Kimberly Costello is CEO of the Doula Foundation. The Springfield-based nonprofit has served southwest Missouri for over 25 years. Costello said it’s doing more than ever to address not just the clinical, but the social challenges facing new mothers, families and babies.
“We have many families that are suffering through single parent homes or domestic violence situations, homelessness, maybe they do not have family support. Maybe they aged out of the foster care system themselves, and they don't have a lot of family support systems in place. They don't understand community resources, and they're many times in survival mode themselves and trying to find out how to get through life and learn basic life skills. On top of now, they're expecting a baby. And so how do I move forward in that space and feel safe and feel supported?" she said.
"A lot of people are familiar with traditional doula services, where a support person or a doula that is non-medical will help a family that is expecting and provide some prenatal support and attend the labor and delivery with that family. What makes us unique is that we are a community-based nonprofit organization. Our team is certified as a birth and postpartum doula and a perinatal community health worker. And we provide not only the prenatal, postpartum education and the labor support, but also trauma informed care. We provide childbirth education, parenting education, all of these things. But also, when we do a home visitation setting and we walk in the door, that curriculum, yes, and best practices are there. But when we see a mom that's falling apart, something has happened. We can adapt very quickly, and we customize our care exactly to what their needs are," said Costello.
"How can we prevent foster care interventions? How can we prevent child abuse and neglect? How can we prevent any of these social concerns from happening? How can we help them get safe housing and a safe place to sleep and for baby to sleep when they come home from the hospital? And so, all of those things are combined with case management, home visitation and the social work aspect of what we do to make sure we're treating the comprehensive family unit," she said.
They know where to focus their effort, she said, because they know their patients, and Missouri’s researchers and leaders in maternal health have pinpointed the states' leading issues
“A few years ago, the state gathered a committee to start the PAMR Report, which we referred to a lot. It's the Pregnancy Associated Maternal Review Report," said Costello.
Eighty percent of the maternal deaths in Missouri were found to be preventable, she said. Costello has lobbied the state to support doula access for years, but one result of the report has been a renewed interest in how doulas can help improve outcomes. The state moved to allow Medicaid to pay for doula services including for a full 12 months of postpartum.
“If you are a mom on Medicaid in Missouri, you are eight times more likely to die of a pregnancy associated death. Most of that is because of access to care and someone helping you with community navigation and getting those resources you need,” she said.
Expanded access to doula support and access to care support in the sensitive postpartum period has an impact, according to Costello.
“They're reducing C-section rates. We're reducing children going into the NICU and preterm and low birth weights. We are actually providing those education pieces and that support piece to reduce stress and anxiety surrounding the birth," she said, "but also that comes to equate to a cost savings for the state. For every dollar that we spend in prevention, we're saving $7 to $10 on the other side of cost for the state with Medicaid dollars."
"There was a lot of research that was put into it and building trust and educating our state leaders. And now they're very excited about working together (and) really merging our clinical and non-clinical settings with community-based organizations to improve maternal health outcomes," she said.
The sustainable funding has also allowed the Doula Foundation to launch an academy to train others, and they are helping to certify doulas to allow them to bill Medicaid and help make their services more widely available. Costello said they next hope to expand doula coverage to private insurers in the state.
"We are not done until every mom receives doula support because we know how vital it is in reducing stress and anxiety and giving that support specifically to someone giving birth and preparing for birth," she said. "And then in that postpartum period that we know is so vital as well, giving them that support that really traditionally did not exist.”
Costello, the Doula Foundation and her peers know that support can mean all the difference to a new mom and baby.
Nick Burasco and Dax Bedell provided production support for this story.
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