International Doula — Volume 21, Issue 1
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3 Public Health Programs: What DONA International Doulas Serving In The United States And Territories Need To Know Amidst The Economic Recession
Jill Wodnick, M.A., LCCE

What Dona International Doulas Serving In The United States And Territories Need To Know Amidst The Economic Recession

Birth doulas continue to impact and imprint women’s birth and breastfeeding experiences.In the past decade, publically funded doula programs have been embraced through federal funds and state health departments throughout the United States that focus on the role of serving low-income women at greatest risk for poor birth outcomes.The work of DONA International, Health Connect One and dozens of local doula programs are bridging a gap to bring doulas to the table for public health.

Based on the new Affordable Care Act, there are public health programs that help keep doulas within their scope of care and compliment a client’s need. My hope is to make this an ongoing article, highlighting community health programs and funding programs that are relevant to doulas. To start the conversation, which I encourage doulas to research further based on state and regional groupings because of differing enrollment eligibility, I will highlight three major programs. These are: Medicaid for uninsured pregnant women; the WIC program from the U.S. Department of Agriculture and Home Visitation programs for pregnant and new families. Many of the programs listed below are intended to improve the health of low- and moderateincome women.

Since 2008, the number of Americans living in poverty has risen by 6 million and the number of Americans on food stamps has risen by 14 million. As birth doulas, we must be mindful and aware that many families have greater needs in our country right now than in recent decades.Expanding our own DONA International resource guide to include these perinatal social service phone numbers is an important step for the health of all expectant families.

Medicaid — when pregnant women do not have private insurance

Currently, there are 4.2 million pregnant women each year in the United States.Forty-one percent of all births are covered by Medicaid, public health coverage funding services for women without insurance. In fact, Medicaid covers a greater percentage of births, including 56 percent of births in Texas, 46 percent of births in California, and 70 percent of births in Louisiana1.

Medicaid enrollment and eligibility is based on how each state designates income levels. When birth doulas meet with expectant parents without health insurance, a doula can simply have the local Medicaid office’s phone number handy. Usually enrollment occurs at the county social services agency and a client would need to bring identification and proof of income2. Medicaid coverage for pregnant women includes prenatal care through the pregnancy, labor and delivery, and for 60 days postpartum as well as other pregnancy-related care.

Because Medicaid eligibility varies at the state level, I believe all doulas working in the United States should read and reference the report by the Kaiser Family Foundation: State Coverage of Perinatal Services: Summary of State Survey Findings 20093. Although this report is a few years old, birth doulas will see it is important that some states will cover childbirth education through Medicaid and other states do not.For example, starting in 2008 in North Carolina, childbirth educators are able to charge for ten hours of education compared with previous years that only reimbursed for eight hours of childbirth education. In addition, this report is quite informative about birth options for pregnant women enrolled in Medicaid, explaining that currently 29 states and Washington, D.C., cover birth centers and 16 states cover home births through Medicaid.

A birth doula who is also trained as a childbirth educator and wants to be able to receive Medicaid reimbursement should sign up for a free NPI (national provider identifier) number4.

The WIC Program: Breastfeeding support and food vouchers for women and children

The United States Department of Agriculture’s WIC (Women, Infants and Children) program provides food, nutrition and breastfeeding support for incomeeligible pregnant women and mothers with children under the age of 5 years old. The program states that “during Fiscal Year (FY) 2010, the number of women, infants and children receiving WIC benefits each month reached approximately 9. 17 million. For the first eight months of FY 2011, States reported average monthly participation just below 9 million participants per month.”5

Many pregnant women or women with children less than the age of 5 do not realize if their family income is less than $42,643 for a family of four, the WIC program offers food vouchers accepted at farmer’s markets, nutritional counseling and even electric breast pumps for women returning to work or school. WIC employs nutritionists, IBCLCs and breastfeeding peer counselors who develop a relationship with families. Ideally, the pregnant woman begins prenatal breastfeeding education early in her pregnancy and learns how the WIC programs support breastfeeding, with incentives for moms who want to exclusively breastfeed. Even if a woman has private insurance, she can still apply for WIC. WIC has free posters and DVDs that all doulas can learn from and share6.Find your local WIC agency through your Department of Health.

Home visitation services for pregnant women and new parents

As birth doulas, we may visit our clients prenatally a few times to develop a trusting relationship and share resources. After the birth, we do another home visit to process the birth, assist with breastfeeding and offer information about community programs. Our experience of home visits is a small but potent way of building a trusting rapport and hearing the needs of our clients. Many times, we may hear that the needs of an expectant or new family are outside the scope of our care as birth doulas. All doulas should know the free and voluntary home visitation programs that exist in the United States. Early Head Start, Healthy Families, Parents as Teachers and Nurse Family Partnership are used in all states and territories, and doulas can easily link their clients with these services. The home visitation programs vary but offer a comprehensive way of supporting pregnant women and new parents, focusing on developmental milestones, playing with infants, expressive language and helping new mothers identify their own goals.

In Newark, New Jersey, the home visitation programs meet quarterly, sharing data on breastfeeding initiation and retention and talking about tools for keeping families engaged. The New Jersey DONA International meeting this past spring featured Felicia Patten from Prevent Child Abuse — NJ who explained to the attending doulas the various home visitation programs and how doulas can make a referral. One of the ways to remain within our scope of care as birth doulas is to make the referral and the family can decide if home visiting is a service they would like. In addition, many programs like Healthy Families, Parents as Teachers and Early Head Start home visitors have hired doulas who want to shift from being on call for birth into a paraprofessional perinatal job teaching childbirth education, developmental milestones and other curriculum that each program offers.

It is important to note that because of the Affordable Care Act, home visitation for expectant and new families is now expanded and funded based on risk factors for pregnant women like the rate of preterm births, low birth weight, poverty rates and the unemployment rate in various states and regions. Valerie Inzinna, a DONA trained birth doula and licensed massage therapist in New Jersey, made a referral for a new mother to whom she was teaching infant massage for enrollment to Healthy Families. Valerie’s client was brand new to the town and truly socially isolated. Valerie thought a home visitor from Healthy Families, which is a program that sees moms and families for weekly visits until the child turns 3 years old, would be an empowering support service, and it has worked out so well. The Ounce of Prevention Fund has a research paper entitled Adding Doulas to Early Childhood Programs, which articulates the role of birth doulas to enhance the confidence of new families while linked with home visitation services7.

As doulas, we need to know how the various home visitation programs are different and what local agency we can make connections with. For example, Nurse Family Partnership is only for first time mothers who must be enrolled before they are 28-weeks pregnant.

Please find your local Early Head Start program, WIC agency and the income requirements for Medicaid in your state.As doulas we are at the front line as a resource for pregnant women. With many expectant families in our country now hurting, these public health programs reinforce how doulas remain within the scope of our care while acknowledging challenging financial times.

Jill Wodnick ran a community doula program in Hudson County, NJ, from 2010-2012. Jill is passionate about bringing doulas into public health programs. She offers advanced doula trainings on the science of sound and drumming for doulas in Montclair, NJ. Please visit www.JillWodnick.com

NOTES:

1. Www.statehealthfacts.org/comparemaptable.jspYr=63&typ=2&ind=223&cat=4&sub=57&sortc=1 &o=a

2. Www.medicaid.gov/Medicaid-CHIP-Program- Information/By-Population/Pregnant-Women/ Pregnant-Women.html

3. Www.kff.org/womenshealth/upload/8014.pdf

4. Nppes.cms.hhs.gov/NPPES/StaticForward. do?forward=static.instructions

5. Www.fns.usda.gov/wic/publications.htm

6. WIC www.fns.usda.gov/wic/faqs/faq.htm

7. Www.ounceofprevention.org/research/pdfs/ First_Days_of_Life.pdf
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