Daniela Procopio of SOLMA Tea poses with her arms crossed in front of a brick wall with greenery wearing a maroon shirt and jean jacket

Breastfeeding and Pumping Tips from Daniela of SOLMA Tea: Podcast Episode #225

Kristin Revere and Daniela Procopio discuss how her breastfeeding journey led her to create SOLMA Tea.  She also shares tips for support and balance as both a mother and an entrepreneur.    

Hello, hello!  This is Kristin Revere with Ask the Doulas, and I am here to chat with Daniela Procopio.  Daniela is the founder of SOLMA Tea, and she is also a mother and obviously fellow entrepreneur.  Welcome, Daniela!

Thank you so much, Kristin!  I’m excited to be here!  Yes, I’m a mother.  I’m an entrepreneur.  I, just like you, wear different hats.

Yes, I’m excited to chat about all the different hats you wear in your own personal journey, as many of us who work in the birth and baby space, our own journeys really help us to solve issues we had with our own pregnancies and early parenting phases of life. 

That’s how things get started, right?  You start solving something that you went through, and you think to yourself, wouldn’t it be great if I’d had this?

Exactly.  So fill us in about your own breastfeeding journey and how that led you to solve issues you found.

Absolutely.  I am a mom of three kids five and under, and I remember when I got pregnant, everybody would talk to me about the road to pregnancy, and then pregnancy, and then childbirth, and then that was it.  Nobody really spoke to me about anything post-childbirth.  So it wasn’t until I had my first and I came home with a baby, and I started on the breastfeeding journey that reality hit me right in the face.  Honestly, I was just shocked at the many, many different challenges that I experienced while on my breastfeeding journey because everyone had always spoken to me, when I’d heard about breastfeeding, “Oh, it’s so beautiful and it’s natural, so it will come natural.”  And yes, it’s beautiful and natural, and it can also be hard, and it can also be challenging, and there can be a lot of unknowns.  Sometimes there’s pain in the beginning, and the list goes on and on and on.  And it wasn’t until I was on my first postpartum journey that I realized all of this.  I was shocked.  I personally encountered latch issues, and I also encountered undersupply issues that became very, very challenging when I went back to work.  Because I had those undersupply issues predominantly, I started looking at various products in the market to help me boost my supply.  And the products worked for me, and I loved them.  I loved the cookies.  I loved the mother’s milk teas that you steep.  The only thing was, as one child became two, and two became three, and life got busier and busier, I realized there was really a need for me for a ready-to-drink product that I could grab and go and still deliver the same ingredients.  So when I couldn’t find something like that that existed, I created it.  That’s how SOLMA was conceived, from that idea.

Beautiful.  I love it.  How did you go about the process of research and product development?  Obviously, you would have hired experts, physicians and lactation consultants to begin this process?

Absolutely.  Absolutely.  I have the experience as a mother who tried these different products, but also, I know that my experience is limited in certain areas, and it’s very important to reach out and hire experts to help you get over the finish line.  So I did work with a lactation consultant.  I worked with a doctor.  And then I also worked with a beverage developer who was able to help me finalize the formulations and really do the production in order to get to my formulation exactly as I wanted it with the ingredients and the dosages, exactly as I want.  So I worked under the guidance of many different experts in order to get me the product that I ultimately ended up with.

Obviously, as far as having some focus groups and hearing from other mothers and what their struggles are, it seems that, again, the convenience factor is missing with having the steep tea.  The ready to go is important for busy, working moms or even stay-at-home moms who are juggling, say, three kids and trying to get out the door for all of the appointments and school, daycare, whatever it might be in a day.

That’s exactly it, Kristin.  And the thing is, for me, I can only take from my own experience.  I had three kids, working full time, so I was the mom on the go in that area.  But other women that I’ve spoken to, perhaps they only have one child, but they’re also helping take care of an elderly parent, or they have other caretaking responsibilities, or they also just have a very, very hectic schedule for whatever reason.  Sometimes they don’t have time to steep tea.  Or sometimes – one of the reasons I started shying away from the steeped tea is, when you have so many little kids, you don’t want a hot beverage near them where they could easily knock it over and possibly hurt themselves.  Because of all those reasons, and to meet women and breastfeeding mothers on their journey wherever that may be, that’s why it was critical for me to really create this product and address that need.

And so as far as balancing everything, how did you go through this product development, marketing concept, branding, and maintain a busy household and take time for yourself and your family?  I’m curious as a fellow entrepreneur how you balance all of that because a product is so much different than a service-based business like my own.

Right.  I’m still figuring out what works.  Every day is different.  I can only say from my own personal experience, and that is that I’m lucky that I have a very supportive partner.  As you know in the entrepreneurial space, every day can be different.  I have a partner who is able to pick up on the days where I can only give 10%.  We have what we say “office hours” at night.  Not every night, but once the kids go to sleep, we take a look at our schedule for the next few days, and we sort of map it out.  Hey, can you do drop off?  Can you do pick up?  Our oldest needs to go to the doctor.  Our youngest needs a dentist appointment.  Can you do this, that, and the other?  And sort of just having somebody on your team that is able to help you manage all the various logistics was really helpful to make sure that, as best we could, we didn’t drop any balls at home.  And then just in general, it was – I will say it.  One of my biggest things is you cannot pour from an empty cup, and it’s important to practice self-care and be gentle with yourself because it’s so easy as a mom, as a – if you work in or out of the home, if you have different dreams, like having your own business, it’s really easy to be go-go-go all day, every day and run yourself down.  It’s so important for me to practice self-care, and that can be something as simple as taking five minutes for yourself in the morning and journal a few things, or meditate a bit.  If you have the ability to make it work, meet up with a girlfriend or grab a coffee or something like that.  Anything – whatever self-care looks like for you, that you’re able to wing at that stage in your life, given the support that you have – I’m a big, big advocate of that because those are the two things that I feel have brought me the success and where I am at this point, having a strong support person that will help you through on the most challenging of days and also making sure that you take care of yourself so you can continue pouring out, into your business and into your family.

Very helpful.  So Daniela, we did address, obviously, the challenges of breastfeeding moms, but SOLMA Tea would also be a great resource for exclusive pumpers or working moms who pump while they’re at work and breastfeed at home and the supply issues that come with pumping.  How did you address that when researching and creating SOLMA Tea?

Yeah, so when we say breastfeeding moms, that’s just like you said; it could be if you’re breastfeeding all day.  It could be if you’re solely pumping.  We wanted to make sure to have a product that would both hydrate and also deliver five of the most well known galactogogues and to promote milk supply.  So that was one of the reasons that was very critical for me.  I wanted to have the bottles.  The SOLMA bottles come in 16.9 ounces because I wanted to make sure that in addition to delivering the ingredients, the galactogogue ingredients to help boost milk supply, you’re also hydrating, because I feel like no matter where you are in this stage, if you’re solely breastfeeding, if you’re solely pumping, if you’re supplementing, whatever it is, wherever you are in your postpartum journey or however it is that you’re choosing to feed your child, if it involves breastfeeding or pumping or anything like that, we wanted to make sure our product was able to support women through hydration and through deliverance of the galactogogue ingredients.

I agree, hydration is so important, and it can be a very depleting phase when you’re breastfeeding, pumping, supplementing.  There’s not enough time to continually nourish yourself and focus on drinking enough water.  It’s very helpful that you kept that in mind to make it easy to drink, and again, not anything that you need to watch or could potentially burn your child.

Right.  And for me, I will be the first one to tell you, I am not the best water drinker.  I don’t really get thirsty.  But every single time I started breastfeeding, I would get this unquenchable thirst.  My husband would know – when you come home from the hospital, they give you this big water bottle, and my husband would know, the minute the baby latched on, he would go refill this water bottle because I would get this unquenchable thirst.  So for me, as a breastfeeding mom, I realized, okay, I’m so thirsty.  It’d be great if I had something that could help quench my thirst and continue to hydrate me because sometimes those teas that you steep are really great for early morning or late night or when it’s cold outside, but if you’re unquenchably thirsty, it doesn’t really quench your thirst.  Or also in the peak of summer, you don’t really necessarily want something hot.  And so all those different reasons were our inspiration behind SOLMA and the ready to drink format.

So where can our listeners find SOLMA Tea?  How are you working on distribution at the moment?

Your listeners can find SOLMA Tea – we are exclusively ecommerce at this point, solmatea.com.  And so you can order directly on our website.  Also, if your listeners have any questions, any comments, or anything like that, anything they want more clarification on or they’re just curious and want to know, we also have a chat service on our website.  I personally answer all the messages that come through.  You can also contact us through social media @solmatea or through email.  Again, I’m the one who fields those questions.  That’s how your listeners can find us!

And what’s next for SOLMA Tea? 

Oh, so what is next?  We are actually in really exciting conversations to continue expanding.  Like I said, right now, we are strictly ecommerce.  We’re looking to get into a few retail locations, so a few exciting conversations in the works there.  Later this year, we are also looking into adding an additional flavor.  Right now, our product comes in three different flavors: chamomile, rooibos, and lemon.  We have one more flavor that we currently have in the works.  So lots of different expansion plans and exciting plans for SOLMA as we continue to grow.

Love it!  Very exciting!  So what tips do you have for our listeners?  As you mentioned, there isn’t enough focus on that postnatal time and planning.  What can our listeners do to make their life a little bit easier?  I know some of the highlights in our conversation, as you mentioned, convenience, talking to your partner, developing a schedule, and having that teamwork.  But what else comes to mind when you think of just the need to really ask for help and create a postpartum plan the way you would a birth plan?

Yeah, so for me, like I said, the biggest thing that I felt was really helpful for my second and my third postpartum period was that now I had the experience of my first, and I knew what to expect.  Obviously, not everybody has that when they’re going through.  They don’t know what to expect.  So being open to that.  Being open to realizing, this is your first time going through it, so be okay with some of the unknowns.  Understand that it’s important to have support, whatever that may look like for you.  So if you have support at home to help you on your postpartum journey, that’s great.  If your support is through a community online, that’s great, too.  Have some sort of support lined up so that in the middle of the night, when you’re in the trenches, you are able to reach out to somebody if you have questions, if you just need a shoulder to lean on.  I think that’s also very, very important.  And something that I always like to say, for women who do have a job outside of the house and are planning to go back to work after a certain time, I think it’s very critical to be able to set expectations with your employer if you are planning on breastfeeding or pumping or anything of that nature, just to understand what sort of facilities and what they look like where you’ll be pumping at work and things like that.  Because for me, having an understanding of what that will look like and setting schedules helps, obviously, ensure that you will be able to have success by having put steps in place to make sure that you are successful.  I’d say those are my few little nuggets in order to help prepare for postpartum.

Thank you!  And so you did mention, again, the research that went into creating SOLMA Tea, but I’m wondering what resources you would recommend for our listeners who are preparing for their breastfeeding journey, whether it’s baby one or baby five, or who do have plans to pump when they go back to work?  What are your favorite resources, whether it’s local or national, to get that help and support when it comes to feeding their babies?

Absolutely.  Two things come to mind.  When I was in the hospital, the lactation consultant came by, and I didn’t realize how important her visit was until later on.  But the hospital where I delivered, and many hospitals, I’ve found since then, have a lot of lactation support groups in order to really help you and other women who are in the same phase as you, the same postpartum phase as you, going through similar challenges, going through similar experiences.  I would definitely tap into that.  If you have a local hospital near you that has this sort of support, I would definitely start there because it’s so much easier when you’re in the middle of the fourth trimester if you have something close to you to be able to support you.

And then for me, the baby center, baby cafés.  We have a few locations near me, and that was another very, very helpful group have nearby because, again, you meet other parents that are in similar stages of the postpartum period.  You meet lactation consultants.  You meet experts in the field.  And you just meet people who’ve been there before you which, honestly, sometimes just having a friend who has had an experience, who’s six months ahead of you and has had that experience, is really helpful.  It’s like having a big sister to tell you, this is what to expect, or don’t worry about this, or oh my gosh, I’ve been there.  This is what I did to fix that.  So I’d say those two things.  Definitely lean on your hospital support, and then look for community support like the baby cafés in your area.  La Leche League is also very big, and if you go on their website, you can also find chapters near you that you might be able to find.  So lots of different resources.  It can be a little overwhelming, but there’s lots out there to help ensure that however you decide to feed your baby is something that you are comfortable with.

Perfect.  And many of those support groups are free, or some are covered by insurance.  For those who are in a rural community and don’t have access to some of these community groups or La Leche League groups, certainly there are many virtual communities that you can get that support.  But nothing replaces the in-person connection and just sitting with other moms and having that camaraderie and community, even if you’re not struggling with breastfeeding.  Sometimes I would go just to chat and get out of the house because it can be quite lonely in that postnatal phase.

Exactly.  I agree with that.

Well, if you would fill us in on your website one more time, Daniela.  It was so lovely to chat with you today.

Kristin, it was so wonderful to chat with you.  Thank you for giving me the opportunity.  Yes, our website is solmatea.com.  Our social media is @solmatea.

Thank you!  And can’t wait to see what’s next beyond your upcoming flavor.

Thank you so much!  We’re so excited.  There’s lots of growth coming for SOLMA, and we’re just excited about our journey from where we started and the people that we’ve reached thus far.  We’re excited to continue growing and see where the year takes us!

Yeah, and getting into retail is exciting!  I’ll be looking for you!

Thank you so much!



Birth and postpartum support from Gold Coast Doulas

Becoming A Mother course

Breastfeeding and Pumping Tips from Daniela of SOLMA Tea: Podcast Episode #225 Read More »

Kristin from Gold Coast Doulas wearing a red blouse and a white blazer sitting in front of a multi-colored wall

Your Options for Birth and Postpartum Doula support with Kristin Revere: Podcast Episode #206

Kristin Revere of Gold Coast Doulas talks about the types of birth and postpartum doula business models.  She also talks about the role of a newborn care specialist.

Hello!  This is Kristin Revere with Ask the Doulas, and today will be my first solo episode.  I was inspired after speaking at a doula conference in Parker, Colorado this past week called DoulaCon, and one of my speaking engagements there was a panel of agency owners and doulas who were experienced working in a variety of scenarios.

I was really surprised by some of the questions from the audience.  The audience was mainly made up of doulas and other healthcare professionals.  I really thought that our audience and doula clients may be interested in some of the options for them as they’re looking at choosing their perfect birth doula, postpartum doula, or newborn care specialist.


There are a variety of different options, and I may have personally experienced some, and others, I may not be as familiar with at all.  I’d love to hear from you if you’re a doula and work in a different model of care, or if you have hired a doula and they practice a bit differently than I have personally experienced or other panelists that I talked to were experiencing for themselves.

Solo birth doula: The client hires one doula to support them during pregnancy, labor, birth, and immediately after baby is born.  You get to know this individual well, and the doula is on call for you.  Many solo doulas are available between 38 and 42 weeks of on-call time.  Some doulas make themselves available before then.  They would rely on backup in case they’re at another birth, they’re sick, or they have an emergency.  The backup may be pre-selected, or you might know who that is, or it could be a last minute call and you don’t know that doula at all.

I was a solo doula myself for a couple of years before starting Gold Coast and was a backup for other doulas and went into births without every knowing the client.  I also relied on them for backup for my own business, and I did my own personal marketing and had my own website as a solo doula.

Partner doulas: This is when two doulas partner up.  They may or may not share a website.  They usually interview together and present themselves as a team.  They would either share calls equally, or one doula would be the primary and the other would be the backup that they know.  This ensures that you know who will be at your birth in most cases.  You wouldn’t need a backup unless for some reason they were both unavailable.  It’s often a more sustainable model for doulas.

I did this partner model with my then-business partner, Carly, before we launched Gold Coast because we worked on the business for six months before doing our launch tour and rolling out our website, and we were both taking clients but really wanted to try out that partner model.  So as individual clients hired us, we met with them together, and they were open to that option.  It worked beautifully for both of us, and we were able to be at our kids’ birthday parties and sporting events and important dates and still be there for our clients.

Gold Coast was founded with that partner model of care, whether it’s for birth or working in teams with our postpartum clients.

Collective: A collective may not just be for birth doulas.  I could also be for a mix of birth and postpartum doulas.  The collective that I was in was a group of individual doulas who shared a website and shared marketing costs.  We took turns attending events and were there to support each other.  So we had backup within that collective, and I taught my classes under that collective, as well.  There are many benefits to that model in that it gives a sense of community.  Doula work can often be isolating.  And it can reduce individuals costs for marketing and website expenses, expos.  You can all pool your money.  I know there are other ways that doulas run collectives besides the one that I personally experienced.  They are sometimes called doula associations, and doulas pay an annual or a monthly fee to join, and they may have Meet the Doula events or Doula Speed Dating, similar to what I had with the collective I was in, and then the potential clients could hire whichever doula they want.

Doula agency model: This is the model that Gold Coast uses.  As the owner, I do all of the marketing and the business end of things.  I do the invoicing and collections from the clients, handle accounting, and it frees up the time for the birth and postpartum doulas and newborn care specialists on our team to work directly with the clients.  It allows them to take more clients because they’re not doing all of the marketing and the sales and customer service, the business end of things that not every doula likes to do.  Or if they have kids at home or another job, it gives them more time and can increase their income.

Some doulas within our agency in Gold Coast share call as birth doulas, or with some clients, we have multiple doulas working with the same client, whether it’s daytime support or overnight newborn care, which is our unique special niche.

All of the doulas in Gold Coast follow the same standards.  They’re all certified.  They carry liability insurance.  Our postpartum doulas are background checked.  Our birth doulas are, as well.  Our postpartum doulas are CPR and first aid certified.  And our clients have a similar experience, especially with the postpartum doulas.  We keep a log and try to have that seamless experience no matter who’s attending.  If a client hires only one doula with us and that doula is sick or has an emergency, or if she’s a birth doula with us and gets called to a birth, then we have a big enough team that a client can always have support if they choose, or they can reschedule with their doula.

There are other agency models that operate differently than Gold Coast, but I wanted to talk about that.  I personally match the clients with the perfect doula or multiple doulas for them and really find out what they’re looking for experience-wise, what their ideal personality is, see what our availability is.  As an agency owner, I can often find a postpartum doula that day or night that a client is calling because we have a big team.  I know their schedule, and we’re able to make it happen because many of our clients are tired and they need sleep.  And a solo doula – we have due dates often six months ahead of time.  We could be fully booked up and may not be able to help a client, and our postpartum – again, with that urgency, the doulas could be limited in the number of clients they take, especially if they’re a birth doula as well as a postpartum doula.  So that is one of the benefits of an agency.

Other models: Other models that I’m not as personally familiar with are hospital doulas that work for the hospital and don’t know the client in advance.  They work a shift, similar to other hospital professionals.  There are also some doula groups that are similar to, say, a medical practice that follow a practice model where there are a variety of birth and/or postpartum doulas, and they have a set call schedule, the way a provider would when they’re attending their patient’s birth in the hospital.  So a doctor would have set days that they’re going to be attending births.  In the practice model, doulas have a similar philosophy and would be on call certain days and times of the week, and the clients know that going in.

There are also community-based doula programs that are often grant-funding and either sliding scale or completely free or very reduced rates to the community.  Doulas have mentoring and usually some of their other fees covered, and they’re given a set fee for the length of the grant.


This refers only to trained, certified postpartum doulas.  Some birth doulas sell postpartum support without being formally trained outside of their birth doula training.

Solo: Postpartum doulas may work solo.  They work for themselves; they pick and choose the clients and the hours that they’re available.  The client knows their doula.  The con would be if the doula is sick or has an emergency; the shift will be canceled unless they have a relationship with a backup doula and the client is okay with having a doula they’ve never met come in to work in their household.

Agency: This is Gold Coast’s model.  It allows for 24/7 care, at least within Gold Coast.  We have the ability to work 7 days and/or nights a week with care.  The agency model may have postpartum doulas only, or it could be a mix of birth and postpartum doulas.  It could be a mix of birth doulas, postpartum doulas, and newborn care specialists.

A newborn care specialist is trained to support baby only and is focused on baby’s care, and that’s often within the first several months.  It could be 24/7.  They often travel and then do a lot of overnight newborn care.  Their training is focused solely on the newborn and their development and care, and sleep is a big part of newborn care specialists.  Postpartum doulas, depending on the doula organization that they’re trained under, they may have a different scope of practice.  Some doulas are focused more on that recovery support of the first six to nine weeks and working themselves out of a job and focused on caring for the family, the mother.  Mothering the mother.  Household tasks, light meal preparation, light housekeeping.  They may or may not do overnight support, depending again on their training and their availability.  Some postpartum doulas, like many on our team, are also trained in infant care and work a longer amount of time and can do all of those household tasks and focus on recovery and feeding but also include more overnight care to ensure that the entire family gets rest while supporting the mother and partner emotionally, giving resources, referring to experts if there are any issues with colic or any medical concerns like tongue tie that would need to be evaluated by an international board certified lactation consultant, a pediatric dentist, and so on.  So we can help get the right resources for our clients.

An agency may be a model for you if you know you want a lot of support.  For example, multiple nights or days of care a week; longer periods of time.  If you know that you want access to the owner or the scheduler, depending on how the agency runs, then you know you get that customer service that you would expect from other companies.

Some newborn care specialists work with a referral firm that would operate more like a nanny agency who would help give them choices of newborn care specialists.  The client hires the newborn care specialist directly and pays a fee to the newborn care specialist agency, the same way that they would to a nanny agency, and the client pays the newborn care specialist based on that individual’s own contract and their terms.  That is a bit different of a model.

We’ll get into how to pay for your doula and some of the other scenarios in the future, but I thought this would be interesting for you as you’re beginning your search for a birth or postpartum doula or newborn care specialist and the choices you have for the different models of care and models of business out there.

Thanks for listening, and can’t wait to chat with you soon.



Birth doulas

Postpartum doulas

Classes from Gold Coast Doulas

Becoming a Mother class

Your Options for Birth and Postpartum Doula support with Kristin Revere: Podcast Episode #206 Read More »

The NDBN Diaper Check 2023 Diaper Statistics for Gold Coast Doula's 8th Annual Diaper Drive

8th annual Diaper Drive

Gold Coast Doulas is holding our 8th annual Diaper Drive from September 1st to October 1st, 2023. Giving back is an important foundation of our business as a Certified B Corporation; clean diapers make a significant impact on the health of new families and our giving focus is on supporting low-income women and children.

Gold Coast Doulas is holding our 8th annual Diaper Drive

One in two U.S. families with young children struggle to afford diapers and no government programs currently provide them. This rate increased from one in three in past years. Food, shelter, and utilities are the only items covered by assistance. Diapers are expensive and many families make tough choices between paying rent and utilities or buying diapers. Research shows that 48% of parents delay changing diapers and 32% report re-using diapers to make supplies last longer.

The Gold Coast Doulas diaper drive coincides with National Diaper Need Awareness Week, September 18th – Sept 24th. Diaper Need Awareness Week is an initiative of the National Diaper Bank Network (NDBN), created to make a difference in the lives of the nearly 5.2 million babies in the United States aged three or younger who live in poor or low-income families.

Our annual diaper drive benefits Nestlings Diaper Bank of West Michigan and Great Start Parent Coalition of Kent County. Holland-based Nestlings has distributed over 2 million diapers and helped over 50,000 families since 2011. Nestlings Diaper Bank also works with 31 partner agencies to distribute the diapers to the families in need.

Our goal is to collect 10,000 diapers to support families in need in Kent, Ottawa, and Allegan counties to celebrate our 8th anniversary. We collect opened and unopened boxes and packages of new disposable diapers, used cloth diapers and cloth supplies, new cloth diapers, and new boxes or packages of wipes. We need your help to make this happen.

Diaper donations will be accepted from September 1 to October 1st at the following partnered drop-off locations:

In Zeeland:
Howard Miller Library: 14 S. Church Street

Lake Michigan Credit Union: 8630 E. Main St

In Holland:
Brann’s 12234 James Street

EcoBuns Baby + Co.: 11975 E. Lakewood Blvd Suite 6

The Insurance Group: 593 Heritage Court

Lucas Scott. Co.: 650 Riley St.

Harbor Health & Massage: 444 Washington Ave

Lake Michigan Credit Union: 677 E 8th St.  and 3494 West Shore Dr


In Greater Grand Rapids:
Rise Wellness Chiropractic PLC: 1005 Lake Dr SE

Hopscotch Children’s Store:909 Cherry St SE

Mind Body Baby: 1501 Lake Dr SE

Advent Physical Therapy: Four locations

  • Cherry St: 245 Cherry St. SE, Suite 102
  • Byron Center: 2373 64th St SW Suite 2100
  • Alpine: 933 3 Mile NW #204
  • Caledonia: 10047 Crossroads Ct Suite 150

Mindful Counseling GR: Three locations

  • 985 Parchment Dr SE Grand Rapids, MI 49546
  • 3351 Claystone St SE Suite G 32
  • 113 Lake Michigan Drive NW, Standale

Fit4Mom Grand Rapids: Donations accepted at classes.

Gold Coast Doulas: Donations are accepted at classes or left outside the door of our office.

We appreciate your support! You can donate directly to fill Nestling’s Amazon Wish List or through their website via Paypal at: http://nestlings.org/how-to-help/.

Contact us at info@goldcoastdoulas.com with questions.

8th annual Diaper Drive Read More »

Erica wearing a green sweater with a blue and white beaded necklace against a black wall

Medicaid for Doulas with Doulas Diversified: Podcast Episode #168

Kristin chats with Erica about the Medicaid coverage for doulas in Michigan and how this improves maternal and infant health outcomes.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you find your podcasts.


Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello, hello.  This is Kristin with Ask the Doulas, and I am so excited to chat with Erica Guthaus today.  Welcome, Erica!

Erica:  Thank you so much, Kristin.  I’m really excited for this conversation today.

Kristin:  So happy to reconnect!  Listeners, Erica was one of our early birth and postpartum doulas at Gold Coast, and you and I have stayed in contact, Erica, for many years with all of the different initiatives that you’ve been involved in throughout Michigan and also nationally.  So I’m so excited to talk to you about Medicaid coverage for doulas in Michigan, and also a bit about what’s going on in the national scope with doula coverage under Medicaid.

Erica:  Absolutely.  There are so many exciting developments that are happening here in our state, which is always fantastic, but we actually are not the ones that have been leading the charge on this front.  You know, there are states that have been in this position and offering this type of coverage and support for more than ten years at this point.  So it’s really exciting that it is finally on our home front and we have access to it in this way.

Kristin:  Exactly, yeah.  I’ve been talking to doula friends in Oregon and Minnesota and then more recently in New York, so I know this has been pending legislation for years in Michigan.  I’m so excited about the plan and the support from Governor Whitmer.  I mean, it is fantastic to have this coverage for Medicaid patients.

Erica:  Yes, it truly is.  I mean, I distinctly remember attending the first webinar, just really kind of getting into what the specifics were going to look like related to Medicaid reimbursement for doula coverage, back in, like, I think August of 2020.  So at that point, it was looking like a very different approach.  It was initially, like, a bill was being introduced by a senator.  And, you know, that was the pathway that was being taken, and then Medicaid decided that they were going to just kind of willingly get on board with things, and that definitely changed the landscape of the conversation.  It also elongates the process because if anyone listening has ever dealt with any aspect of public health or Medicaid coverage as a beneficiary or supporting people, you know, in either a personal or professional manner as they navigate the DSHS system, nothing is fast.  Nothing is every straightforward and easy.  It’s very, very complex.  So it has been a very long and anticipated wait, and I’m really glad to be on this side of it.

Kristin:   Definitely.  So fill us in a bit about your history, both working as a doula to training community-based doulas and then getting into the maternity space within the nonprofit sector.

Erica:  Absolutely.  So I have had a kind of long and interesting journey to get to this very spot right now.  I first started working with childbearing families back in 2008 as just a kind of peer support navigator.  I have four kids myself, so they are now 17, 15, 13, and 11.  And it was when my two oldest were really young that I was the person that kind of became the go-to when it came to knowledge and questions and things like that.  So it was very kind of loose, but I also became the person that everyone’s like, you should be a midwife.  You should be doing something different in this space.  So I had to really sit with that for a while, but also I continued having babies, and that makes it really hard to step into birth work.  We moved back to Michigan after living out of state for a couple years, and I decided to step into the professional birth world as a doula.  I started as a postpartum doula.  That really, I think, will always and forever be my first love, the postpartum space, mostly because I really – postpartum was hard for me, especially with my fourth pregnancy and postpartum experience.  A lot of challenges.  It honestly informs and drives my work now.  But it really – that’s where my heart was, and that’s what I felt called to.  And just as a natural transition from the postpartum space, I started getting asked, hey, would you support this birth?  My friend is pregnant.  You know, that type of thing.  And so I just decided to go ahead and take the step in that direction because it was just this very natural unfolding.  And so I became a labor and birth doula, as well.  And that is usually how I did my work with Gold Coast, actually, way back in the beginning of Gold Coast being in the community.  I was really for labor support.  And so that really kind of laid the foundation, but it also transitioned me into that community-embedded space.  I brought a pay-what-you-can model as an individual practitioner so that services were more accessible and hopefully more equitable to people, and everyone kind of was always like, is this really what you say it is?  Like, is it really pay-what-you-can?  Yes.  It really was pay-what-you-can.  So I had clients who could pay literally $100 towards their services.  I had clients that could pay more than double what I would have been asking if I just had a set price.  And what was really interesting to watch unfold was that over the course of the year, generally speaking, the average of the revenue that I brought in averaged out to what I would have just been charging at a flat rate, except it allowed more people to have access, which was really cool.  It was just really neat to see how that was possible but while still actually making, you know, an income that was impactful for our family.  So that again, though, just having that eye on the need that was being unmet at that point in time and the gaps in coverage and things like that is what forced me – I shouldn’t say forced.  I really chose to fully step into that more community-based space, starting first as a project coordinator for a pilot program with MomsBloom for community-based doulas in Kent County.  And then that really just kind of took me more and more into the nonprofit space and how it relates to birth and birth support, working with, like, really hyper-local, like tiny teams, and then most recently working in the national landscape and being able to work with not only doulas, but birth workers of all types throughout all 50 states.

Kristin:  Amazing.  So tell us about your new business that launched in response to Michigan’s Medicaid coverage.

Erica:  Yes.  So this new business is called Doulas Diversified.  It is a division or program of our parent company, which is This Is Diversified.  So Doulas Diversified is really one of a kind at this point in time in that it is a Medicaid exclusive doula agency.  So I’ll be really honest and say that I was at a point career-wise where I was really ready to step fully away from both the nonprofit space but also the birth space.  I was really burned out, which if you are a doula or any type of birth worker, you know that feeling.

Kristin:  We all understand that well, yes.

Erica:  Yes.  Very, very well.  And so I swore it all off.  I was like, no.  I am done.  I need to do something completely different, use my skills in a different way.  And then it started to really come to the surface that Medicaid reimbursement was really looking like it was actually going to stick.  And so I had to pause and I had to check myself a little bit, and I decided, you know what?  Maybe now actually is the time to move forward with this plan that has really been brewing in my head for close to ten years.  And that is saying, we’re showing up for this very specific population that spans, honestly, like, all races, all socioeconomic statuses as long as they qualify for Medicaid.  It’s just a really interesting space.  But there are huge gaps in coverage, and it’s also where we see a lot of negative outcomes, and also negative experiences when going in to have a baby.  So that’s where we come in.  And it’s really exciting.  It’s also really crazy right now just because of the pace at which things are developing.  But yeah, we’re really excited to bring this really to communities across the entire state.  We’re not local, like, specific to one local arena.

Kristin:  Right.  I mean, being a state-wide agency is so much more impactful than being geographically based out of Lansing or Grand Rapids.  And so yes, and Gold Coast at this point has made a decision that we are not accepting Medicaid patients, as our core focus is postpartum and expanding geographically with our postpartum services.  So our plan is to refer any of our inquiries to Doulas Diversified.

Erica:  Yes, which I appreciate so much.  And also I think – you know, I’m sure there are probably a lot of questions about why Gold Coast as an entity has decided not to engage, and I think that’s actually important to talk about.  Again, I mentioned before that Medicaid is very twisty-turny, right?  Nothing is straightforward.  And as a result, in most cases – and this is kind of true with insurance, in general – it can often be both cost and time prohibitive for people to engage with those systems.  I know in recent years, I have seen a big movement with, like, primary care providers moving into more of a concierge model where they are independent.  And, you know, they are cash pay only or they might take, like, flexible spending or health savings accounts, something like that, but they’re no longer working with insurance, and I completely understand why.  You know, you really have to work three times as hard for every dollar that comes in when you’re utilizing insurance reimbursement or Medicaid reimbursement to get those dollars into your practice, and so you really have to stick with it and you have to chase the money.  Everyone’s like, oh, just hire a biller and a coder.  Well, that can also be super cost-prohibitive because they have minimums.  You know, your monthly claims.  And the reality that we face right now as doulas is that, one, this is all completely new.  Right?  This is still – I would go so far as to say that it’s still relatively uncharted territory in the birth world, so we don’t know.  We don’t know what the actual numbers are going to look like.  We don’t know what our revenue streams are going to look like from this yet.  And so that means with all of those unknown factors, we can’t just hire, right?  We cannot say we’re going to commit to that type of expenditure.  And so just trying to figure out how to navigate it and also, you know, keep a business afloat is a lot to take on.  So I appreciate you setting that boundary for yourself, Kristin, so that you can really focus on the continued reach and success of Gold Coast, because it’s not – Medicaid is not for everybody, and that’s okay.

Kristin:  Exactly.  And I think for us, it’s just capacity and my time as the sole owner, and as you mentioned, the billing and really all of the charting and the fact that, as you know, Gold Coast works on the team model and really getting all of our subcontractors set up with all of the registration and, you know, dealing, navigating the insurers who are accepting Medicaid.  And so that was not something that we were able to navigate, and as a certified B-Corp who gives back both in volunteer time and in charitable giving focused exclusively on low-income women and infants, we felt like, we’re already doing that work.  We’re giving to charities who navigate the giving more effectively, so everything from Clinica Santa Maria to Pine Rest Mother-Baby Program to Nestlings Diaper Bank to Preeclampsia Foundation, we’re able to directly give, and so you have to pick a core focus.  I love that you are focused exclusively on Medicaid clients.

Erica:  Yes, absolutely.  You really do have to niche down, if you will, if you’re going to experience longevity in the work.  I think, you know, we all came into this space very bright-eyed and altruistic, a lot of times, about what’s possible.  But I also can say that, you know, on average, the lifespan or the longevity of a doula coming into the work at the very beginning is about two years.  And that’s not actually super long when we talk about or think about the training that goes into it, the work, if you’re working towards certification, if that’s your pathway.  And then actually getting your toes in and starting to work with clients.  By the time those things have transpired, really, it’s realistic to say that people are only doing the work for about six months before they’re just making the decision that it’s not for them.  And that for me is a real struggle.  Like, I really want to work to combat some of that as well, and you can’t do that when you are trying to have your fingers in every single space.

Kristin:  Exactly.  So true.  So let’s get into – you know, every state is different, and obviously, there are states like Oregon and New York and Minnesota that cover doulas, but again, you know, talking to a doula there, it’s a completely different plan than what we’re navigating for the first time ever in Michigan.  So let’s get into a bit about what the coverage includes and what it doesn’t include for Medicaid patients.

Erica:  Yes.  I think that what it doesn’t include is actually a really smart piece of this conversation because I think that that may be where the clarity comes from.  So what it includes as of right now is six visits, and I’ll expand on that in just a moment, and then it also includes coverage for the actual labor and birth.  I am going to be very transparent and say that the reimbursement rates that have been spoken at this point in time are not near as high as most doulas would like to see.  Hopefully, that’s something we can work on over time.  I was really hopeful that, you know, we were going to take the lead of states like Rhode Island, New York, New Jersey and, you know, start at a higher rate of reimbursement.  Unfortunately, that’s not how things came through.

Kristin:  Definitely higher than the first two times that we signed letters on.

Erica:  Yes, that also is important to acknowledge, right?  That we actually did make some progress, and I was genuinely surprised when the revisions came out and they were responsive to the feedback, because that often is not the case.  So I do try to celebrate small victories, and that felt like one, for sure.  So with the six visits, those are intended to cover both the prenatal and the postpartum period.  For some providers, six visits is more than enough to cover what they need to and be certain that their clients are equipped for the experience that they’re about to have and to also do postpartum follow up for them.  For other providers, especially those who are community-based practitioners, six visits is not even close to enough.  So it does definitely require some adjustments to models of care and approach, for sure.  And I also think that a really meaningful experience can still be cultivated with six visits on the table.  And then the labor support, that is honestly really kind of open and really will be determined by individual doulas and how they’re going to approach that.  You know, the thing for a lot of doulas as providers is that so many of them have been working with Medicaid population and Medicaid beneficiaries for years at this point, and they’ve just been doing it with – for no compensation at all.  So I have kind of coined the phrase, you know, like, this is a promise of a paycheck, because also when you’re talking about this Medicaid reimbursement, it is that.  It’s reimbursement.  This is not being paid up front for doing the work like we would if we were just invoicing clients, and it takes time.  It takes time to actually see those dollars come in.  One of the things I love is I believe it was New Jersey, actually.  They wrote in a provision in their legislation that put kind of a timestamp on the Medicaid health plans in which they have to pay by, and I was like, that is so incredibly smart because Medicaid, by law, can take their sweet time in processing payments back.  For example, you can submit a claim.  Medicaid can deny that claim.  They actually have a year to respond to that initial claim, which I think is something that a lot of people don’t know.  So they have a year in which to respond.  They can deny it.  Then as a provider, you can appeal that.  You have a year to make that appeal.  So we’re at a potential two-year timeframe.  You know, this again is worst case scenario, but I also think it’s important to really lay it out.  So you have a year, then, to refute that claim, and then they have another year after that in which to do their final response.  So, you know, worst case, it can take up to three years to actually see just response to one claim individually.  My hope is that that’s not going to be the case because otherwise this program is not going to be a success.  Like, I’m just going to be really bold and say it because people need to get paid for the work that they’re doing.  You know, I am not a believer in uncompensated labor, and when you’re talking about reimbursement, that’s already kind of a part of the narrative.

Kristin:  Absolutely.  And some doulas, based on life and family situations, only take a handful of clients a year.  I mean, honestly.  So they can’t wait two years to get compensated if they’re an individual doula who’s not working in an agency like Doulas Diversified.

Erica:  Yes, exactly.  You know, that’s our hope, actually, is that we can come in and say, “Allow us to do the heavy lift of chasing your money for you, and you just keep showing up for people in the way that they need you to show up.”  Because honestly, you can’t do both of those things and do them well.  And we want to set people up for success.  We want families to have a really positive and empowering experience.  And, you know, we’ve created a model where we think that both of those things are possible.

Kristin:  So amazing.  So let’s get into – I know we talked about what the benefit includes.  Let’s chat about what it does not include, including the role of a postpartum doula.  Like, those postpartum visits are more like the birth doulas’ postpartum recap visits with some education, with some lactation support, with resources.  But they’re not, you know, caring for baby or doing household tasks or sibling care or other postpartum doula roles that are different than a birth doula’s certification trainings.

Erica:  Yes, absolutely.  So it is really important to get clear on that aspect.  This is not – this really – I wish that the language actually used, like, labor support doula,  instead of just doula as a blanket statement, because this really does have to be compartmentalized, and looking at it just isolated to the prenatal education period, the actual labor and birth experience, and that immediate postpartum period really, like, the two weeks after, and not really much beyond that.  So you could, you know, look at a situation where you’re saying, okay, I’m only going to use two of my visits that I’m allotted before – like, in the prenatal period; attend the birth, and then I’m going to save four visits for after, if a family really, really needed some type of support, but honestly, it’s not really designed for that.  So, you know, postpartum doula relationship is so different from that of a labor doula.  I mean, you really are kind of integrated into that family’s landscape for the time period that you’re together.  You know, you’re in a very vulnerable space with them.  You’re in a very intimate setting with them because you’re in their home, right, not only caring for them, but often caring for children in addition to their infant, and yeah, it’s just such a different setting that it requires a high level of compensation, honestly.  And that is just not something that – I don’t even know that Medicaid has an understanding of the impact that that could have for families.  My hope is that because this dialogue has now started through labor support, that it can open up, you know, a new pathway of opportunity for that to become part of what is offered, as well.  But for now, it just isn’t, which is really sad, and I wish that there was a way to navigate around it because so many families who are in vulnerable situations, transient situations, transitional time periods, they need postpartum support more than anybody else.  So my fingers are crossed that long term, we can bring coverage into that space, as well, but for now, it’s just not on the table.  Again, small victories; we can celebrate the fact that nationally, Medicaid has really pushed for that twelve-month expansion coverage for postpartum birthing people.  Before that, it was a lot of times only six weeks, so that is really significant, to have that as part of it, which means that access to support services for things like perinatal mental health and perinatal mood disorders and things like that will be easier to have service providers reach out.  But there still is a long way to go in that regard.

Kristin:  Agreed.  Let’s chat a bit about the reason that Governor Whitmer and her team have made such a strong stance and tied in Michigan’s doula Medicaid program to the Healthy Moms, Healthy Babies initiative and really what that means for Medicaid patients.

Erica:  Absolutely.  So this is where we can get a little bit into the nitty-gritty and talk a little bit about statistics because I don’t think you can have this part of the conversation without that information as part of it.  So what we see on average, nationally speaking, is a mortality rate which, I should probably also dispel some language stuff here.  So when we think about birthing people, we think about kind of two areas.  One is mortality.  The other one is morbidity.  Mortality obviously being death-related, and morbidity being negative outcomes, right?  Just because you did not die via childbirth, it does not mean that your experience was healthy and well.  So it’s really important to keep that in mind.  But when we think about maternal mortality but also infant mortality, generally speaking, Black women and Black birthing people die at a rate of two to three times that of their white counterparts.  So what that means in simple terms is that for every one white birthing person that dies as a result of their childbirth experience, you are looking at two to three Black women having the same outcome.  When you look at it on a larger scale, the numbers are really scary and sickening, actually.  And I think it’s also important to insert here that those outcomes are regardless of socioeconomic status.  They are regardless of education level.  So you can have Black women who are highly educated, right?  Advanced degrees.  We’re talking lawyers, doctors, right?  Very, very high levels of education; very, very well off, in terms of their economic means, and they can still have worse outcomes than an eighth-grade educated white woman.  So it’s, I think, having – when you’ve not had that picture painted before, it’s important to take that in and honestly just sit with it.  When you really start to let it soak, it’s like, wow, how is this where we still are?  It’s 2023.  We live in such an information-rich society as a people globally.  We can look at all of these different scenarios related to technological advancements and how they can impact birth in positive ways, and yet we’re still here.  Michigan has been honestly kind of at the forefront of leading changes that can potentially impact birth outcomes for years at this point, which is great.  We’re talking like early 2000s is when they really said, hey, we have a problem here.  And again, small victories.  It’s important to celebrate the fact that we have seen a decrease at a state level when we look at the averages.  Back in the early 2000s, there were some counties where we were seeing 7 to 10 to 12 times the mortality rates in those communities for Black women against their white counterparts, which is just – I can’t – I just can’t fathom.  So we have made improvements.  I think it’s very important to recognize that.  Things that are in place, even if they weren’t necessarily enough, they also have had significant impact.

Kristin:   Yes, agreed.

Hey, Alyssa here.  I’m just popping in to tell you about our course called Becoming.  Becoming A Mother is your guide to a confident pregnancy and birth all in a convenient six-week online program, from birth plans to sleep training and everything in between.  You’ll gain the confidence and skills you need for a smooth transition to motherhood.  You’ll get live coaching calls with Kristin and myself, a bunch of expert videos, including chiropractic care, pelvic floor physical therapy, mental health experts, breastfeeding, and much more.  You’ll also get a private Facebook community with other mothers going through this at the same time as you to offer support and encouragement when you need it most.  And then of course you’ll also have direct email access to me and Kristin, in addition to the live coaching calls.  If you’d like to learn more about the course, you can email us at info@goldcoastdoulas.com, or check it out at www.thebecomingcourse.com.  We’d love to see you there.

Kristin:  And, I mean, honestly, doulas have been so supportive in this state.  I’m looking at, like, during the pandemic and the stay at home order, and yes, being able to be considered essential workers and to have the hospitals and the governor’s approval to work at that time and the impact we made on families and the stress on health of COVID.  So again, not everyone was able to afford a doula, but at least for clients who could, they had that support.

Erica:  Yes, for sure.  Because that was not the case in every state, actually.  And even still now, there is a lot of bureaucratic red tape that’s been put in place to actually restrict doulas coming into the environment under the guise of public health and wellness.  So we are very fortunate here to have the level of support that we do.  But I think linking this to COVID is probably a good place to start, Kristin, in terms of Healthy Moms, Healthy Babies, because COVID was kind of the great equalizer, and people started to see public health issues in a way that I have not witnessed them see and perceive them before.  So it really thrust a lot of these really important conversations into the light, which is great.  So, you know, during COVID – it was actually the lieutenant governor’s office, I think, was the first to announce this initiative related to really Black health and BIPOC health in general, and then it really just continues to be pared down from there into these specific areas that need special attention, and mom baby health is really at the center of that.

Kristin:  Exactly.  And, you know, getting into the importance of the role of the doula as a nonmedical, emotional support continuously from the moment we’re hired, so – and that really gets into the issues immediately after having a baby.  You know, the check-ins that we do; the fact that we have the follow up postpartum appointments, because they’re often not seeing their physician or sometimes midwife for six weeks.  And so you get into issues not only with the mother, but the baby that are left untreated, and there may be fear of going back to the hospital, and what do you do with your baby?  There can be issues with hemorrhaging.  So really, there are nonmedical support, we’re able to make referrals and suggest they call their doctor and try to get them in, because depending on the personality, some people will just wait it out.

Erica:  Yes, absolutely.  I’m guilty of that big time, you know, because I think it’s really easy to try and convince yourself, like, no, I’m totally overreacting.  It’s just my hormones.  You know, all of those things.  Just trying to justify an experience.  That, again, is where doulas as a neutral party, right, we’re actually sleeping most of the time, right?  So we’re not sleep deprived.  We can really look at individual situations objectively and say, yeah, you know what – because how much blood is too much blood loss when you’re immediately postpartum?  Blood pressure wise, how high is too high?  How much milk is not enough milk?  All of those things come into play.  So we can sit and hold that space for conversation, you know, offering encouragement and support.  But again, filling that gap between leaving the hospital and actually seeing your provider again.  So many immediate postpartum families need a gentle push to seek additional attention, and without doulas as part of their care team, they would just go without, which can have catastrophic outcomes and impact.

Kristin:  Exactly.  And, I mean, it could be referrals to a therapist if they’re having perinatal mood disorder concerns that are beyond the baby blues.  And then also giving resources like MomsBloom that does offer volunteers in the home to help in that postpartum phase.

Erica:  Yes.  You know, Michigan, again – I feel really lucky that we have the resources that we have here.  You know, whether it’s an entity like MomsBloom, and I know there’s interest in growing that in other communities across the state.  So many community-based nonprofit entities who are saying, “We are here for you if you need resources, if you need peer support, whatever that looks like.”  And then also, you know, having the resource of the Mother Baby Program at Pine Rest.  When I share about that with people out of state, they’re like, no way.  Like, that is such an amazing opportunity for people to get support, and it just doesn’t exist in other places, so we’re really, really lucky with the things that we have available to us.

Kristin:  Yes, I’ve attended doula trainings out of state and trainers and doulas alike knew about our program and even had clients travel from, say, Chicago to Grand Rapids for the mother baby program.

Erica:  It’s not unheard of at all, and I have tried to make connections.  Like, yeah, open up a conversation.  You know, I have no idea what’s possible in your own community, but there are some really amazing things that are available here that also have longevity to them, right?  So they’ve been through the trials and tribulations of kind of working out hiccups, which means that other people can really glean from their experience and expertise, as well.

Kristin:  Yes, exactly.  So if any of our listeners are interested in utilizing this benefit, and I know it’s so early on, so it may not be communicated very readily through providers at this point, but what does it look like to receive care?  How do you find a doula for doula covered states who would be on the registry, and of course, obviously, they can easily contact Doulas Diversified and know that every doula who works with you is registered through Medicaid, but really kind of those first steps, and how do you get approval?  Is a doctor required to sign, or what is going on?

Erica:  I’m going to work backwards here because the last thing that you just said is a really exciting development that just at the very end of last week came to light in that a blanket kind of referral, if you will, has been given from our top health official in the state of Michigan, which has eliminated the need for individual referrals for Medicaid beneficiaries to engage with doula services.  So that just honestly blew open doors that would have definitely been a barrier to accessing care, and I’m super excited.  And it’s also in place, really, for an indefinite amount of time.  It’s until we don’t see disparity anymore.

Kristin:  Exactly.  It’s such a strong statement.  When we saw that – it’s amazing.

Erica:  Yes, it is.  I’m sure you can hear the genuine glee, because it is – it’s just this, like, wow, it is – to take that strong of a stance and make that public statement, it’s just a really strong move, and honestly, I’m also hopeful that it can open up opportunity and can set precedent for other states, as well, who are still in the process of adding this as an option for clients.  So there’s that.  So short answer is no, at this point, you don’t actually need a referral, which means that you can go and secure services yourself if you are a Medicaid beneficiary.  Now, there’s a lot of nuance to that, because that makes it sound really easy and straightforward, and unfortunately, it’s not going to be.  Doulas have a lot of requirements that they have to meet in order to be eligible to work with health plans, so there’s a state registry that they’re required to be part of, and there’s a credentialing process that goes along with that.  Right now, there’s a very short list of approved training organizations that doulas have had to have trained with.  So again, long term, there are definitely barriers to access that I hope we can continue to work on.  But for now, it is what it is, and we’re trying to move forward the best that we can.  Once doulas have met those requirements, then they actually have to go through the process of credentialing with each Medicaid health plan that they intend to work with.  That’s a process.  There are dozens of health plans throughout the state.  And each one has their own process.  Each one has a different set of requirements.  And each one takes time.  Best case scenario, they hope to provide response and credentialing outcomes within 90 days, but again, that’s three months.  So if a doula was to apply for credentialing today, it is entirely possible that they actually wouldn’t be able to start working with clients until April.  And so we’re in this kind of space in between.  Yes, this has been approved.  Yes, things are moving forward.  And also, we actually cannot start doing the work with clients or attending births with clients until, and that until has a big question mark after it.

Kristin:  Right.  Thank you for explaining that, because it is confusing.  Hopefully as our listeners are learning about the Medicaid program in Michigan, you know, they’re reaching out early so they’re able to secure a doula versus having a due date around the corner and it not being possible.

Erica:  Absolutely.  So what we have opened up is essentially a waitlist for people who are saying yes, I want this.  I have my health plan.  And so we’re saying great.  Again, being very transparent about everything we have to work for before we can actually enter into relationship with them.  So we are more than willing to take names and contact information, due dates, that type of thing, and all of the nitty-gritty information and hold onto it and then reach back out as soon as things are ready to move forward.  And then the same thing goes, honestly, for doulas, as well.  If you’re a doula in Michigan and you’re like, man, I really wanted to do this.  I really wanted to take Medicaid, but I am super overwhelmed, and I just need some support or guidance, or I would really love for someone to actually take care of the administrative side of things so I can just work with clients – we would love to talk to you, as well.  We have a couple of meet and greet events that are coming up in the next couple of weeks where we will get into more of the specific information about how this will work.  Of course, everyone wants to know how they will get paid.  That’s something we’ll cover at that point in time, as well.  But on either side of the equation, whether you’re a pregnant person looking for care, or if you’re a doula who wants to do the work and is feeling lost, or just was wanting to try to do it in a different or more sustainable way, you can always check out our website.  All the info is there.  You can fill out the forms, and then we can be in touch that way.

Kristin:  Fantastic.  So Erica, what are you seeing in your work on the national front as far as potential states that are pending Medicaid legislation or just any other national trends going on in the doula space?

Erica:  Absolutely.  So one of the ways that people can honestly just become informed with exactly what’s happening in their state is there’s a really great kind of living database on the website healthlaw.org, and if you go to healthlaw.org/doulamedicaidproject, you can access that.  You can also read a bunch of background, information, too, that kind of gets into the importance of having Medicaid coverage for doula services.  But that database is a state by state listing, and it will tell you, like, exactly where your state is and other states are in the process.  You know, if they have something that’s in place; if there’s something – if there’s active legislation being worked on.  If measures were suggested and failed, that’s also on there.  And also if nothing is happening, because maybe you are the catalyst to get something started.  So I would definitely encourage people to go look at that and kind of dig in because there’s a lot of just difference everywhere in approach.  So Oregon is what I refer to as the OG state.  They were the leaders way back in the day in bringing this about, and also, it’s not been flawless, and for a lot of doulas, it’s also not been a positive experience engaging with their systems.  I’ve had multiple conversations with different doulas, different agencies and organizations there who have really struggled to get paid, and unfortunately, that, I can say, is a trend in other states that have put things into play.  Just because the legislation is there, just because Medicaid has said, yeah, sure, we’ll do this, doesn’t mean that they’re going to make it easy to actually get your money.  And so my hope is that Michigan can lead the charge in setting a really great example of how things can be done in a way that is mutually beneficial for all parties involved, both the health plans, the doulas as service providers, and the families as recipients of that care, because I do believe it’s possible.  I mean, I was a Medicaid mom at one point in time, so I know what it’s like to be on that side of things, too.  And it can be done in a way that is holistic and very humanizing and supportive and healthy.  But it also takes a lot of work and intention to make that happen.  So when you look at things that have happened over the years in Oregon, I think a lot of states that are thinking about introducing legislation, they look to that for guidance.  But I also would encourage them to look at states like Rhode Island and also New York and New Jersey.  New York and New Jersey really kind of – well, New York actually was before Rhode Island.  New Jersey really looked to Rhode Island legislation to kind of take that and say, hey, can we actually make this one better.  They were successful in that.  It was incredible.  So they do; they have higher reimbursement rates.  That’s what we should be looking at.  They put pathways in place that make it easier for doulas to get payments and things like that, and also, it is still not flawless.  There’s a lot of work to be done in that regard.  So this is the beginning, really.  Yes, Oregon – I think it was, like, 2012, 2013 when things went into place there.  So that feels like a long time, but when you take a step back and have a larger or a broader view of the Medicaid system as a whole, that is literally just the tiniest sliver of time.  And this is about longstanding change, and so we really still are at the beginning of that journey.  Hopefully, we can shape it into something that can withstand the test of time and really is impactful.

Kristin:  Exactly.  And for our listeners who are not covered by Medicaid, of course, there have been a lot of changes as far as options to afford a doula, and, you know, it started with the health savings and flex spending.  I have been working, as you know, on getting insurance coverage for doulas since my sola doula days, so it’s been years and years, almost ten years.  So I see a lot of these Medicaid initiatives in different states really leading to hopefully general insurance one day covering doulas.  But in the meantime, a lot of companies have been adding doulas to maternity benefits.  And, you know, Pioneer Construction locally added doulas to their benefit package, both birth and postpartum, and a lot of other national companies, like CBS and most recently LinkedIn, Salesforce.  So many companies are adding doulas to their benefits.

Erica:  It’s really exciting.

Kristin:  It really is.  And then gifting is a big thing that we’ve noticed during the pandemic when family members haven’t been able to travel to support or, you know, just comfort level, even with taking COVID out of the mix, we’ve got flu season, colds, RSV, and so really wanting to have a healthy, trained caregiver in the home.  Parents and friends and family members have been gifting postpartum support, birth support, classes, as shower gifts, gifting those services.  It’s the biggest trend I’ve seen in the last couple of years.

Erica:  Yes, it’s fantastic and honestly is such a great shift; again, one I really hope sticks.  I know you chatted a while back with Kaitlin at Be Her Village, who is really leaning into that specifically.  In doing work with Kaitlin myself, I learned that the baby gift industry is a $12 billion industry.  I don’t know; I still – like, every time I say it, I’m like, how is this possible?  Besides capitalism, obviously, but to be able to redirect even a small percentage of that revenue into this type of support would be so impactful, not only for families, but also for doulas as providers, right?  So many doulas also have families.  Like, they’re not doing this just out of the goodness of their heart or because it’s fun, right?  Living an on-call lifestyle is really, really challenging for everyone that’s involved.  It is a family decision.  And so being able to redirect dollars and, again, really think about this; like, how can we do this work sustainably?  You know, your model of working in teams, I think, is such a great step towards that.  But I think we do have to get to a place of where we’re really starting to think strategically and outside of the box and creatively about how are we doing to make this stick around and have it be a really bona fide source of income for the people who are doing the work.

Kristin:  Absolutely.  And I could talk to you forever, but we’ll try to keep this short.  But I would also mention that part of the changes that I’ve seen as a doula over the years is there are more inductions, whether they’re medically necessary or COVID-related.  But that can really make a birth end up being multiple days, which is hard on a doula and her family, and obviously, hard on our clients and can not always but may include other interventions, include a Cesarean birth.

Erica:  Yes, definitely.  I know we’ve definitely seen an increase since COVID, and again, it’s going to take a good while for us to know exactly how much of it was warranted and how much was not, but it did – things have changed so much since you and I stepped into this space and started doing this work.  Some positive changes; some not so positive.  But I think the one constant is that need for just really informed support and that neutral party that can be part of a situation and help to just guide things for best possible outcomes because so often, best possible outcomes is not in alignment with what you dreamed for your birth.  And so that’s where a doula can really come in and help with that acceptance process, the processing of your birth experience when things when left when you wanted it to go right, and there’s not another profession, I don’t think, that can step into this space in the same way that doulas are able to.

Kristin:  Exactly.  And I would add to that, that our clients and our listeners, the pregnant population, you need to advocate for yourself.  So a doula, we can remind you, we can help you with a birth plan, but we are not there as an activist, and really having these conversations with your provider and making sure you’re both on the same page during your pregnancy.  I’m a firm believer in having a birth plan and having your whole care team, including your nurses, really understand some of your goals and wishes.  I’m not a fan of four-page plans, but some basic bullet points and using that a conversation starter and really the doula being there to remind you of some of the preferences you discussed during your birth.  But you know your body, and you know your baby better than anyone else, so really advocating for yourself during pregnancy, after delivery.  And our clients and our listeners – I mean, after you have a baby, you’re seeing the pediatrician very frequently, so talk to your pediatrician.

Erica:  Yes.  Ask all the questions, right?  And also, don’t just take a response or an answer at its face value.  Like, don’t shy away from asking why.  Ask for more information.  It’s okay, right?  Look for clarification if you don’t feel like you understand something.  And that might be from the provider directly.  It might also be taking that information back to your doula or back to another member of your care team.  But it’s so important to really be clear, right, about your expectations.  I’m really big on expectation management, which birth plans are great for getting clear on those.  And also just reminding people of the importance of flexibility and remaining fluid and pliable during your experience because something I’ve always shared with my clients is that the only thing that’s predicable about birth is that it’s unpredictable.  The best laid plans, right, where you have that four-page birth plan that details every single thing you could ever want, need, hope, or desire – so often, it’s going to have to get tossed right out the window, either because of something you’re experiencing during your process or your baby or both of you together.  And that’s just part of it sometimes, and that’s okay.  But it’s how we recover from that transition is what matters and is the part that usually you’ll remember the most, a long time down the road.  So just get really clear as much as possible and don’t be afraid to question everything that comes your way.

Kristin:  Wonderful advice.  Thank you, Erica.  And one last time, give us your contact info so potential doulas can join your agency, as well as the Medicaid patients who want to connect with you.

Erica:  So the most efficient way for people to be in contact with us is to head to our website, because again, we have contact forms, whether you are a Medicaid beneficiary or client or if you are a doula who wants to provide services.  You can also find us on social media because, you know, that’s just a thing that’s required these days.  We’re on both Instagram and Facebook, so you can find us in either one of those venues.  If you’re somebody who’s like, I just really need to talk to somebody, you can also give us a call.  We have a toll-free number so that again, access from anywhere in the state.  That number is 833-MIDOULA, which is 833-643-6852.  I know sometimes that is just really helpful, that you just need a grounding experience, and so we don’t shy away from that, either.

Kristin:  For sure.  Thank you, Erica, and I appreciate all of the important work you’re doing.

Erica:  Thank you so much, Kristin.

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.

Medicaid for Doulas with Doulas Diversified: Podcast Episode #168 Read More »