Four years after Virginia became the fourth state to cover doula care for Medicaid recipients, just one percent of expectant and new moms choose to enroll. But one rural county supports a popular Medicaid-certified doula who was born and raised in the region she serves.
Two-month-old Gwen hiccoughs as her mom, Stephanie LaPerle, visits with doula Erin Jones in their tidy Louisa County kitchen.
“I have a lot of anxiety, some depression, mostly anxiety, so I thought postpartum would hit hard,” said LaPerle, 39, a vet tech turned stay-at-home mom whose husband sells medical devices. “We started texting, and she offered to be there during my delivery, which, I was so scared about giving birth. My family is quite far away.
“Really, I used you as a sounding board,” LaPerle added to Jones, who was holding Gwen. “You’re drooling on her!”
“Wouldn’t be the first time,” laughed Jones. “Don’t worry about it. That’s part of the job, too.”
Jones was born and raised in Louisa County and practices with OBGYN Denise Young. The two are part of a team caring for patients at Central Virginia Health Services, 90% of whom are on Medicaid or eligible to receive discounted services.
After Young does an exam, Jones drops in to chat and share her number. Plenty of patients don’t know what a doula is, but about half keep in touch with Jones, a single mother of five, throughout pregnancy and after giving birth.
In addition to fielding clients’ texts, sometimes dozens in a day, Jones delivers baby supplies and groceries, gives rides to appointments, checks in on no-shows, makes hospital and home visits, and troubleshoots emergencies.
“Monday, she texted me and she was like, ‘I don’t know who else to talk to about this,’” said Jones of another client. “But she’s had, she woke up and her pants were wet, and it was odorless, and it kind of sounded like water breaking, but it turned out to not have been that, and then she was in the bathroom throwing up for an hour, and she was having all this stomach pain, and she was like, ‘I don’t have anybody else to talk to about this,’ even though we hadn’t even met in person yet, but just from texting with her.”
Dr. Young didn’t start out looking for a doula. Two summers ago, though, one of her patients died from an overdose just four weeks after giving birth.
“And I didn’t see it coming,” said Young. “I had known her for years, I delivered three children, and it just was crushing. And I felt like, ‘We have to do better.’ And even though we are trying, we’re trying to do all the things they tell us to do, screening for depression, screening for needs, screening for everything on paper, and I knew that patient really well. I really felt like we had missed, somehow, and applying for that grant was to help try to fill some of those gaps and maybe not have that happen again.”
Virginia began covering doula services for Medicaid enrollees in 2022. But fewer than 1% of eligible expectant and new moms sign up with one, despite studies that show doulas improve birth outcomes, breastfeeding success, and reduce the frequency of medical interventions such as C-sections.
While the majority of the state’s roughly 200 doulas work in urban areas. Jones’ territory is Louisa’s 511 square miles of rolling countryside.
“Having the doulas themselves be from the community, I think, is really important.”
Alison Cuellar is a professor of public health at George Mason University who studies Virginia’s Medicaid doula program.
“Here, where we have persistently in the U.S. seen, we're just not getting better on some of these maternal outcomes, and, in fact, some of them are swinging the wrong direction, and getting worse. What about the peer? What about this community health individual, and, in the birth context, that’s the doula, can we make some progress there? There is evidence that it can work.”
Another of those helped by Jones is a 33-three-year-old mother gave birth to a son last June. A former IV drug user who asked that we not include her name moved into transitional housing last September with Jones’ help.
“I’m not used to that. I’ve kind of always, just, didn’t really have anybody, you know. In my family, you know, they were all doing their own thing, or whatever it was, so I didn’t really have anybody, and I was getting into bad relationships, and all that,” she said. “After I had him, everything just started to be clear of what I needed to do, and I just had the right people. Luckily.”
While Jones was initially paid through two small private grants, she got Medicaid-certified earlier this year, so the clinic will soon be able to bill the state for the care she provides.