Doulas can be a lifeline for new moms, but the emotional and physical support they provide is often not covered by insurance.
While many states have made doula care more accessible, Wyoming has yet to get on board.
Sarah Heatherton lives in Jackson Hole in the western side of the state.
“This is Jonathan,” she said, introducing her eight-week-old, crying baby in her home in mid-October.
Jonathan arrived a lot faster than his mom was expecting. Her water broke in the car on the way to the nearby hospital.
“I felt so out of my body and so, almost in shock and out of control,” she said, in front of a window looking out at the Teton mountain range.
But her doula, Liz Alva Rosa, helped her plant her feet on the ground.
“You kind of have to try to separate, draw a boundary between the chaos,” Alva Rosa said, lounging next to Heatherton on a big couch, “and try to keep the energy down and keep the energy low.”
Unlike doctors or midwives, doulas don’t make any medical decisions or deliver babies, but keeping moms calm during childbirth can help move labor along and lead to fewer medical interventions, like C-sections.
“Traditionally it would be your mom or your aunt or, you know, an experienced other mother, but we're not surrounded by childbirth anymore,” said Alva Rosa, who’s been in the business for 23 years.
Alva Rosa also prepares parents before birth and checks in on their mental health after. She charges $1,800 with some sliding scale options. Clients typically pay out of pocket. Heatherton could afford the extra cost, but many can’t.
“You're gonna prioritize the hospital bill if you can only pick one,” she said.
That’s why more than half of states are allowing doulas to get reimbursed by Medicaid, which covers about 40% of births in the U.S. for largely low-income people.
Wyoming hasn’t gotten on board yet, but Arizona, Colorado, Nevada and New Mexico have. A map from the nonprofit National Health Law Program shows Montana and Utah are also in the implementation process.
“We went pretty quickly from two states to 28 states in five to six years,” said Amy Chen, senior staff attorney at the nonprofit and leader of the Medicaid Doula Project, which advocates for reimbursements.
Speaking at a maternal health summit in Wyoming in September, Chen said people are becoming more aware of maternal mortality rates. More pregnancy-related deaths happen in the U.S. per capita than in any other high-income nation, and rates are especially high for rural, Black and Indigenous people.
Chen said women started turning more toward doulas, midwives and home births during the COVID-19 pandemic.
“Just sort of trying to think outside of the box in terms of a typical hospital birth, and I think doulas were part of that,” she explained.
In Colorado, since 2024, doulas have received up to $1,500 per Medicaid birth.
“We're providing a lot more doula care, just more hours, more clients than we ever have because of the Medicaid benefit,” said Ali Batwin, a postpartum doula in Colorado.
Plus, once Medicaid reimburses, private insurers often follow. However, it can still be hard for doulas to get paid this way, as they often need specific certifications, and reimbursement rates can be low.
Lawmakers and advocates also have to coalesce around the idea to get it passed, which may be a big ask in conservative Wyoming. It’s one of the few states to reject Medicaid expansion under the Affordable Care Act.
“I really believe that having a doula is a ‘nice-to-have’ and not a ‘have-to-have,’” said Jenn Lowe, who leads advocacy organization Healthy Wyoming, which pushes for other types of Medicaid expansion.
Lowe said she had a great experience with a birth doula herself, but she thinks the state needs to focus on expanding access to medical care. Almost half of Wyoming’s counties didn’t have a practicing OB-GYN as of 2024, according to a Wyoming Health Department report.
“We need to focus resources on what's gonna help — right now — women have healthy births,” Lowe said, suggesting funding transportation or lodging for women when they need to travel.
Lowe hopes the Wyoming legislature will also address a more basic issue in the new year: continuing Medicaid coverage, in general, for new moms a year after birth. The state does that now, but its provision is set to sunset on March 31, 2027, and moms might only get coverage for 60 days post-birth. Advocates say this isn’t enough, as complications can happen later on in the postpartum period.
Britt Boril, executive director of WyoUnited, an organization that advocates for reproductive freedoms, said the state should also find ways to recruit more physicians.
“Medicaid expansion for doulas on its own, I don't think would solve our crisis,” Boril said. “It's just one piece in a larger puzzle.”
Cheyenne doula Faithe Dell agrees with that. She said doulas could help bridge gaps for pregnant people.
“If you can only do a virtual appointment with your OB once a month,” Dell said, “then having a doula who you can go to and be like, ‘hey, I'm having this pain. Should I contact my doctor? Should I contact my midwife?’ can be helpful.”
Dell riffled through her doula kit at a local park. It’s a big, black duffle bag that has everything from diapers to chapstick to her favorite: a wide-tooth comb moms can squeeze during contractions.
“It actually gives their brain something different to focus on,” Dell explained.
If Medicaid were to reimburse doulas in Wyoming, Dell said this wide-tooth comb could reach more hands. She currently offers discounts to low-income and military families — and sometimes takes them on for free — but can’t always do that.
“It costs me every time I have to replenish my kit,” Dell said. “You know, I can say all day long that I do this just to help families, and while I do, I still have to take care of mine.”
This story was produced by the Mountain West News Bureau, a collaboration between Boise State Public Radio, Wyoming Public Media, Nevada Public Radio, KUNR in Nevada, KUNC in Northern Colorado, KANW in New Mexico, Colorado Public Radio and KJZZ in Arizona as well as NPR, with support from affiliate newsrooms across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting and Eric and Wendy Schmidt.
