The most recent and largest systematic review (PDF published in 2012 by Hodnett and colleagues) of continuous labor support summarizes the experiences of over 15,000 women who participated in 21 randomized controlled trials. The authors conclude that continuous support during labour has clinically meaningful benefits for women and infants and no known harm.
When continuous labor support is provided by a doula, women experience a:
- 31% decrease in the use of Pitocin (artificial oxytocin)
- 28% decrease in the risk of Cesarean section
- 12% increase in the likelihood of a spontaneous vaginal birth
- 9% decrease in the use of any medications for pain relief
- 14% decrease in the risk of newborns being admitted to a special care nursery
- 34% decrease in the risk of being dissatisfied with the birth experience*
Findings of Hodnett’s et al meta-analysis of 15 trials from North America, Europe, and Africa conclude that women cared for during labor by a birth doula, compared to those receiving usual care were:
- 41% less likely to give birth with a vacuum extractor or forceps
- 28% less likely to use any analgesia or anesthesia (epidural)
A doula’s job is to support your ideal birth. While most doulas are enthusiastic about natural/physiological childbirth, studies show that a woman’s satisfaction with her birth experience greatly depend on whether or not she felt supported and included in the decisions being made during her birth. A doula helps you advocate for your birth preferences. Her only goal is to help you have a satisfying birth experience, whatever that means for you. You can read more here: Feeling Good About Your Birth written by my mentor, Ana Paula Markel.
A doula can still be very active at a birth that includes an epidural or cesarean procedure. At a cesarean birth a doula can help to make sure the room is kept calm and peaceful, offer a description of the birth as it occurs or record the birth with a video or digital camera while the birth partner sits near your head to provide emotional support, or vice versa. After the baby is born, a doula can help baby establish breastfeeding if desired, or if necessary, either the birth partner or doula can accompany the baby while the other person stays with you in the operating room while the surgery is completed. A doula can also write a birth story of the cesarean birth, helping to reinforce your memory of a beautiful and loving birth experience. Please check out this wonderful article Best Cesarean Possible written by Penny Simkin, the “Doula of all Doulas.”
Research shows that the chance of having a forceps or vacuum-assisted delivery or cesarean birth decrease if the epidural is not administered until a consistent active labor pattern has been established. Many doctors allow a laboring woman to receive her epidural until she reaches 4-5 cm dilation which could take hours before reaching this point. During this time a doula can offer the many comfort measures in which she is trained. Once the epidural has been administered a doula can ensure you are in an appropriate position to protect your back and hips and help you feel more connected to your birth experience by talking with you about your baby’s arrival.
Insurance reimbursement of doula services is becoming a more common occurrence in the birthing world. Hopefully this trend will continue as more insurers realize that women with doulas have fewer interventions and therefore less expensive births. I’m happy to provide you with the necessary documentation to move forward with an insurance reimbursement. Here are some helpful tips for submitting to your insurance company for reimbursement or medical Flexible Spending Account (FSA) to help reduce your costs.
1. Pay in full for the doula services provided.
2. Get a receipt from your doula. The receipt will include the following information:
- Doula’s identifying information
- Diagnosis code (V22.2, intrauterine pregnancy)
- CPT code (99499, Evaluation and Management Services – Labor Support)
- Date and location services were provided
- Mother’s name
- Total charge for services
- Dates and amounts of payments
- Payment method
3. Submit the receipt with a claim form to your insurance or FSA company’s claims department.
4. Within a month, you should receive a response. If you receive a letter denying the claim, do not be discouraged. Prepare a new packet to resubmit to your insurance company for a secondary review, and copy everything in the packet to the insurance company’s CEO explaining why you feel services should be covered (and be sure to point out how much money the insurance company saved because of the services your doula provided, i.e. if you forewent medical pain management because of your doula or feel you avoided other interventions that are costly to insurance providers, such as augmentation of labor or cesarean birth). In this resubmission packet, you should include the following:
- Another copy of the receipt
- Letter from you to the insurance company CEO explaining why you think this should be covered
- Letter from your doula stating the benefits of doula care
- Cochrane Review on continuous labor support
- DONA’s Position Paper: The Birth Doula’s Contribution to Modern Maternity Care
- DONA’s position paper: The Postpartum Doula’s Contribution to Modern Maternity Care
- Letter from your midwife or doctor stating why s/he feels the additional support of a doula was beneficial
5. Be persistent. Make phone calls if necessary. If your claim is ultimately denied, call and ask for a specific reason why. If they refer you to your policy, ask them exactly what clause and what wording in your policy excludes doula services.
6. Whether you are reimbursed or not, please let me know what kind of response you get from the insurance company. Each time someone requests reimbursement, it tells the insurance companies that this is an important service. They may consider it more carefully next time. If you are reimbursed, this is very good news for doulas and we always want to know!
The most important thing is finding a doula that is a good fit for you and your partner. Ask for recommendations from friends and family if they’ve had a doula at their birth. Ask your care provider if they’ve worked with doulas in the past and get recommendations for doulas with whom they’ve had good experiences. Here are some questions to ask your potential doula during the interview process:
Why did you decide to become a doula?
What is your philosophy of birth and supporting women and their partners?
What is your favorite thing about being a doula? Your least favorite?
What training have you had?
How long have you been a doula?
How many births have you attended?
How many clients do you take on per month?
What do your services include?
Do you work with a back-up doula?
When and where do you join us in labor?
Interview more than one doula to find someone you really connect with. Remember that as you interview her, she will also be interviewing you to make sure that you will make a good team!