madoula,” Bergeron remembers one interaction with a client’s mother, who had never heard the term, when her daughter introduced Bergeron as “my doula.”

Medical providers, too, were skeptical, she said. “They thought I was going to tell them to go against what the doctor was saying or tell the clients to be combative,” she remembers. Sometimes, she would pretend to be a friend or a sister of her client’s to make sure she would be allowed in the delivery room.

The landscape has changed a lot since then, Bergeron noted. “Before, it was like you had to reach these people, and then teach them what a doula was, and then convince them of why they needed to hire you,” she said. “Now, everybody’s like: Who’s your doula?”

Louisiana has some of the worst maternal health outcomes and infant mortality rates in the nation, and doula services have been shown to improve both. But while having a doula has become much more common, the cost and availability of services, especially in rural areas have made the services inaccessible to many. Some of that is now poised to change.

Established in 2022, Louisiana’s Doula Registry Board has been tasked with creating an application process for doulas statewide to become registered with the state, making it easier for insurance companies to verify a standard of care. Currently, doulas have the option of completing a certification program — and many do — but it isn’t required. There’s no standard requirements for certification, leading to a wide spectrum of specialties and qualifications among practicing doulas.

The board finalized and approved an application process on March 13, and is currently working with a technology company to create the online application platform. The board hopes to begin accepting applications this summer, according to Dr. Veronica Gillispie-Bell, medical director of the Louisiana Perinatal Quality Collaborative and Pregnancy Associated Mortality Review. As medical director, Gillispie-Bell is in charge of selecting the board’s members and is a non-voting member herself.

Finding and keeping members for some positions on the board has been no small feat, which Gillispie-Bell and other members said has slowed down the process.

A young couple stands in front of a house, the woman holds their baby in her arms.
Blair Duplechain, 24, Callie Ardoin, 21, and their daughter Hope stand in front of Ardoin’s grandmother’s house in Basile, La., on Friday, March 22, 2024. Photo by Alena Maschke

For its first few months worth of meetings, the board met and voted via video conference. But once pandemic exemptions to the state’s open meetings law ended and members had to drive to New Orleans to participate and vote, doulas representing farther away regions of the state started dropping off and seats remained unfilled, making it difficult for the board to assemble the number of members required to vote.

Dawn Collins, who just finished her term as chair of the board, said the multi-hour drive was one of the main reasons she gave up her position on the board entirely at the end of her term. Collins, who moved to Shreveport from California with her husband while he served in the Air Force, represented the northwest region on the board along with being its first chair. This meant driving five hours each way to attend meetings and paying for accommodations to avoid driving ten hours in one day.

“I can’t afford to keep doing that,” she said. “It’s just unrealistic.”

All three seats representing the three central and northern regions of the state — Shreveport-Bossier City, Monroe and Alexandria — are currently vacant. In general terms, this also reflects the parts of the state where doula services remain least accessible, said Tiffany Wyatt, who represents Acadiana on the registry board.

“There’s doula deserts,” Wyatt said. While Lafayette doctors have become very welcoming to doulas, Wyatt notes that in some of the more rural areas of the state, skepticism persists and doulas are rare. As a result, Wyatt said cesarean section rates are higher in northern parishes, as fewer women have a doula to educate them on their options and advocate for them at the time of delivery.

“It’s just a more difficult environment to advocate for what families want,” Wyatt said. Meanwhile, having access to a doula can decrease costs to both individual clients and their insurers, Wyatt noted, by preventing the administration of medications or services, like epidurals and C-sections, if a mother wants a natural birth instead.

In rural Acadiana, Ardoin and her boyfriend are now the doting parents of 4-month-old Hope, who coos often and has already learned to hold up her own head. She wants to have more children in the future, Ardoin said, and she wants a doula to be part of that process.