Missouri set to expand services for pregnant women. Medicaid will begin paying for doulas.

JEFFERSON CITY — In a decision aimed at improving Missouri’s dismal maternal mortality ranking, Gov. Mike Parson’s administration is rolling out a new plan to help low-income women through pregnancy.

In an emergency rule going into effect Tuesday, the state’s Medicaid health insurance program will begin paying for services provided by doulas — professionals who support women through pregnancy and up to one year after birth.

“The goal of these services is to provide a stable source of psychosocial support and education throughout the perinatal period and during the birth,” the rule filed by the Missouri Department of Social Services notes.

The bid to boost the use of doulas, who can help reduce cesarean sections and preterm births, as well as increase breastfeeding, is seen as one component in the state’s fight to climb out of the bottom fifth of the nation when it comes to women dying while pregnant or within one year of pregnancy.

In a recent report issued by the Missouri Department of Health and Senior Services, an average of 70 Missouri women died while pregnant or within one year of pregnancy each year over a five-year period from 2017 to 2021.

DHSS Director Paula Nickelson called the numbers “unacceptable.”

The report said the pregnancy-related mortality ratio was 32.2 deaths per 100,000 live births, placing the state among the worst in the nation behind a group of southern states including Tennessee, Mississippi, Alabama and South Carolina.

Nationally, the rate is 23.2 deaths per 100,000 live births, giving the U.S. the highest maternal mortality rate of any developed nation, according to The Commonwealth Fund.

When compared to other countries, Missouri’s rate is worse than Iran, China and Syria.

The emergency rule acknowledges the state’s record of futility in addressing the issue.

“In recent years, the maternal mortality rate in Missouri has been higher than the national rate and is considered to be one of the worst in the United States,” regulators noted. “As a result, DSS finds an immediate danger to the public health, safety or welfare of pregnant women in Missouri, which requires this emergency action.”

Agency spokeswoman Baylee Watts said doula services have been offered through the state’s managed care insurance program in select regions, but this is the first time these services will be available statewide as a covered benefit.

“We are thrilled about this development, as it introduces another option for mothers seeking doula services,” Watts said in a statement to the Post-Dispatch. “Additionally, this will contribute to achieving optimal maternal and infant health outcomes while also addressing racial disparities in those outcomes.”

According to the department, the initial cost of the expansion is estimated at $66,069, but the heightened use of doulas could result in an offsetting savings if the rate of cesarean births covered by the state’s MO HealthNet Medicaid program is lowered.

The rule also outlines training and other rules for doulas, including certification from training organizations. In addition to completing continuing education courses, a doula must hold liability insurance, the rule notes.

Medicaid funds pay for nearly 50% of births in Missouri.

In outlining the state’s high maternal mortality rate, DHSS said that 77% of pregnancy-related deaths were determined to be preventable.

Missouri’s embrace of doulas comes after Walmart, the nation’s largest private employer, last year expanded its health care coverage for employees who want to enlist the services of a doula.

Walmart said the program is meant to address racial inequities in health care and improve the maternal and infant health of its workers and their babies, especially in areas where access to care may be limited.

Along with the administration’s decision to fund doula services, Missouri’s Republican-led Legislature endorsed a plan last year to address maternal mortality issues by providing a year’s worth of medical coverage to new mothers and their babies through the federal Medicaid program.

Support for extending coverage to one year is viewed as a way to address a potential increase in births in the wake of the U.S. Supreme Court overturning Roe v. Wade in 2022.

Tops among causes of death for pregnant women was cardiovascular disease, followed by mental health conditions and infection.

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Missouri ranks near the bottom of the nation in the rate of women dying during or soon after pregnancy.

Moms and babies in St. Louis face risky pregnancies and first year

Many advocates talked of the importance of increasing access to doulas, professionals who support women through pregnancy to postpartum

Missouri takes steps to improve its dismal maternal mortality rate. More is needed.

Missouri ranked 44th in the nation for maternal mortality. In 2023, Gov. Mike Parson pledged to begin addressing the problem.

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