The Office of Professional Regulation wants to create a new certification process for doulas as the state inches closer towards qualifying doula services for coverage under Medicaid, the federal low-income health insurance program.

Doulas are non-medical professionals who provide support during pregnancy and childbirth, as well as in postpartum care.

About half the states, and Washington D.C., already allow Medicaid coverage for doula care or are in the process of making the change.

And as support grows in Vermont to establish rules for Medicaid reimbursement for doulas, the state wants to set up a certification program to better regulate the practice.

“Essentially, across the country, doulas have never been regulated in any kind of overarching way. There’s no accreditation that’s codified,” said Sarah Teel, a doula who lives in the town of Washington and is a founder of the Doula Association of Vermont. “It’s a non-clinical role. We’re not part of the health care system, and so it hasn’t been a regulated profession.”

But as more states have recognized the advantages of qualifying doulas for Medicaid, which would open up the services to more low-income individuals, Teel said there needs to be some oversight of the profession.

“What has happened over the years with many, many states coming on board and implementing Medicaid coverage is there obviously needs to be some mechanism for the state Medicaid agency to have the assurance that this is a Medicaid provider that can meet the needs of the Medicaid population,” Teel said.

A 2022 report from the U.S. Department of Health and Human Services found that labor support offered by doulas significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia.

Vermont lawmakers last year asked the Office of Professional Regulation to look into the most appropriate way to regulate the industry, as the state contemplates qualifying doula services for Medicaid.

OPR was looking for the “least restrictive” form of regulation, according to a recent report, and it does not recommend registration or licensure at this time.

In the end, the office settled on a voluntary certification of what it calls “community-based perinatal doulas,” which are doulas who “provide doula services to under-resourced and marginalized populations at low- or no-cost, most often through community-based agencies.”

Marti Churchill is a certified nurse midwife, and founder of the volunteer doula program at UVM Medical Center.

Churchill’s program provides free doula care to patients who don’t have the ability to pay for the service.

She said data across the country show that people from low-income backgrounds suffer more complications during pregnancy, and at the same time those populations have trouble accessing doula care.

So opening up Medicaid coverage, Churchill said, would benefit those who most need the service.

“In the rest of the world of medical care if it were a medicine or a pill it would be definitely recommended and prescribed regularly,” Churchill said. “So this is something that’s really needed.”

“We work with doulas all the time during labor and delivery,” said Bronwyn Kenny, an OB-GYN at the University of Vermont Medical Center and a member of the Vermont Medical Society. “We’re not entirely sure how or why it works, but there’s really good evidence that it does reduce things like C-section rates and postpartum depression in other states that have started to cover doula services under Medicaid.”

The Office of Professional Regulation will work with stakeholders to determine the most appropriate certification requirements.

The office also said it will stay in contact with the Department of Vermont Health Access to make sure the new certification program aligns with federal Medicaid requirements.

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