Ten years ago, when 22-year-old Chelsea Bellon wrote in a Missoula moms Facebook group that she would be giving birth to her first child alone, members of the group recommended she see a doula.“My immediate thought was, ‘I don’t have funding for that,’” Bellon, a citizen of the Yankton Sio ux Tribe, recalled in a recent interview with Montana Free Press.A doula is a trained, nonmedical professional who provides care to pregnant people before, during and after birth. They can accompany people to doctors appointments, help manage stress and make home visits to check on the parents and baby. While doulas can receive training and education in their field, the profession is generally unregulated in Montana.Bellon ultimately found a doula who offered services at a discounted rate. Her doula helped her stay calm during her 62-hour labor and repositioned the baby to ease pressure. The doula also translated medical jargon, helping Bellon communicate her preferences to doctors. “It felt like I had an interpreter through the whole process,” Bellon reflected. Ten years later, inspired by her own experience, Bellon is now a postpartum doula. Though she offers her services at discounted rates and accepts trade and barter deals, Bellon said the cost to patients remains a barrier to care. As a doula, she encounters people — much like her 22-year-old self — who won’t even consider her services because they assume they can’t afford them. While a growing body of research shows doula care can help improve health outcomes for mothers and children, doulas statewide say people who need their services most cannot afford them. A new bill progressing through the Legislature, however, aims to change that by making doula care more accessible to those who want it.WHAT IS SENATE BILL 319?Brought by Sen. Cora Neumann, D-Bozeman, Senate Bill 319 would allow doulas to apply for and receive licensure under the state Department of Labor and Industry. It would also allow the state health department to provide Medicaid coverage for state-certified doula services. If passed, the bill would go into effect Jan. 1, 2026. A fiscal note created by the governor’s budget office estimates that SB 319 would cost taxpayers about $119,000 annually. That number is based on the assumption that doulas will be involved in 6% of Medicaid-covered births per year in Montana.  Nearly two dozen people spoke in support of the bill in a February legislative committee hearing. They argued SB 319 would make doula care more accessible and therefore will help improve health outcomes across the state, particularly in rural and tribal communities where obstetric services are limited. Proponents said the bill would also make the doula profession more sustainable, as it would allow providers to bill for their services. Several Indigenous doulas said SB 319 would have profound impacts in Indian Country, where people face significant barriers in accessing quality and culturally informed health care. While opponents largely agreed that doulas fill critical gaps in care, they generally took issue with the idea of government funding that care. “I do think doulas are great. I think they’re wonderful,” Sen. Tom McGillvray, R-Billings, told his colleagues in a Senate floor hearing earlier this month. “ … One of the reasons I am a Republican is because I believe in limited government. This bill is the opposite of limited government.”Sen. Dennis Lenz, R-Billings, said doulas are “essentially an extended friend, extended family.”  “That’s where we’re at. Time was, we had family that would fill this role,” he said. “They can continue to do the work, but paying Medicaid? … Where does it stop?”Sen. Jeremy Trebas, R-Great Falls, objected to the bill’s cost, warning his colleagues in the Senate that “each bill is just a little increase until everything all together is a big increase.”McGillvray told his colleagues in the Senate Finance and Claims Committee last week that the state budget “should be reserved for essential services.” Doula care, he argued, is not essential. He noted that Medicaid already covers medical care for mothers and infants and echoed Lenz’s statement that doula services are similar to those that could be provided by a friend or family member. “We don’t have superfluous money to be spending on having a friend there to support you,” he told committee members. When weighing the cost of legislation generally, McGillvray told MTFP in a recent interview that he considers whether the money could be better spent somewhere else. He said he believes funds would be better spent to aid “[developmentally] disabled people, the elderly and the infirmed.”“I can’t make a case that if we don’t have a doula, the world is going to end or somebody’s not going to get the help they need,” he said. “ … I just can’t make the justification for it.”Despite opposition, however, SB 319 has continued to advance through the Legislature. When the bill initially failed to advance out of a committee, Neumann, a doula herself, used a maneuver called a blast motion to bring SB 319 to a vote on the Senate floor, where it passed two later votes. The bill was then referred to the Senate Finance and Claims Committee, where it advanced March 21 by a two vote margin.The bill must pass one more vote in the Senate before it heads to the House for consideration.MATERNAL CARE IN MONTANAMontana ranks 32nd in the United States in maternal mortality, according to a Georgetown Institute for Women, Peace and Security report. The same report found that Native Americans in Montana have a maternal mortality rate seven times higher than that of white women in the state and nearly six times higher than the national average.  Hospital obstetric care, which is costly and requires specialized medical professionals, is declining across rural America. In Indian Country, it’s nearly nonexistent. Indian Health Service is the federal entity responsible for providing health care to members of federally recognized tribes. Of the seven IHS service units in Montana, only one on the Blackfeet Reservation has a hospital obstetric unit.Studies show that doula care can improve health outcomes for mothers and children, particularly in low-income and rural areas where people struggle to access care. A 2013 study published in The Journal of Perinatal Education found mothers who worked with doulas were four times less likely to have a low-birth weight baby, two times less likely to experience a birth complication and more likely to initiate breastfeeding. A 2023 report found doula care reduced the number of cesarean and premature deliveries. CULTURALLY INFORMED CARESeveral Indigenous doulas who addressed lawmakers at the Capitol during hearings on SB 319 said doulas play an especially important role in tribal communities, acting as a bridge to Western medicine while also providing culturally sensitive care. Misty Pipe, a doula on the Northern Cheyenne Reservation in southeastern Montana, said she often talks to clients about historical trauma. Birth is viewed as a ceremony in many Indigenous cultures. Yet, assimilation efforts, Pipe said, disrupted that practice. Misty Pipe, a doula on the Northern Cheyenne Reservation in southeastern Montana, poses for a photo with her family. Credit: Provided by Misty PipeWhen children were away at government-funded Christian boarding schools — where they were forbidden from speaking their language and practicing culture — Pipe said they often missed the births of their siblings and cousins, therefore missing out on foundational cultural and community ceremonies. Talking about the past, Pipe said, promotes healing.Past illegal incidents and persistent chronic underfunding have sowed a deep-seeded distrust of Indian Health Service. IHS in the 1960s and 1970s sterilized Native American women without their consent. An IHS doctor on the Blackfeet Reservation sexually assaulted Native American boys for decades before being transferred to another IHS facility in South Dakota where he did the same thing. Reports found the agency was complicit in the scandal. “A lot of people say, ‘Oh, that happened in the past. You have to get over it,’” Pipe told MTFP. “Well, my mom went to boarding school. My grandmother went to boarding school. I am just one generation away from that, and we need to talk about it.”Pipe isn’t alone in infusing culture into doula care. Bellon asks mothers what they’d like to do with their baby’s belly button, which holds significance in some Native cultures. Julianne Denny, a doula on the Rocky Boy Reservation in north-central Montana, asks pregnant clients if they’d like to make moccasins for their babies. She invites them to pick berries and mint leaves and offers to smudge the baby after birth.INDIGENOUS DOULAS ADVOCATE FOR SB 319Like many Indigenous doulas in Montana, Pipe provides all her services at no cost to meet community needs. Access to maternal care on the Northern Cheyenne Reservation is limited. Pipe gave birth to one of her own children at the urgent care clinic on the reservation and for another of her births, she labored as an ambulance drove her 100 miles to the nearest hospital in Billings. She said a friend of hers gave birth on the side of the road on the way to Billings. “These are traumatic environments,” she said. “You should be able to have quality care in your community.”Pipe works at the post office in Lame Deer, and said her doula work wouldn’t be possible without the help of a coworker who covers her shifts when she’s serving pregnant clients.Julianne Denny is a doula on the Rocky Boy Reservation in north-central Montana. Credit: Provided by Julianne DennyDenny runs into the same issue on the Rocky Boy Reservation. She charges little to nothing for her services and told MTFP that her work brings her “no financial gain.” When Denny recently traveled to Billings to support a client, she paid for her own gas, lodging and food, amounting to about $1,000. Denny works as a graphic designer to make ends meet but said it can be difficult to work several jobs and be present for her own children.“My kids get less time with me,” she said. “It shouldn’t have to be like that — especially when I’m providing these really significant services to people.”Sheri Walker, a doula in Helena who charges $975 for basic services, said she’s seen cost deter people, too.“The reality is that the people I serve tend to be wealthy,” she said. “The people that need this kind of support most often don’t have access to it. I don’t see single moms or people struggling with housing crises because it’s totally out of their realm.”Walker founded the Montana Doula Collaborative in 2021 with two main goals. She wanted doulas to be paid a living wage, and she wanted more people in Montana to be able to access doula care. Passing SB 319, Walker said, would do just that.If SB 319 were to become law, Pipe said she could quit her job at the post office and work as a doula full-time. “Let’s approve this medical doula bill, and let’s watch the c-section rates go down,” she said. “Let’s watch the low-birth weights go down. Let’s watch postpartum depression go down. Let’s show them what we can do.”The post Bill could increase access to doula care in Montana appeared first on Montana Free Press. ...read more read less