North Carolina doula care demands grows

FILE PHOTO

North Carolina's demand for doulas has led UnitedHealthcare to expand its coverage to include advocates for pregnant women during their childbirth journey.

A major health insurance company is moving to expand coverage to include a doula offering for employer-sponsored health plans as more expectant mothers seek out non-medical support through pregnancy.

UnitedHealthcare expanded coverage to include doulas, which serve as advocates for pregnant women and focus on both guiding new parents and addressing the needs of the newborn. The announcement comes as more women seek out doulas for their pregnancy journeys. The International Doula Institute finds that the demand for doula services grew by 8% in 2025.

Dr. Lisa Saul, chief medical director of women’s health for UnitedHealthcare, said doula services give people access to non-clinical support that's crucial during the postpartum period.
“Having a person that has gotten to know you throughout your pregnancy and can identify when certain things might seem to be a little bit off can often help us to detect when someone is struggling prior to the usual timeframe,” she said.

The expansion to doula coverage comes as North Carolina grapples with a high maternal mortality rate compared with other states. According to the Commonwealth Fund, North Carolina reported more than 50 pregnancy-related deaths per 100,000 births, one of the highest rates of mortality in the country.

But as doula coverage becomes a greater focus for insurance companies, some doulas question whether they’ll be able to recruit and retain doulas in their network. Aida Algarin, owner of Central Carolina Doulas, said she worries that low payouts and red tape that she finds in Medicaid-covered doula care may cross over and hinder insurance providers from recruiting doulas into their networks.

“The success of insurance companies offering doula services is dependent on recruiting doulas – and the kind of doulas that their clients want,” she said. “That has to make the incentive package and the program appealing for doulas.”

A report by the Medicaid and Chip Payment and Access Commission found doulas expressed concerns about Medicaid enrollment because of reimbursement levels and administrative burdens to being an in-network provider.

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