Summers: Indiana’s maternal mortality rates are unacceptable; Doulas Can Help

The lack of sufficient maternal health care is killing Hoosier women and children, but having a doula during pregnancy and child birth has the ability to save lives, according to advocates.

According to the Centers for Disease Control and Prevention, Indiana is the ninth highest state in infant mortality. Our maternal mortality rate is even more dire, as we have the third highest in the nation. These rates are simply unacceptable, especially in a state that largely touts itself as “pro-life.”

In 2020, I created the legislature's Maternal House Caucus to address these shocking numbers, which disproportionately includes Black mothers. However, Indiana is slow to implement meaningful changes. It is imperative that we raise awareness on this issue and pass the legislature to end this crisis.

77.8% of pregnancy related deaths could have been prevented. This is horrific reality should be sparking some major questions from lawmakers. If these deaths could have been entirely avoided, why are so many Hoosier women and children dying? Why is our state not placing more emphasis on solutions proven to decrease the number of tragic, birth-related deaths?

One such solution is more doulas in the field, a notion I have advocated for many times in the past. Doulas not only provide emotional and physical support for expecting mothers, but educational resources, less stressful birthing environments, and post-birth care. This continuous pregnancy care has been shown to have many benefits, such as shorter labors and preventative treatment for risks during pregnancy and labor. Women paired with doulas are two times less likely to experience a complication during birth.

All too often, women are left powerless in labor. The feeling of having both your own life and the life of your child in the hands of medical specialists is a terrifying experience in and of itself. But what makes vulnerability even more terrifying is the lack of control women have over their own labor. Unwanted labor exams, cohesion to birth in a certain manner, and a lack of consent by medical staff are all-too frequent issues plaguing the medical system. In a 2019 study, 73.2% of participating women were mistreated during their childbirth care. A 2023 study indicates that approximately one in five mothers reported similar mistreatment. Of particular concern, 30% of this number accounts for Black, Hispanic and multiracial mothers, demonstrating a clear medical bias.

This lack of consent and mistreatment is a systemic problem that many simply refuse to endure any longer. Women should never be talked down to or made to feel unsafe during this extremely vulnerable time. Women need an advocate, not an adversary. This negligence is why so many turn to doulas for support.

Time and time again, doulas are proven to improve maternal outcomes across demographics. A 2023 study by the National Institutes of Health shows that when middle- to upper-income women have a doula during labor, the likelihood of cesarean delivery and epidural analgesia significantly decreased. When a low-income mother is paired with a doula, infants are four times less likely to have a low birth weight. 41% of these women were Black, a notable improvement for a demographic facing racial discrimination in the medical field.

Racial disparity in health care is a continued hindrance to Black women receiving proper care. In 2020, the maternal mortality ratio for Black Hoosier women was 208 per 100,000 births. In Indiana, Black infants die at 2.6 times that of white infants.

Source: Indiana University Public Policy Institute Center for Research on Inclusion and Social Policy

All the research points to a failure to adequately care for Hoosier mothers and infants. Is it really any wonder why many are turning to alternative maternal care? I fully believe that if we want to change maternal care for the better, our state must take a deeper look the benefits of matching women with doulas.

In 2019, state Indiana legislators passed Senate Bill 416 allowing doulas to be covered by Medicaid. This move made Indiana the third state to enact this coverage, which is an impressive feat. But I must highlight a glaring flaw: Medicaid coverage for doulas is available, but not required. Even more disappointing, funds for this Medicaid expansion were cut from the budget in 2019. As a result, less people can afford doula care, which can often come at a steep cost. Republicans have turned a blind eye to the needs facing pregnant and birthing mothers. Meanwhile, it's women who pay the price. Doulas can save many Hoosiers lives, but only if they can afford to use them.

In 2022, a support services bill passed during the special session to ban abortion resulted in the formation of a 13-member state doula reimbursement advisory board. The purpose of the board is to recommend appropriate Medicaid reimbursement and focus on funding for doula services. I firmly believe this is a move that will help make maternal care more comprehensive and equitable for all Hoosiers. Every woman deserves to have a stress-free pregnancy and birth. We must do everything we can to push our state's numbers in a positive direction. Supporting doulas can help us meet that goal.

We know doulas provide critical care. We know they make women feel safe and heard. We know their care can result in both healthier babies and mothers. The way forward is clear: Fund Medicaid reimbursement, educate mothers on all their childbirth options and support this life-saving profession.