Missouri lawmakers have approved legislation that would expand Medicaid access to doula services, a move supporters say could strengthen maternal health care as more Black families seek culturally responsive support during pregnancy and childbirth.
The measure, House Bill 2372, now awaits action from Gov. Mike Kehoe. Among its maternal health provisions, the bill would formally establish the “Missouri Doula Reimbursement Act” and expand pathways for doulas to receive reimbursement through Missouri’s Medicaid program, known as MO HealthNet.
Doulas are trained birth workers who provide nonmedical support before, during and after childbirth. They do not deliver babies, but often help pregnant women navigate medical appointments, labor, postpartum recovery and breastfeeding support.
Under Missouri’s existing Medicaid framework, pregnant Medicaid recipients already can access doula services when recommended by a physician or other licensed provider. Covered services include prenatal visits, labor support and assistance during the postpartum period.
The legislation would place broader doula reimbursement provisions into state law and expand how doulas participate in Medicaid-managed care programs. The bill also adds childbirth education classes to covered maternal care services.
Missouri began reimbursing doulas through Medicaid under an emergency administrative rule issued in 2024 after state officials cited concerns about maternal health outcomes and access to care for pregnant women.
Since the program launched, more than 625 Missouri Medicaid participants have used doula services during pregnancy and postpartum recovery, according to the Missouri Department of Social Services.
The proposal comes as doulas have become increasingly visible in Black maternal health advocacy efforts in St. Louis and nationally.
Black women continue to face disproportionately high rates of pregnancy-related complications and maternal mortality compared with white women. Public health researchers have linked those disparities to unequal access to care, chronic stress, underlying health conditions and racial bias within the medical system.
State Rep. LaKeySha Bosley, a Democrat from St. Louis who has supported expanding doula access, said doulas can help address gaps many women of color experience in the health care system.
“It not only bridges the gap which we have not historically seen ourselves,” Bosley told KBIA earlier this year.
Research cited by supporters of the legislation has linked doula-assisted births to lower rates of cesarean sections, fewer premature births and improved breastfeeding outcomes.
In Black communities, doulas increasingly are viewed as part of rebuilding support systems around childbirth that many families say were weakened over generations as birth care became more institutionalized and less community-centered.
Many Black doulas describe their work as extending beyond delivery rooms. In addition to labor support, they often help families locate transportation, food assistance, housing resources and postpartum support.
Missouri is among more than 30 states that either reimburse doula services through Medicaid or are implementing policies to do so.
The broader health care legislation also includes provisions related to telemedicine, contraception access and maternal care services. But the doula provisions have emerged as one of the bill’s most closely watched maternal health components.
“This will assist women who are going through one of the proudest moments, potentially, of their lives … make sure that they have an advocate with them as they’re going through their birthing plan and doula services,” Peters told the Missouri Independent.