As a postpartum Doula, Dawn Oliver does her best work in the middle of the night.
During a typical shift, she appears at her customers’ home at 10 p.m.
After going to sleep, she can feed the baby or wake the mother to breastfeed. She calms the child asleep again. Sometimes she prepares meals for the family in a Crock pot or empties the dishwasher.
She leaves the next morning and returns, often nightly, for two or three weeks in a row.
“I am certified to do everything,” said Oliver, Van Hardeville, South Carolina, who runs compassionate care Doula services. It requires a village to raise a child, as the adage goes, but “the village is not what it used to be,” said Oliver.
Doula’s are trained to offer critical support for families – before giving birth, during delivery and in those discouraging early days that parents are desperate to sleep and babies are still getting around the clock. Although Doulas usually does not have a medical or nursing diploma, research shows that they can improve health results and reduce racial health differences.
Yet their services remain out of reach for many families. Oliver charges $ 45 per hour at night and health insurance plans often do not cover her reimbursements. That is partly the reason why the business community ‘ebb and flow’, said Oliver. Sometimes she is completely booked for months. Other times she goes without a customer for a few weeks.
That can change soon.
Two dual accounts, introduced in separate rooms of the general meeting of South Carolina, would both require Medicaid, which pays for more than half of all births in the state, and private insurers to cover the costs of Doula services for patients who choose to use one.
South Carolina is not out of a bit. Even while states are creating the next decade for a significant reduction in federal medicaid financing, legislative authorities throughout the country continue to adopt laws that give Doula access to Medicaid beneficiaries. Some state laws already require that private insurers do the same. Since the beginning of 2025, the legislators in Vermont, in addition to the Republican controlled legislators in Arkansas, Utah, Louisiana and Montana, have adopted laws to facilitate the Medicoid coverage of Doula services.
All in all, more than 30 states are paying back Doulas via Medicaid or they implement laws to do this.
It is remarkable that these coverage requirements match one of the goals of Project 2025, whose mandate for leadership ‘report, published in 2023 by the Conservative Heritage Foundation, offered a blueprint for President Donald Trump’s second term. The document calls for increasing access to Doula’s “for all women, whether they give birth in a traditional hospital, via midwife or at home”, with reference to concern about mother mortality and postpartum depression, which can “be exacerbated by poor birth experiences”. The report also recommends that federal money is not used to train doctors, nurses or doula’s to perform abortions.
The Heritage Foundation did not respond to an interview request.
In the meantime, the idea that Doulas, parents and state -medicia budgets can benefit by reducing the precious caesarean section and early birth combinations, supported by a growing number of research and there is a grip on conservatives.
A study Published last year in the American Journal of Public Health, it turned out that women who participated in Medicaid used a Doula run a 47% lower risk of delivering C-section and a 29% lower risk of premature birth. They were also 46% more likely to attend a postpartum check.
“Why don’t you want someone to use that kind of care?” said Republican State Rep. Tommy Pope, who also sponsored the bill for the repayment of the Doula in the House of Representatives of South Carolina. “I see no reason why we shouldn’t do that.”
Pope said his daughter -in -law gave birth to the help of a doula. “It opened my eyes for the positive aspects,” he said.
Amy Chen, a senior lawyer at the National Health Law Program, which follows the legislation for reimbursing the Doula throughout the country as part of his Doula Medicaid ProjectLegislers said the tendency to support these efforts when they have a personal relationship with the issue.
“It is something that many people resonate with,” said Chen, “Even if they have never been pregnant themselves.”
Conservative legislators who subscribe to abortion bans at state level, she said, often vote for measures that support pregnancy, motherhood and child health, which are intended all these reimbursement accounts from Doula.
Some Republicans feel that “they should come for that,” said Chen.
Research in health care also suggests that black patients, who suffer considerably higher death rates for mothers and babies than white patients, can benefit from Doulazorg in particular. In 2022, black babies in South Carolina had more than twice as much chance of dying from all causes before their first birthday as white babies.
This applies to women in rural parts of the country where labor and delivery services have been closed or never exist.
That is why the Montana legislators have adopted a bill for Doula this year – to limit gaps in health care for national and indigenous communities. To this end, in 2023 the State established a bill that requires Medicaid to repay obstetricians for home births.
Senator Mike Yakawich from Montana, a Republican who supported the Democratic-sponsored Doula fee law, said that pregnant women should have someone to call a hospital outside, where healthcare can be expensive and intimidating.
“What aid can we offer for mothers who expect? My feeling is, it’s never enough,” said Yakawich.
Britney Wolfvoice lives at Northern Cheyenne Indian Reservation in southeastern Montana, about two hours from the nearest birth hospital. At the beginning of July she was seven months pregnant with her fourth child, a son, and said she intended to have a doula by her side for the second time in the shipping room. During the earlier pregnancy of Wolfvoice, a indigenous doula named Misty Pipe oil and spray in the delivery room, rubbed Wolfvoice back through contractions and helped to ensure that Wolfvoice’s husband was the first to see their daughter.
“Because I was in a hospital, I felt heard for the first time,” said Wolfvoice. “I just can’t explain it better than I felt at home. She was my safe place.”
Pipe said that hospitals are still associated with the government that children have removed with violence from Indian houses due to colonization. Her goal is to give people a voice during their pregnancy and delivery.
Most of her customers cannot afford to pay for Doula services outside the pocket, Pipe said, so she does not charge anything for her birth services, in which she balances her role as Doula with her daily job at a post office.
“If a mother is vulnerable, she could miss a prenatal appointment or go alone, or I can take free time and take her myself,” Pipe said. “No mother should be birth in fear.”
The new Studies Act enables her to be paid for her work as Doula for the first time.
In some states that have established such laws, the initial participation by Doulas was low because Medicaid refunds were not high enough. Doula’s reimbursement rates, Chen said nationally.
For example, in Minnesota, where in 2013 legislators accepted one of the first Doula allowance accounts, Medicaid initially paid only $ 411 per customer for their services. Ten years later, the State had increased the repayment rate to a maximum of $ 3,200 per customer.
But Chen said it is unclear how federal medicaid cuts can influence the fate of these laws of state.
Some states that have not been approved for the repayment accounts of Doula, including South Carolina, may be hesitant to do this in this area, she said. “It’s just an uncertain time.”
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