My clients need post-partum Medicaid coverage

A doula & childbirth educator speaks out about the challenges facing Black moms and babies

By: Cindy McMillan | June 2021

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I became a doula because I didn’t want anybody to have to go through what I experienced during and after childbirth. I hemorrhaged after giving birth and nearly bled to death, and the doctor made me feel like it was my fault. My son died because his care team did not listen to me and my family. Unfortunately these are the types of painful and preventable experiences that people of color are far more likely to face in the health care system.

Maternal and infant deaths are more than twice as common for Black families as for white families. Those are the statistics, and they are also my experience. As a doula, I get the chance to advocate for Black moms so that they can be heard and treated with respect during and after pregnancy and childbirth.

When Medicaid Ends Too Soon

Most of the moms who are referred to our care at Sistas Caring 4 Sistas are covered by Medicaid. They are all at higher risk of maternal or infant death, whether that’s because of a past traumatic birth experience, infant loss, low birth weight, or other factors. Medicaid is a lifeline for our clients.

In our state, Medicaid covers nearly half of all births. Unfortunately that coverage ends just 60 days after giving birth. For the moms who lose that coverage, we see the negative impacts:

  • For many new moms, 60 days is too soon to make decisions about birth control. They’re still learning to bond with a new baby, learning to breastfeed, struggling to care for younger children or keep their jobs. But if you miss that 60-day window, your options are much less.
  • Many moms get postpartum depression. It’s a real thing, and I think many supportive people overlook it because they’re so focused on the new baby. They don’t see how that new mom is struggling just to feed herself, to get through the day, to focus on work or school with a new baby. There are no therapists that say “Hey, come talk to me, I’m not going to charge you.” There’s always a fee. Without health coverage, that’s not accessible.
  • Finally, for women of color a big factor in maternal death is hemorrhaging afterwards, within the first year. It happens frequently. If something goes wrong, or they’re not feeling like themselves, whether mentally or physically, they have no way to get to medical care because they don’t have insurance coverage.

Extending Medicaid Coverage Post-Partum

I was so glad to learn about the legislative proposal to extend Medicaid from 60 days of postpartum coverage to 12 months (Senate Bill 530). I think it’s the best gift they could give any woman right now who has to rely on Medicaid.

Most Black moms that I see, the first time they ever go to a doctor is when they’re pregnant. Many women without health coverage have never been to a doctor or hospital before they were pregnant, because that’s when you must go. It’s also when they first begin to build some trust with the health care system, getting regular checkups and all those things. Once they get comfortable, after having a baby, we could address chronic health conditions, well visits, all the things they need to stay healthy and be a great parent. But that can only happen if the health coverage is in place. That’s another reason that extending the coverage to 12 months is such a good idea.

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Coverage for the Whole Lifespan

We still need to go further. In my work with Sistas Caring 4 Sistas, I’m just working with maternal health. But what about the rest of the body – the heart, the brain? Our whole bodies have to rely on this health care system, and it’s not good enough. I hope we can expand Medicaid to get everybody the coverage they need. I also hope that we can work with Medicaid to cover doula services.

Advocating for Families

We have done a lot at Sistas Caring 4 Sistas to improve the care that women of color are receiving in our local hospital. We have seen the changes from when we first started, when our white clients were treated so differently from our Black clients in childbirth. Because we’re there advocating for our clients, we have seen so many improvements in care, whether it’s at the interpersonal level of listening to the patient and using more respectful language, or the policy level of not pushing women to consent to caesarians right away, or having more Black nurses on the floor.

We can all advocate for birthing people by listening to them. Ask them what they need. Every mom is different, everyone needs different things. Health coverage is a key piece of what they need, and we can all advocate for that. We all need someone there to support us and to be a friend. That’s essentially what a doula is.

Cindy McMillan is a doula and childbirth educator. She is the Director of Sistas Caring 4 Sistas Community-Based Doulas for Social Justice, a program of of MAHEC OB-GYN in Buncombe County.

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