Gov. Greg Gianforte on Monday signed a bill into law that professionalizes doula care in Montana, resolving one of the most contentious topics of debate this legislative session.
A doula is a trained, nonmedical professional who provides care to pregnant people and families before, during and after birth. Doulas can accompany people to doctors appointments, help manage stress and make home visits to check on parents and babies. A growing body of research shows that doula care can improve health outcomes for both mothers and children.
Some hospitals employ doulas. Families can also privately contract doulas. While doula care is sometimes covered by insurance, families that contract doulas often pay out-of-pocket for services. Practitioners can join the Montana Doula Collaborative to network and access resources.
While doula practice has been unregulated in Montana, the new law — enacted by Senate Bill 319 — requires practicing doulas to gain licensure through the state Department of Labor and Industry. To gain a license, practicing doulas must submit an application to the department, satisfy other department requirements, and pay requisite fees. The new law also allows doulas to bill Medicaid for their services.
Medicaid coverage, supporters say, could expand access to doula care by removing a cost barrier for low-income families. Proponents of the legislation believe the law will also improve health outcomes for parents and children, particularly in rural and tribal communities.
A fiscal note created by the governor’s budget office, based on a forecast that doulas will be involved in about 6% of Medicaid-covered Montana births per year, estimates the law will cost taxpayers about $119,000 annually. The law takes effect Jan. 1 and has a sunset date of Dec. 31, 2030.
Sen. Cora Neumann, D-Bozeman, the bill’s sponsor and a former doula, told Montana Free Press Wednesday she was relieved to see the bill signed.
“This is the most comprehensive care we can provide to mothers and families and babies,” she said. “It’s not a one-off visit. It’s actually a continuum of care. It’s a huge benefit that has such high returns.”
Montana ranks 32nd in the United States in maternal mortality, and Native Americans in Montana have a maternal mortality rate seven times higher than that of White women in the state, according to a Georgetown Institute for Women, Peace and Security report.
Studies show that doula care can improve health outcomes for mothers and children, particularly in low-income and rural areas where people face barriers in access to health care. A 2013 study found that mothers who worked with doulas were four times less likely to have a low-birth-weight baby, two times less likely to experience a birth complication, and more likely to initiate breastfeeding. Other reports have found that doula care is associated with a reduction in cesarean and premature deliveries.
Neumann told lawmakers in several hearings the legislation would save lives.
“There are large parts of Montana that have no OBGYN services, no prenatal care,” she told colleagues in a February Senate Public Health, Welfare and Safety Committee hearing. “Doulas are in the community, and they can go to people’s homes. They know the communities and the women that they’re working with.”
DOULAS IN MONTANA
Julianne Denny, a doula on the Rocky Boy’s Reservation in north-central Montana, said the new law will make the profession more sustainable for practitioners.
“We’ve been just biting at the bit to get this through so that some of us can have careers in our cultural practices,” she told MTFP on Wednesday. “We’ll be able to take care of others and take care of ourselves.”
Misty Pipe provides doula services at no cost on the Northern Cheyenne Reservation. She said the law “is just the start of a whole new healing for my community.”
“Our people are going to have all-around support,” she told MTFP. “This is a huge step. … And it’s going to save a lot of lives.”
Stephanie Morton, executive director of social-services nonprofit Healthy Mothers, Healthy Babies, called the bill’s passage “a big deal.”
“We know that families need more support,” she told MTFP Wednesday. “… Being able to support and expand access to a smart and efficient use of resources? Yeah, we’re pretty excited about that.”
LEGISLATION HOTLY DEBATED
“This bill I believe was the highest drama of the session,” Neumann told MTFP. “It was because of sexism. It was because of women wanting to control their own bodies. And it was something seen as outside of men’s control.”
The bill prompted impassioned discussions in both the House and Senate, and amendments spurred further hearings.
While opponents generally agreed that doulas provide an important service, some questioned whether it should be a government responsibility to fund it. Others argued that licensure was unnecessary, likening doula services to the care a family member could provide.
In an April 11 session on the House floor, Rep. Tom Millet, R-Marion, asked why the state should regulate doulas.
“That’s not what Republicans are for,” he said.
Sen. Tom McGillvray, R-Billings, shared a similar argument in a March Senate hearing.
“One of the reasons I am a Republican is because I believe in limited government,” he told colleagues. “This bill is the opposite of limited government.”
Rep. SJ Howell, D-Missoula, disagreed, arguing that expanding access to doula care “is absolutely the right role for government.”
“This is a good thing,” Howell said. “This is adding a layer of medical workforce that Montana desperately needs.”
While some opponents took issue with the bill’s $119,000 cost to the state’s General Fund, Rep. Melody Cunningham, D-Missoula, who carried the bill on the House side, said that expense “will be far offset” by the savings that come with improved health outcomes.
Sarah Swanson, Montana Department of Labor and Industry commissioner, spoke in opposition to the bill during several hearings, citing procedural challenges. Later amendments that required licensure and established a termination date in four years assuaged her concerns.
She said during an April committee hearing that the licensure requirement provides helpful standardization for the agency, and the law’s sunset date “assures doulas that in four years, if it’s in fact not working for their profession, we get to come back and look at it again.”
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