South Dakota’s maternal mortality rate is nearly triple that of the national average. That’s why HB 1081, “Establish Provisions Related To The Reimbursement Of Doula Services Through The State Medicaid Program,”  was brought to the table by Rep. Mellissa Heerman this legislative session. The bill would grant up to $1,000 in reimbursement for doula services, including prenatal, labor and delivery, and postpartum care.

“This is a stepping stone to having everybody be able to access doula support,” Renee Forred, who owns a doula business, said. “We need to be able to extend this support to everybody – not just those who can pay privately.”

But what functions do doulas provide that doctors and nurses, even midwives, do not? Doulas are certified professionals who provide physical, emotional, and informational support during pregnancy, birth, and postpartum. They can help mothers create a birth plan and articulate their needs and desires to medical professionals, provide support during labor, and act as a resource for evidence-based information. However, doulas are not equipped to give medical advice or diagnosis, and they do not perform medical procedures or births, as midwives do.

“Doulas are an integral part of the safe and efficient care of our laboring patients,” OBGYN Emily Abele said. “Doulas help patients with support during their labors which helps decrease anxiety and helps patients do effective position changes to help expedite their labor course.”

In the hearing on Thursday, January 25th, the Obstetrics Director at Brookings Health System,

Michelle Sand, testified in favor of HB 1081. She has been a key stakeholder in the initiative due to her 12 years of experience as a Labor & Delivery nurse.

“It is apparent that the current state of our maternal outcomes, both nationally and locally, are far from where they should be,” Sand explained. “Recent maternal morbidity and mortality are rising and more likely to impact populations for marginalized and low income communities, which does include those on Medicaid. These disparities stem from barriers to access, differences in healthcare quality, underlying chronic conditions and the impact of negative social determinants of health.”

Sand went on to note that in South Dakota, one in 12 mothers have limited access to maternal care services. Some birthing centers have shared that 30-40% of their mothers on Medicaid do not receive prenatal care – a critical factor in ensuring a healthy birth.

“This is a huge problem that will continue to grow and negatively impact the families and communities and state of South Dakota if not fixed,” Sand stated.

Additionally, evidence shows that the presence of doulas at births can reduce costly procedures, such as epidurals, C-sections, the use of Pitocin, premature births, as well as other complications. Other states have found that due to the improved outcomes of births where doulas are present, costs to their medicaid programs are either insignificant, or they even find a cost savings thanks to the preventative measures of the doulas’ work.

The only opposition to the bill came from Matt Althoff with the Department of Social Services, because he believes that in partnership with the governor, who has already expressed interest in the initiative, they can enact the provisions the bill lays out without going through the legislature.

Ultimately, Rep. Heerman tabled her own bill as a gesture of goodwill toward the governor’s office and their request, which showed her commitment to the cause even if the path forward is different than what she asked for. We look forward to seeing what Representative Heermann and DSS are able to accomplish together in the months ahead.