Major insurers continue to expand access to doula care, citing worsening maternal health outcomes nationwide and a growing body of evidence that doula support improves clinical results and member experience.
Doulas are trained professionals who provide physical, emotional and informational support before, during and after childbirth, but do not provide clinical services.
In March, UnitedHealthcare said it would extend doula coverage to eligible employer-sponsored plans nationwide, a move that could reach more than 7 million members by 2027. Depending on an employer’s plan design, members may access a set number of doula visits or a reimbursement allowance, either in person or virtually, with flexibility to choose doulas regardless of network affiliation.
“UnitedHealthcare now will be the first to offer doula support in employer-sponsored and commercial members at this scale across plans nationwide,” Rhonda Randall, DO, chief medical officer for the insurer’s employer and individual business, told Becker’s.
Elevance Health has offered doula coverage through some of its Medicaid plans since 2018. As of 2025, the company has expanded the benefit to 10 states for Medicaid enrollees and across select commercial markets. The Elevance Health Foundation has also awarded more than $30 million in grants since 2021 focused on maternal and child health, including programs to train and certify hundreds of doulas across 18 states.
“We did our own research, and we ran our own pilots on this over the past several years,” Cynthia Brown, MD, Elevance’s medical director and clinical lead for women’s health, told Becker’s. “What we found was women who use doula care have more full-term births, less lower birth weight infants, less C-sections, and lower NICU admissions. We also saw better pregnancy and postpartum mental health.”
In April, a systematic review published in JAMA Network Open found that doula care was most consistently associated with reduced maternal anxiety and improved breastfeeding initiation, with more mixed evidence around cesarean delivery rates and pain management. The review, which analyzed 22 articles on 21 clinical trials published between 2000 and early 2026, found that most existing trials were underpowered and that study designs varied widely, limiting the conclusions that can be drawn.
Dr. Brown noted that doulas do help reduce certain C-section rates, particularly around softer indications like elective repeat procedures, but medically necessary interventions still occur regardless of doula involvement. The stronger and more consistent signals, she said, involve improved mental health.
“Mental health is a big driver behind preterm births, worse outcomes, and lower birth rates,” she said.
Centene, the largest Medicaid managed care organization, has been pursuing similar goals through its partnership with Heartland Forward, a policy organization focused on economic and health outcomes in the Midwest and South. The companies last year launched the Maternal and Child Health Center for Policy and Practice, with an initial focus on expanding midwifery and doula workforce pipelines in rural areas.
“In 2024, we were responsible for more than 330,000 births, a third of whom are high risk,” Alice Hm Chen, MD, executive vice president and chief health officer at Centene, told Becker’s. “Community-based doula care has the greatest benefits in some of the most vulnerable populations, so it really does seem to have a mitigating effect on some of the structural barriers.”
Industrywide, insurers also face challenges surrounding doula credentialing and varying Medicaid reimbursement structures, along with workforce supply pressures and low awareness of expanding benefits among members.
“This is a time to double down on maternal child health, because it is the future of our country,” Dr. Chen said. “I think we’d love to see providers, payers, and policymakers converge around the right policies, the right practices, the right support.”
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