Doulas can offer valuable support when you're having a baby. But they can also be expensive. So if you're thinking about hiring one for your pregnancy and delivery, you might be wondering whether the cost will be covered by your health care plan.
Doulas are trained, nonmedical professionals who provide emotional, physical, and informational support to women and their partners before, during, and shortly after labor.
The goal? "To provide a safe, satisfying birth experience," says doula Lisa Greaves Taylor, LCCE, CCCE, CD(DONA), CLSC, ILFS, the founder of Birth Matters NYC, and a member of the What to Expect Medical Review Board.
While doulas can't replace an OB/GYN or midwife, they can be with you to help navigate childbirth and ensure that your needs and wishes (like minimal interventions) are met as much as possible.
Working with a doula can improve pregnancy and birth outcomes, suggests a recent review published in the journal Cureus. [1]
"She calms you and eases your worries leading up to birth," says What to Expect Community member mac29118, who had a doula at all three of her births. "And in the delivery room, she’s there to navigate you through the most vulnerable time of your life. You need that commanding source of peace and wisdom in that room."
But paying for one isn't typically as straightforward as paying for your doctor or midwife care. Here's what you should know about doulas and insurance coverage, plus how to cover the costs if doula care isn't part of your insurance plan.
How much do doulas cost?
Doula rates vary widely, with total costs ranging from around $1,500 to $4,000. The rate an individual doula charges may depend on their location and experience level (doulas in large cities and/or with more experience tend to cost more than those in smaller towns or with less experience).
Read This Next
That fee typically covers services that start during your pregnancy and end shortly after you give birth.
"Common doula support packages include one to two prenatal visits in your home, continuous in-person labor, and birth support, which can be anywhere from four to 48 hours depending on how long labor lasts, and two to three postpartum visits in your home," says Becky Ofrane, DrPH, a doula, and an assistant professor of public health at Montclair State University in Montclair, New Jersey.
Are doulas covered by insurance?
It depends. Some private insurance companies have started to cover doulas, but it's still far from the norm, leaving families to shoulder the costs.
That said, "it's becoming more common," says Ofrane. In the last few years, states like Rhode Island and Louisiana have begun to require that private insurers offer doula coverage, while others nationwide may offer partial coverage.
Reassuringly, some What to Expect Community members report having their doulas covered by their plans.
"Mine is covered by our insurance, thankfully, since my husband is deployed and won’t be home for the birth. She will be my only support person," says What to Expect mom BabyMindSchism.
The picture is a little rosier for federal programs like Medicaid. To date, up to half of the states have either implemented or are in the process of implementing Medicaid coverage for doula services, according to the National Health Law Program and the Bixby Center for Global Reproductive Health. [2]
Those states include California, Florida, Illinois, Maryland, New York, New Jersey, Pennsylvania, Oregon, and Virginia. You can see a full list of states that currently offer Medicaid coverage and where efforts are in progress via the National Health Law Program's Doula Medicaid Project.
In some cases, your private insurer or Medicaid may require a letter of medical necessity (LMN) written by your doctor explaining why you need a doula.
"Generally, most insurance companies wouldn't cover it unless someone has a major medical risk factor," Taylor says. “Medical complications such as gestational diabetes, hypertension, and carrying multiples might be considered medical indications to cover doula support."
Since there's no one-size-fits-all answer, the best way to determine what your coverage options are is to call your provider.
Should doulas be covered by insurance?
Many experts say yes.
"Private and public insurance should absolutely cover doulas, since maternal and infant health outcomes have been shown to improve with doula support," Ofrane says.
Taylor agrees: "We definitely need to improve accessibility, so the more points of access, the better," she says. "Insurance coverage would be a good step toward improved accessibility for those who need the support the most but might not be able to afford it."
Doula support has been shown to improve pregnancy outcomes and reduce medical interventions related to birth, including a two-fold reduction in birth complications, a 40% reduction in C-section risk, and a more than 20% reduction in preterm birth, according to a cost-benefit analysis conducted by the Bixby Center for Global Reproductive Health.
These benefits can go a long way towards addressing the country's maternal morbidity rates, especially for BIPOC pregnant women.
"If we want to make headway in addressing maternal mortality, you have to roll [coverage] out for everybody. Anybody can benefit from the extra support a doula can provide," says Amy Chen, a senior attorney with the National Health Law Program who started the Doula Medicaid Project in 2018.
There's parental well-being to consider too. Doulas can help provide more satisfying birth experiences and make women and families feel more supported postpartum, according to the American College of Obstetricians and Gynecologists (ACOG).[3]
That could account for the fact that doula-supported births are associated with a 65% reduction in the risk of postpartum depression and/or postpartum anxiety, the Bixby Center report notes.
It's worth pointing out, too, that avoiding birth complications can result in significant cost savings that would more than justify a doula's fee.
On average, hospitalization for preterm birth costs around $44,000, about $40,000 more than the cost of a noncomplicated full-term birth, the Bixby Center estimates.
How to find out if your plan includes doula coverage and what to do if it doesn't
Since there's no one-size-fits-all answer, the best way to determine what your coverage options are is to call your provider and ask them directly.
They can let you know if coverage is offered, and if so, whether you need to do anything additional in order to obtain it (like get a letter of medical necessity from your doctor).
If your plan doesn't cover doulas and you have a pre-tax account like a Healthcare Savings Account (HSA) or a Flexible Spending Account (FSA), you may be able to put that money towards a doula. In that case, you may need a letter of medical necessity, Taylor notes, which is another reason to check with your insurance provider before making any plans.
Also important to note: Doulas aren't covered with dependent care flexible spending accounts and limited-purpose flexible spending accounts, which typically covered vision and dental services, Taylor says.
You can also check with your employer directly to see if they offer fertility benefits from programs like Carrot, Maven, or Progyny, which reimburse for doula services.
Your doula may need to provide paperwork that they've undergone certain training certifications, Taylor points out, so check with your employer's program to get the details.
How to make doulas more affordable without insurance
If the insurance route just isn't an option, there are still other ways to manage the cost of a doula. Try these suggestions:
Ask about a payment plan. Many doulas will allow you to pay in installments. Depending on your income, they may also offer services with sliding scale fees, Chen notes.
Consider a doula-in-training. Doulas who are still completing their certifications typically cost less. "Newer doulas often offer reduced fees to gain experience," says Ofrane.
Look into a community doula. Community-based doulas typically offer free or reduced cost support for members of communities who have historically had worse birth outcomes. You can find local community doulas via DONA International or DoulaMatch.net, or ask your health care provider for recommendations.
Research local programs. Ask your local maternal health agency if there are state or city funding programs you can take advantage of. You can also look into national programs geared towards serving groups with worse birth outcomes, like the Dove Black Birth Equity Fund.
Ask family and friends to chip in. See if loved ones will help pay for a doula in lieu of traditional baby shower gifts, Taylor recommends.
Try bartering. Some doulas are open to trading services, so don’t be shy about asking. "Maybe they could provide doula services in exchange for you helping them design a new logo for their web page. It's worth it to have these conversations," Chen says.
Find another support person. "A lot of the research on doulas shows that it’s actually the attentive, continuous support that benefits the mom through labor, not just the fact that it’s from a trained or certified doula," says Ofrane. Having a trusted friend or family member be there for you can make a big difference.
While more insurance plans are starting to cover doulas, many still don't pay for doula support. But if you're willing to do some legwork and get creative, you may be able to find other ways to pay for this valuable service during one of the most important times in your life.
Doulas can cost anywhere from $1,500 to $4,000, and some aren't covered by insurance. Some insurance plans like Medicaid are starting to cover doulas, but it’s not the norm yet. It’s a good idea to check with your provider to see if your plan helps.
If insurance doesn’t cover a doula, there are still options to make it more affordable. You can ask about payment plans, consider hiring a doula-in-training, or look into community-based doulas. Some doulas may even offer sliding scale fees based on your income.
Research shows that having a doula can reduce the risk of complications during birth, lower the chance of needing a C-section, and decrease postpartum anxiety and depression. Plus, doulas offer a level of personalized support that can make a big difference, especially for first-time parents.
Yes 
No 
Trending On What to Expect
