What to Do if You Can't Afford a Doula

May is International Doula Month, and in celebration, we want to bring attention to one of the most common barriers to having one: affording the cost. It's not that you must have a doula to have a healthy and satisfying birth experience, but the research shows that continuous support, like the kind a doula provides, increases oxytocin and mobility (both of which can lead to a shorter labor), as well as decreases pain and anxiety. All of these add up to better infant outcomes, lower c-section rates, and higher likelihood of satisfaction for parents. 

For those committed and hoping for a doula, but struggling with the cost, we hope the following suggestions provide some guidance and help to achieving your goals.

Insurance coverage - Increasingly, insurance companies are covering part or all of the cost of a doula. Doulas are considered "out of network" and will need to be submitted for reimbursement after your birth, which means you will have to pay the cost up front. Talk to your insurance provider to find out what, if any, coverage they provide for a doula. Even if your provider says they do not reimburse for doula care, you can still try to submit receipts. If your request is denied, you can go through the appeal process. Some families have had success despite a lengthy process. 

Medicaid coverage - The following states are actively reimbursing people with Medicaid plans: FL, MD, MN, NJ, OR. The following states will begin reimbursing for doula care in 2022: DC, IL, IN, NV, RI, VA. For specific information about your state's status on Medicaid reimbursement for doulas, check out the database at National Health Law Program. Even if your state is not listed as having a program, it's worth calling your Medicaid representative to be sure. For example, Georgia is not listed as "actively reimbursing," but has an active Medicaid Reimbursement Pilot program. 

HSA/FSA - Many Health Spending Account / Flex Spending Account programs through your insurance allow you to use funds in the account for doula coverage. Talk to your insurance provider and/or HR representative to learn more. 

Hospital doula program - Some hospitals in the United States have implemented a doula program in which a doula is part of the hospital staff and is available for any family who wishes to have a doula during their birth. Contact the hospitals in your area (or neighboring areas, if that's a possibility for you) to find out if this kind of program exists near you. Or, search online using the term, "hospital doula program" plus your city or county name (or the largest city nearest you).

Financial assistance / sliding fee scale / scholarship fund - Some doulas and doula agencies offer financial assistance based on need. They will often require an application demonstrating the financial need for assistance. 

Low-cost doula program / volunteer doula program - In some areas, non-profits have organized to offer a low-cost or no-cost doula program for families who would benefit most. Use search terms like, "low cost doula" or "volunteer doula" plus your city or county name (or the largest city nearest you). 

Payment program - Most doulas will allow you to make payments toward your doula fee. Ask about a payment plan. 

Creative financing - If you're stuck trying to come up with the money, think of ways you can earn or raise money for doula fees. Have a fund-my-doula baby shower; host a yard sale; set up a fundraising page; comb through your monthly budget to see if you can free up some money; ask a good friend or family member for a loan or gift (only if this is safe to do).