HOLISTIC DOULA CARE

While both midwives and doulas are statistically associated with improved outcomes, they have very different roles.  A midwife is a healthcare professional trained to deliver babies, make recommendations and perform clinical tasks to evaluate the well-being of mother and child, including assessing fetal heartrate and maternal vital signs (like blood pressure) prenatally and during labor, controlling hemorrhage, suturing lacerations, etc.  In contrast, a doula is a non-medical support person only.  We are focused on the social and emotional aspects of childbirth, such as helping our clients feel prepared for and capable of coping with hospitalization, birth and postpartum.  Instead of clinical assessments, our prenatal appointments focus on planning, addressing fears, and developing a trusting relationship.  Similarly, our care during labor involves offering physical comfort measures and reassurance, as opposed to medical surveillance.  Because midwives and doulas have complimentary roles, it is common that families planning to deliver with a midwife will still hire a doula (see the next FAQ for more information!).

If your birth will be attended be a midwife, it is important to understand that most midwives do not provide continuous support during labor.  This is because midwives have other clinical and administrative responsibilities to attend to that leave little room for providing physical and emotional comfort, the most important of which is ensuring your safety.  For example, if you are delivering with a hospital-based midwife, other demands on her time will include charting, assessing fetal heart tracings, checking on other patients, interacting with other providers such as nurses and obstetricians, attending cesarean sections, and admitting new patients.  If you are delivering with a homebirth midwife, she may also be organizing her equipment, charting, supervising a student midwife, rescheduling a prenatal appointment she had that day with another client, or discussing matters with her partner while you are laboring.  Additionally, many homebirth midwives like to give clients space to labor with their partner undisturbed, which means that they may only come into your immediate space when its time to assess fetal heart tones, take your blood pressure or make some other clinical observation.   Finally, it is important to note that need for pain relief secondary to fetal malposition is the number one reason people transfer to the hospital from planned home births -- so having a doula can really help combat this risk, especially if you are a first time parent.  As a result, those delivering with midwives, whether hospital or homebirth, can still benefit immensely from doula support, and will often hire a doula to fill that gap.

Absolutely.  I doula for home births attended by credentialed midwives (certified professional midwives or certified nurse midwives).  I do not attend unassisted births (births that are intentionally planned to occur without a midwife present).

I doula at all hospitals and birth centers in my service area, which encompasses Western Wisconsin's St. Croix & Chippewa Valleys, as well as portions of northwestern Wisconsin and West Central Wisconsin.  Examples include but are not limited to: TruLiving Birth Center (Menomonie), Western Wisconsin Health (Baldwin), Mayo Clinic (Eau Claire), Marshfield (Eau Claire & Rice Lake), Westfields (New Richmond), Amery Hospital (Amery), Footprints in Time Birth Center (Black River Falls & Greenwood), Osceola Medical Center (Osceola) and St. Croix Health in St. Croix Falls, WI.  

In Wisconsin, doulas are not covered by public or private insurance at this time.  There have been proposals to expand the state budget to include doulas in Badgercare, and there was a pilot program in Milwaukee several years ago.  However, nothing has passed into law so far.  Occasionally private insurance may cover doulas after your deductible is met, subject to certain limitations and criteria.

In Minnesota, doulas certified with specified organizations *are* covered by MA, however the list of allowed programs is very short and currently does not capture a large section of the doula workforce.  Additionally, the infrastructure required to bill Medicaid is complex and currently only available through one specific non-profit, Everyday Miracles in Minneapolis, which only contracts a handful of doulas.  As a result, most doulas in Minnesota are not able to bill MA at this time.  Recent legislation signed by the governor does expand the ability of individual doulas to bill Medicaid outside of Everyday Miracles, however the logistics will take a while to implement and due to startup expenses involved, will likely only be available through larger organizations initially.

In general, doulas are not covered by commercial insurance plans in either Wisconsin or Minnesota.  Generally this is because we are independent and not "in network" or contracted with any large carriers. 

However, increasingly, employers and other third parties are offering reimbursement or even cash stipends for doula services.  Target, WalMart, AllinaHealth and others are recent examples.  Whether your doula is covered will depend on the specifics of the policy, including around required certifications and the extent to which the fee schedule encompasses your doula's full fee.

Yes and no!  Logistically, this is a self-pay service; I am not set up to bill third parties, and my credit card processor (PayPal) has taken the position in the past that they will not process payments made through HSAs for compliance reasons.  As a result, you will still need to pay out of pocket.

However, I have had many clients successfully obtain reimbursement for from their (or their partner's) HSA after the fact.  I encourage clients to consult their benefits administrator or applicable employer policy to find out if doulas are an allowed expense (commonly they are!).  If so, I can provide a receipt following the conclusion of our time together indicating the service(s) provided and amounts paid, that you can submit for your money back.

Some HSAs will require a "letter of necessity" in order to reimburse; in this case, you'll need to ask your provider (midwife or physician) to write a note indicating why doulas are beneficial and recommended to improve outcomes.* 

In general though, my clients have found the process accessible, and to my knowledge the success rate for HSA reimbursement among my clients has been 100% so far.

*See below a template under, "Why Hire a Doula? Research on the Benefits of Doula Care."