Because I am a Woman

A 2011 Cochrane Review looked at 21 studies involving 15,000 pregnancies and found that women who were provided a doula’s “continuous support” during childbirth experienced shorter labors, fewer Caesarians and were less likely to require the use of instruments — forceps, vacuums — or epidural drugs. “Continuous support during labour has clinically meaningful benefits for women and infants and no known harm,” the review concluded. “All women should have support throughout labour and birth.”

Unfortunately, all women don’t. “The women who stand to benefit the most from doula care have the least access to it — both financially and culturally,” Kozhimannil notes. “Most doulas are white middle-class women serving white middle-class women.” And because few private insurers cover a doula’s services, any woman who wants one in the delivery room is forced to pay for the care — often $400 to $800 — out-of-pocket.

Kozhimannil wondered if state Medicaid programs might actually reap long-term cost savings by providing their poor patients with doulas, thus avoiding the astronomical hospital bills associated with premature labor, Caesarean section and neonatal intensive care. (At the moment, just five states allow public funds to pay for labor coaches, according to the Kaiser Family Foundation.) If doulas really did decrease the risk of complicated pregnancies, it would make sense to invest in their services up front, in the same way that it’s cheaper for an insurer to pay for a customer’s gym membership now than to treat her diabetes later.