A Doula’s Role in Supporting Pregnant People with Substance Use Disorder

Jessica Cohen, MSW, AMCHP Program Manager, Health Systems Transformation Team

The experience of giving birth may not look the same across continents and countries, but globally we share an interest in improving maternal and infant outcomes. One strategy for improving outcomes, which is recommended by the World Health Organization, is to have a birth companion, such as a doula, to provide support to pregnant people during pregnancy, labor, childbirth, and postpartum. Doulas are trained to recognize red flags, such as severe discomfort; advocate for pregnant people; and provide emotional support throughout the entire experience. The presence of a birth companion has been shown to improve health outcomes for moms and babies.

“The word doula [may be] a fairly….recent term, but the tradition of women supporting women through birth and labor has been happening since people have given birth.” – Amy Chen, senior staff attorney, National Health Law Program, Doula Medicaid Project

Doulas also can play a critical role in supporting pregnant people who face additional challenges, such as substance use disorders (SUD). Pregnant people with SUD face stigmatization and possible punitive measures that can have a negative effect on their birthing experience. Doulas can provide support, advocacy for their clients, and nonjudgmental companionship. 

To further explore the role doulas can play in supporting pregnant people with SUD, AMCHP and the National Association of City and County Health Officials produced a podcast featuring two doula certified peer recovery specialists, Melinda McMichael and Joyce Miller, from the Illinois Pregnant and Postpartum Women with Opioid Use Disorder Program. These women shared their experiences working at the intersection of substance use disorder care and birthing support. Amy Chen, senior staff attorney of the National Health Law Program’s Doula Medicaid Project and Jessica Stieger, AMCHP program manager and certified doula, also discuss the role of Medicaid, state public health systems, and opportunities to promote doula care for people with substance use disorders.

The podcast highlights the importance of doula support for pregnant people who use substances. It discusses how doulas can serve as a buffer against stigmatization from providers, by providing compassionate care and understanding to birthing people. The effects of stigma related to substance use are compounded when people must also contend with the effects of racism. Doulas help clients navigate intersectional oppressions and support improved outcomes by pushing back against providers’ and other professionals’ implicit biases and advocating for their clients.

“If you heal the mother, you heal the child, you heal the family, which is very important for the community. You start with one person and you try to make changes…and hopefully you can touch the lives of many families.” – Melinda McMichael, doula peer recovery specialist

Public health and Title V programs have many opportunities to support doula care for all pregnant people, especially for people who use substances. Maternal and child health programs should consider the following strategies: 

• Explore your state’s legislation related to Medicaid coverage of doula care. 
• If Medicaid coverage is available for doula support in your state, assess and advocate for sufficient reimbursement rates. 
• If your state Medicaid program does not include coverage for doulas, consider opportunities for Title V to provide funding support for doula services.

• Provide assistance to bridge gaps in needed services to support the doula workforce, such as offering funding for doula training.
  

• Provide assistance to bridge gaps in needed services to support the doula workforce, such as offering funding for doula training.

As the public health field continues to address maternal and infant outcomes across the globe, maternal and child health programs should consider these strategies to advocate for doula care. As a final step, we recommend listening to the full podcast to hear doula certified peer recovery specialists share their perspectives, experiences, and a call to action for public health programs to fully embrace and support doula access for all families.