State lawmakers are considering expanding access to birth doulas for Medicaid patients.
A total of 23 states allow their Medicaid programs to cover doula services, but North Carolina isn't one of them. A legislative committee reviewed the topic on Tuesday, part of a healthcare oversight hearing that also included an update on the state's shortage of childcare facilities.
Experts say expanding doula services could help address North Carolina's high infant mortality rate, which is ranked 11th highest in the country. Doulas don't deliver babies themselves, but they provide support and information to parents before, during and after childbirth.
"A good amount of evidence shows that doula care is associated with decreased maternal stress, lower C-section rates, lower odds of postpartum depression and anxiety, and improved trust and relationship with the birthing process," said Erin Fraher, a researcher at the UNC-Chapel Hill Cecil G. Sheps Center. "And because of those improved outcomes, because of fewer postpartum visits to the hospital or visits to the physician, there is potential for cost savings for state Medicaid programs."
Rep. Grant Campbell, R-Cabarrus and a doctor, says allowing Medicaid to cover doula services could help if the profession is properly regulated.
"I've delivered almost 8,000 kids," he said. "I've worked with doulas, and for the most part, they're absolutely fantastic, but there's a difference between a certified doula and someone that says 'I had a baby and I hung out with my cousin when she had a baby.' If we're going to get these benefits, we've got to make sure we're getting the right type of personnel there."
Doulas could help address shortages in rural areas. About 28 of the state's 100 counties no longer have any obstetric providers, forcing families to drive long distances to give birth, according to the Sheps Center.
Childcare shortage is getting worse
The legislature's healthcare oversight committee also got an update Tuesday on North Carolina's shrinking availability of childcare providers.
While the state's population has grown, the N.C. Department of Health and Human Services reports that the number of childcare facilities has dropped from 5,921 in July 2019 to 5,160 in January of this year — a 13% decline.
"If the rate of decline does not improve, we project North Carolina will fall below 5,000 licensed facilities by 2027," the report from DHHS said. "This would be a historic low for the state."
Childcare center closures are hitting the state's rural counties particularly hard, with the number of facilities dropping by more than 20% in counties like Camden, Perquimans and Warren.
The state's childcare subsidy program is also able to serve fewer kids as it awaits additional funding from the legislature, leading to long waiting lists of eligible families.
While the demand for childcare is high, low wages make it difficult for childcare facilities to recruit staff and keep classrooms open.
Earlier this week, Gov. Josh Stein called on the legislature to approve an additional $20 million to fund childcare subsidies.
