Doulas & new insurance code, Oct. 1: your thoughts

jimeneti_MSNstudent · Oct 17, 2009

I think that's wonderful. Hopefully more hospitals will routinely offer doula services to their L&D patients. Many people still do not know what a doula is. Maybe it will become more commonplace for a laboring woman to have the support services of a doula (right now, you pretty much have to pay out-of-pocket). There have been many studies showing the positive effects of doula support during labor and delivery, both medical and psychosocial (creating a positive experience for the family).

babyktchr, BSN, RN · Oct 17, 2009

I find it hard to believe that an insurance company will pay for a doula when they routinely deny routine preventative screenings and necessary procedures without jumping thru bureaucratic hoops. I will be interested to see if this really comes to frutition. I personally have not come across a doula that I would have back in my facility.

HeartsOpenWide, RN · Oct 18, 2009

This would be great. I am currently working on a grant to get money for doulas for low income woman...would save me a bunch of time!

hallcrest · Oct 18, 2009

wow babyktchr....strong words! how many doulas have you worked with?

babyktchr, BSN, RN · Oct 18, 2009

I have had 8 come to my unit from time to time. To be honest, I probably haven't had the optimal chance to really see what doula's can do from these experiences. I read on this sight all of the time how doula's are so wonderful, and all I can do is shake my head. Maybe one day I will see the other side.

hallcrest · Oct 19, 2009

Thanks for your reply babyktchr. I have had one and only one experience with a doula, and that was the birth of my baby girl just shy of 2 years ago. It was fantastic, but I am not so naive as to think that every doula or every birth is as delightful as ours was.

I am especially interested to hear from L&D nurses how a possible shift toward embracing the care of a doula might practically alter the role of the nurse, and how this shift might alter the role of the nurse in the delivery room.

Elvish, BSN, DNP, RN, NP · Oct 19, 2009

In 'micro' I can see difficulties as babyktchr described. There are some doulas that are wonderful and some not so much. I've seen mostly great ones in my place.

Looking at it in 'macro', I think it is a wonderful thing....the same way I'd love it if my insurance paid for lactation consultants. Overall I think it's a great idea and very forward-thinking. Maybe they're thinking potential reduced costs in terms of fewer c/sections or costly labor interventions. Either way, I'm glad someone somewhere is starting to do this. I'm sure it'll take a while to catch on in my neck of the woods, but just because there are some bad doulas out there I don't think doula reimbursement should stop.

rickelli · Oct 19, 2009

I think that it is wonderful that they can be compensated for what they do. I had a doula with my first surrogacy and she was great. I think that a good doula offers great support for the family and birthing mom especially when the nurse has so many things to do on her own and with other patients. And the husbands can usually only handle so much. The nurse doesn't always have time to do the little things that make the mom more comfortable. I think that these doulas need to be screened so that not just anyone can come in and say they are a doula and charge the insurance. I also believe that doulas are great to have around for women who don't have a support team at all (no husband, boyfriend or family members that want to take the time). My doula is now a midwife so I do think she was very qualified as a doula.

nurturing_angel · Oct 19, 2009

I personally love working with doulas. With all the responsibilities a labor and delivery nurse has today, its comforting to know that someone is actually with my patient all the time and helping her deal with labor. I am lucky that at least 95% of all the doulas I have worked with have been awesome and fit in well with the birth team. I have heard that in order to be eligible for a provider code to bill medicaid and private insurance, you must be certified as a labor doula by one of the certifying organizations such as DONA or CAPPA. Perhaps this is a way to make sure the doulas working with our mothers are trained properly now.

I was under the impression that lactation consultants have always been able to get provider codes and submit charges for reimbursement. How do the ones who open up private offices get paid? I will ask a lactation consultant friend of mine.

rickelli · Oct 19, 2009

DONA is a good organization I trained as a doula through them and it wasn't easy. I had a few days of long hours at a hospital and it wasn't to cheap either. Continuing on as a doula is hard if you can't get clients it takes time to build a business from it and in order to get certified with documentation you have to attend some births and have the whole team (mother, father, doctors and nurses fill out paperwork) so if you get good marks from the doctors and nurses then you are doing a pretty good job.

Doulatron · Oct 21, 2009

I find it hard to believe that an insurance company will pay for a doula when they routinely deny routine preventative screenings and necessary procedures without jumping thru bureaucratic hoops. I will be interested to see if this really comes to frutition. I personally have not come across a doula that I would have back in my facility.

This is a really good point, Babyktchr. It's my experience each small step a bureaucracy (medical or otherwise) takes toward more inclusive, human-friendly policies leads the way for others to follow.

I hope that you do have a chance in the future to work with doulas whose helpful presence gives you a great experience. I think we're mostly a pretty great bunch