āBackground
In collaboration with the California Department of Health Care Services (DHCS), this AFL provides hospitals with helpful information about Medi-Cal doula services and benefits, and recommendations for patient visitation policies and procedures to accommodate doula services and foster a doula-friendly environment for patients and their families. On January 1, 2023, DHCS added doula services as a covered benefit for Medi-Cal members. Doula services include personal support for birthing individuals and families throughout pregnancy and one year postpartum. This includes emotional and physical support provided during pregnancy, labor, birth, and the postpartum period, as well as support for and after miscarriage and abortion.
To help increase access to doula services, DHCS' Medical Director, Karen Mark, MD, issued a standing recommendation (PDF) for any Medi-Cal birthing individual who is pregnant or was pregnant within the past year to receive the following services:
- One initial visit
- Up to eight additional visits that may be provided in any combination of prenatal and postpartum visits
- Support during labor and delivery (including labor and delivery resulting in stillbirth), abortion or miscarriage
- Up to two extended three-hour postpartum visits after the end of a pregnancy
Benefits of Doula Support
A doula is a professional trained in childbirth who provides non-clinical emotional, physical, and informational support before, during, and after labor and birth. Doula support during pregnancy and birth reduces rates of cesarean deliveries, length of labor, premature delivery, low birth weight, and administration of pain-relief medications.[ā1] Birthing individuals receiving continuous support during labor report higher levels of satisfaction with their childbirth experience. Additionally, support from a doula may be beneficial for birthing individuals of color and those from low-income and underserved communities by helping to bridge any cultural or linguistic gaps between birthing individuals and medical care providers.
Visitation Requirements
Title 42 CFR section 482.13(h) requires hospitals to have written policies and procedures addressing visitation rights of patients and any restrictions/limitations to visiting rights must be clinically necessary and reasonable. Pursuant to Title 22 CCR section 70707(b)(17), a patient has the right to designate visitors of their choosing, which can include, but is not limited to, a spouse or a domestic partner (including a same-sex spouse or domestic partner), a doula, another family member, or a friend, etc. unless:
- No visitors are allowed.
- The facility reasonably determines that that the presence of a particular visitor would endanger the health or safety of a patient, a member of the health facility staff, or other visitor to the health facility, or would significantly disrupt the operations of the facility.
- The patient has indicated to the health facility staff that the patient no longer wants this person to visit.
If hospitals place any visitation restrictions/limitations, they must provide a clear explanation of the clinical rationale for the restriction or limitation in the policy. ā
Both CDPH and DHCS acknowledge that there is sensitivity around doulas being considered āvisitors," particularly when a doula accompanies a birthing individual into the hospital. Please note that CDPH and DHCS are only using this term to describe the category within written hospital policies and procedures that doulas can reference to better understand individual hospital practices.
Recommendations for Hospitalsā Patient Visitation Policies and Procedures
To maintain patientsā rights and foster a positive environment for birthing individuals, babies, and their families, CDPH recommends hospitals consider the following:
- Review patient visitation policies and procedures and update if necessary to specifically address doulas.
- Exclude doulas from the visitor limit if the policies and procedures contain a restriction/limit on the number of visitors (e.g., if the hospital has a limit of two visitors, a doula should not count toward the visitor/support person limit).
- Ensure frequently asked questions (FAQs) for visitation policies are easily accessible (e.g., easy to locate on the hospital website and post or make copies available on hospital premises).
- Provide training to hospital staff of all levels (e.g., administrative, clinical, and executive staff) on patient visitation policies and procedures to ensure appropriate implementation and to avoid any unnecessary restrictions/limitations on patientsā visitation rights, including access to doulas in hospitals.
Questions
If you have questions:
Sincerely,
Original signed by Chelsea Driscoll
Chelsea Driscoll
Acting Deputy Director
[1] Sobczak A, Taylor L, Solomon S, Ho J, Kemper S, Phillips B, Jacobson K, Castellano C, Ring A, Castellano B, Jacobs RJ. The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review. Cureus. 2023 May 24ā