Michigan tops doula goal in push to improve maternal and infant health

Michigan has more than 1,000 registered doulas, with most serving Medicaid families statewide
The state expanded doula coverage as part of a plan to reduce health disparities
Doulas are linked to fewer C-sections and preterm births

Michigan is rapidly expanding doula access after beginning to cover the service through its federally funded Medicaid program, a shift that health officials say will improve birth outcomes and strengthen maternal care.

There are over 1,000 registered doulas in Michigan, which surpassed the state’s goal of having 500 registered doulas by 2028, as part of the Michigan Department of Health and Human Services’ Advancing Healthy Births Plan.

The plan aims to eliminate health disparities and expand access to doula services, which includes the creation of a statewide doula registry to help individuals find a provider near them.

Doulas are professionals who provide physical, mental and spiritual support to pregnant mothers before, during and after birth.

“We wanted to make sure that people who needed doulas feel safe with the doulas that they found and that they felt represented within their doula community,” said Erika Millender, a doula and a member of the Michigan Doula Advisory Council, which works with the state as part of its doula initiative.

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“We wanted to open up the organizations that provided doula training. There’s a doula for everyone but not every doula is for every person,” she added.

Of the roughly 1,000 doulas statewide, over 700 are enrolled as Medicaid providers, which “ensures every Michigan county has access to at least one doula who serves Medicaid-eligible families,” according to MDHHS.

The state started covering doula services through Medicaid in 2023 and expanded coverage last year to include 12 visits during pregnancy, increased the rate for labor and delivery support to $1,500 and the reimbursement rate for a visit to $100.

In recent years, more women have become interested in midwife and doula services because of the disparities associated with hospital births.

Women who have a doula are 47% less likely to have a cesarean delivery and a 29% lower chance of having a preterm delivery, according to a study published in the National Library of Medicine.

“Doulas are absolutely vital to improving birth outcomes. We provide emotional, educational and physical support, but we also advocate for families, making sure their voices are heard and their choices are respected,” Millender said.

The problem is especially severe for Black women, who face a pregnancy-related death rate more than three times higher than that of white women.

More than 80% of pregnancy-related deaths, whether they occur during labor or within the year after it, are preventable, according to the Centers of Disease Control and Prevention. Social factors like income, access to high-quality care and the ability to manage health conditions can play an important role in maternal health.

“When we intentionally focus on improving outcomes of Black and Indigenous families who have disproportionately higher rates of perinatal mortality and morbidity, we create a wave of safety and dignity that genuinely improves the experience for everyone,” Millender said.

State health leaders say the wider reach of doula care may help push Michigan’s infant mortality rate below the current 6.1 deaths per 1,000 live births. Although that’s the lowest it’s ever been, it’s still above the national average of 5.5 deaths per 1,000 live births.

“Michigan’s investment in doulas is transforming maternal health outcomes across the state,” said Elizabeth Hertel, MDHHS director, in a press statement. “When families have access to trusted birth support, we see healthier parents, healthier babies and stronger communities.”