NORTHAMPTON — State Rep. Lindsay Sabadosa says doulas are the “gold standard” of birthing resources — and now access to these “birthing coaches” is set to expand thanks to provisions included in a new sweeping maternal health bill signed into law late last month.

The Northampton Democrat has been pushing the legislation, which for the first time requires MassHealth to cover services offered by doulas, since she was first elected in 2018.

“The coverage by MassHealth means that everyone across the state, not just in specific areas,” will have access to doulas, said Sabadosa, who cited the extensive costs associated with the birthing resource — costs MassHealth had initially been hesitant to accrue.

Doulas act as nonclinical birthing coaches, providing physical, emotional and informational support to an expectant mother before, during and after childbirth. While not replacements for pediatricians, the bill offers doula coverage for up to a year postpartum. They differ from midwives, who focus on providing medical care during pregnancy, birth, and the immediate postpartum period.

While there are different types of doulas — some that specialize in abortion therapy and others with pregnancy loss or miscarriage, for example — this legislation exclusively covers birth doulas.

More than simply therapists, they offer professional, experience-based information on the biology of birthing, providing massages, essential oils and other services. To date, 120 licensed doulas in the state have registered with MassHealth.

Sabadosa said the insurance coverage is the key component in the legislation, and will open the door for additional legislation to support doulas and doula care.

“When we initially sat down with MassHealth, their reaction was, ‘it’s going to be too expensive. We agree with you in theory, but it’s too expensive.’ Over the years we got MassHealth to come on board, and not only have they come on board, but they really want to run with it,” she said, adding that in the past doulas had only been covered in select hospitals, but otherwise patients paid out of pocket.

“Everybody else in the room is there for that person,” speaking of family or friends that may be present while a woman is in labor. “They are really also very, very focused on that baby. And so this is the one person (the doula) that’s focused entirely on the person giving birth and what their experience is and what their pain levels are,” said Sabadosa.

Doula Jennifer Walts has closely followed the legislation. As co-director of the doula program at Northampton’s Seven Sister Birthing Center, Walts said the legislation is a good step to offer care to more patients, but she wished it had gone wished it had gone further.

For example, under the new law, MassHealth will cover eight hours of pre- and post-birth care, not including labor. Pregnant people who paid out of pocket in the past — between $1,650 and $1,850 in western Massachusetts — would have access to significantly more hours of care from their doulas.

According to MassHealth, combined treatment between pre-natal and postpartum must equal eight hours, with doulas making $900 for labor whether the delivery take three hours or three days.

Walts said that despite the 12 months of postpartum care the bill speaks about, most clients have exhausted their MassHealth coverage after prenatal care, and would then be in a situation to pay for the doula services out of pocket if they wished to continue.

Walts also expressed disappointment that the maternal health bill did not include access to prenatal childhood education for parents, which are available for a charge at birthing centers. She said the education would “benefit many people to know their choices for birthing decisions.”

The legislative process

The doula legislation had been in the works for six years. Initially a project of Rep. Patricia Haddad, D-Somerset, Sabadosa took over the cause early in her elected career in 2018. After a presentation by the March of Dimes, an organization dedicated to preventing maternal health risks, Sabadosa realized doulas were a big part of the solution in addressing birthing mortality rates and maternal health care deserts in the commonwealth.

“As I listened to the story, it felt like, ‘oh, if you’re going to try to find ways to ensure that people who are giving birth have support during that process and after that, the doula is ideal, right?’ That’s the gold standard. In fact, what the March of Dimes was suggesting was doulas,” said Sabadosa, adding she had been familiar with doulas due to their presence in Northampton.

After filing the bill “for a few years” alongside then representative now state Sen. Liz Miranda, D-Suffolk, Massachusetts now joins 14 states that have implemented doula care into their Medicaid coverage, and other states considering implementation.

“It’s really exciting to see this after six years,” said Sabadosa.

The maternal health bill more generally, “looked at all the problems with our current system and it offered solutions to them,” with the goal of “filling gaps” in the current MassHealth model by adding midwifery and birth center resources, she said. The bill offers other maternal resources, including lactation and postpartum depression screenings.

Samuel Gelinas can be reached at sgelinas@gazettenet.com.