Casey to introduce bill expanding Medicaid maternity care to include doulas and midwives

Pennsylvania U.S. Sen. Bob Casey is among a group of congressional Democrats who introduced the “Mamas First Act” on Thursday to require Medicaid coverage for prenatal, delivery, and postpartum care by doulas, midwives and tribal midwives.

The federal legislation follows the passage of a similar bill that passed the Pennsylvania House of Representatives to cover doula services for expectant and new mothers here. 

Both bills are intended to help address the racial and ethnic disparity in maternal mortality rates between women in the United States. 

“Every mother deserves support and care before, during, and after birth,” Casey said. “This legislation will help address the maternal health crisis in this country by ensuring that Medicaid covers the full spectrum of care that mothers and infants need.”

Casey introduced the bill in the U.S. Senate with Sens. Elizabeth Warren (D-MA), and Cory Booker (D-NJ). A House companion bill was also introduced today by U.S. Reps. Gwen Moore (D-WI), Ayanna Pressley (D-MA), Lauren Underwood (D-IL), Alma Adams (D-NC), and Debbie Dingell (D-NC).

“America’s ongoing maternal health crisis magnifies the need for federal interventions that can save lives. The Mamas First Act is an important effort because it will expand access to providers who can offer emotional and physical support during and after the birthing process – comprehensive beyond the hospital setting where nearly all U.S. births occur,” Moore said.

According to a draft of the Senate bill, the Centers for Disease Control and Prevention finds the maternal mortality rate of 69.9 deaths per 100,000 live births for Black women is nearly three times that for white women. Deaths among American Indian and Alaskan Native women number about 49 per 100,000 live births while there are 28 deaths per 100,000 live births among Hispanic women.

“While maternal mortality disparately impacts Black women and indigenous women, this urgent public health crisis traverses race, ethnicity, socioeconomic status, educational background, and geography,” Casey’s bill says.

About 80% of these deaths are preventable, Casey’s bill says, but United States maternal mortality rates are the highest in the developed world and are increasing rapidly. In Pennsylvania, a report this year by the newly formed Maternal Mortality Review Committee showed 107 Pennsylvania women died in 2020 during pregnancy or within one year of giving birth.

Doulas are non-medical, trained professionals who provide emotional, informational, and physical support before, during, and after pregnancy and childbirth, such as helping with breastfeeding and breathing techniques during labor.

According to the NIH, mothers who have the assistance of a doula are four times less likely to have a low-birth weight baby, two times less likely to have a birth complication with their baby or themselves, and significantly more likely to begin breastfeeding.

A midwife is a trained medical professional who provides care for healthy mothers during pregnancy, in delivery and after giving birth. Midwives deliver babies in the home, birth centers and in hospitals.

A tribal midwife is a person recognized by an indiginous tribe to practice midwifery for that tribe, Casey’s bill says.

Midwife-led care correlates with cost savings, decreased rates of intervention, lower cesarean rates, lower preterm birth rates, and healthier outcomes for mothers and babies, according to Casey’s bill..

Pennsylvania’s House Bill 1608  is part of a package of legislation on Black maternal health — dubbed the “Momnibus” by supporters — that also includes a requirement for Medicaid to cover blood pressure monitors for pregnant women and new moms.

Both state House bills will now go to the Republican-controlled state Senate for consideration, where a similar bill to require Medicaid reimbursement for doulas was introduced last year by Sen. Judith Schwank (D-Berks). It has yet to be considered since it was referred to the to Senate Health and Human Services Committee in January 2023.

Other bills in the Momnibus package call for investment in maternal health care deserts, maternal mental health, eliminating implicit biases in maternal health care and providing new parents with supplies to care for newborn babies.

(This article was updated at 2:15 p.m. on Thursday, May 9, 2024, to include information about cosponsors of the Mamas First Act and quotes from Casey and Moore.)