Kotek Sponsors Legislation to Improve Birth Outcomes

April 28, 2011—A bill that would integrate doulas and other community health workers into the Oregon Health Plan passed the House unanimously on Tuesday.

 

House Bill 3311 directs the Oregon Health Authority to investigate how doulas and other community health workers can improve the birth outcomes of underprivileged and underserved women.  

 

“We have a lot of women in this state who give birth and have poor birth outcomes that we can improve upon, particularly women who give birth through the Oregon Health Plan,” said Rep. Tina Kotek, the bill's co-sponsor.

 

Oregon’s infant mortality rate among African Americans is 9.4 per thousand, compared with 5.5 per thousand in the Caucasian population, according to statistics kept by the Oregon Public Health Division. According to the Urban League of Portland, African American infants are twice as likely as Caucasian infants to be born with low birth weight.

 

The March of Dimes, in 2010, gave Oregon a grade of “C” for having an immature birth rate of 10.1 per thousand, compared with a 7.6 per thousand national average.

 

Shafia Monroe, the executive director of Portland’s International Center for Traditional Childbearing, which trains doulas, reacted to the bill’s passage with “total jubilation.”

 

“Every woman deserves a doula,” she said. “It can make such an impact on the future of the state.”

 

Doulas provide emotional support

 

Doulas, she said, are birth coaches who provide an enormous amount of emotional support to a mother during pregnancy, birth and immediately after giving birth.

 

Monroe said underprivileged women often have no health insurance, lack access to healthcare, and may not get the amount of pre-natal care they need. That directly impacts their pregnancy and their infant.

 

“Economic uncertainty, poor housing, inadequate education and unsafe neighborhoods all contribute to levels of stress in and out of pregnancy for many low-income [people],” wrote the Urban League of Portland in support of the legislation.

 

Doulas can help such women by being a sounding board for an expecting or new mother, provide service referrals, help women navigate the healthcare system, and educate them about their pregnancy experience and being a mother.

 

Doulas, advocates said, are also able to provide culturally specific services to different minority groups.

 

“Because they are trusted, community health workers can elicit more complete health histories and explain medication instructions in terms people can understand,” said Noelle Wiggins, the manager of Multnomah County’s Capacitation Center. “Because they…serve as role models, they can be successful at helping people adopt healthier behaviors.”

 

Women who use doulas, Monroe said, experience less post-partum depression, eat better, are more willing to breast feed and, in general, are more ready to be a successful mother.

 

“We know that by having [a doula], it’s going to improve your pregnancy experience, your birth experience, and your post-partum experience,” she said.  

 

Kotek didn’t have to be swayed to sponsor this legislation. “These are paraprofessionals who really do make a difference in the lives of pregnant women, but are not well integrated into the healthcare system,” she said.

 

Currently doulas don’t play a major role in Oregon’s healthcare system. Like midwives, they aren’t required to be licensed, and are not trained or certified by the state. Doulas use the fee-for-service model, and insurance companies rarely provide coverage.

 

That makes it difficult for lower-income women to access doulas. “It’s an equity issue,” Monroe said.

 

Research shows doulas improve birth outcomes

 

A 2007 Cochrane Collaboration study examined births where support was provided by hospital staff, by the mother’s family and friends and by doulas. It found that women who utilized doulas were less likely to need pain medication, epidurals, or a Cesarean section (C-section), and were more likely to have a spontaneous vaginal birth, shorter labor and be happier with the childbirth experience.

 

“Early benefits [of utilizing a doula] include reductions in anxiety scores, positive feelings about the birth experience, and increased rates of breastfeeding initiation,” found a 1999 study in the Journal of Women’s Health and Gender-based Medicine. “Later postpartum benefits include decreased symptoms of depression, improved self-esteem, exclusive breast feeding and increased sensitivity of the mother to her child’s needs,”

 

Numerous health organizations encourage the use of doulas, including the World Health Organization, The American College of Obstetricians and Gynecologists, and The American Academy of Family Physicians.  

 

Oregon Health Authority to study options

 

The Oregon Health Authority is required to report to the February 2012 legislature on how to incorporate doulas and community health workers into the Oregon Health Plan.

 

Kotek ties the effort directly to efforts being done around the transformation of healthcare. 

 

“We want to integrate community health workers if we’re going to transform healthcare to reach communities that are underserved,” she said.

 

The bill was amended to take out the phrase “women of color” and instead include the phrase “who face disproportionately greater risk of poor birth outcomes” because, according to Kotek, the phrase better encapsulated the populations impacted by negative birth outcomes.