A bill in the Massachusetts House of Representatives and Senate would expand access to doulas for Medicaid recipients, provided they know a thing or two about “chestfeeding.”
The bill (H.2372/S.1475) also has the first use of the term “chestfeeding” in the history of the Massachusetts legislature.
State representatives Liz Miranda (D-Roxbury) and Lindsay Sabadosa (D-Northampton) are the bill’s primary sponsors in the House, while state Senator Joan Lovely (D-Salem) is the sponsor in the Senate. All three are women.
For those who are unfamiliar with it, “chestfeeding” is a gender-neutral version of “breastfeeding.”
“Chestfeeding is a term used by many masculine-identified trans people to describe the act of feeding their baby from their chest, regardless of whether they have had chest/top surgery (to alter or remove mammary tissue),” the University of Rochester Medical Center’s Lactation Medicine department explains.
The language refers to biological females who identify as men.
The bill would expand Medicaid to include coverage for a doula from conception until one year “after birth, pregnancy loss, stillbirth, or miscarriage.”
A doula is “a professional labor assistant who provides physical and emotional support to you and your partner during pregnancy, childbirth and the postpartum period,” according to the Mayo Clinic.
The Mayo Clinic also explains that doulas typically offer pregnant women support in the following areas:
Attention to physical comfort through techniques such as touch and massage and assistance with breathing
Emotional reassurance, comfort and encouragement
Information about what’s happening during labor and the postpartum period, including explanations of procedures
Help with facilitating communication between you and the hospital staff
Guidance and support for loved ones
Assistance with breast-feeding
The bill, if passed, would order MassHealth (the state agency that administers the state’s Medicaid program) and the Massachusetts Department of Public Health to create and maintain a registry of doulas who are eligible for Medicaid reimbursement. To be eligible for reimbursement, doulas would have to show competency in various fields; MassHealth and the state Department of Public Health would have to measure that competency.
One of those areas in which doulas must show knowledge to be eligible for Medicaid reimbursement: chestfeeding.
The bill says that the doulas must show competence in the following:
(A) understanding of basic anatomy and physiology as related to pregnancy, the childbearing process, the postpartum period, breast-milk feeding, breastfeeding and chestfeeding;
(B) capacity to employ different strategies for providing emotional support, education and resources during the perinatal period;
(C) knowledge of and ability to assist families with a wide variety of non-clinical labor coping strategies;
(D) strategies to foster effective communication between clients, their families, support services and health care providers;
(E) awareness of and ability to provide information on integrative health care systems and various specialties of care to address client needs beyond the scope of practice of the doula;
(F) knowledge of community-based, state- and federally-funded, and clinical resources available to address client needs beyond the scope of practice of the doula; and
(G) knowledge of HIPAA compliance and client confidentiality.
Additionally, the bill mandates that doulas serving MassHealth patients must either show competency or “demonstrate actively seeking training or engagement” in the following areas:
(A) health equity;
(B) implicit bias;
(C) racism, including structural, interpersonal, and institutionalized racism;
(D) reproductive and birth justice;
(E) cultural sensitivity and humility;
(F) trauma-informed care, including for survivors of sexual assault or birth trauma;
(G) parental mental health needs;
(H) needs of persons with disabilities or disabled persons;
(I) sexual and gender identities; and
(J) social determinants of health.
The bill was reportedly on favorably by the Massachusetts Legislature’s Joint Committee on Health Care Financing, and the House Ways and Means committee recommended the bill “ought pass” back in February. However, the bill has not come up for a vote in either chamber of the legislature.
Lovely and Miranda each testified on the bill during a public hearing about a year ago — on June 7, 2021, before the Joint Committee on Health Care Financing. Neither used the term “chestfeeding,” although Lovely at one point referred to “breastfeeding.”
Sabadosa also testified on legislation before the committee that day, but did not mention the bill.
(In the video of the committee hearing, Lovely’s testimony begins at 8:15; Miranda’s at 46:21; Sabadosa’s at 27:38.)
The offices for Miranda, Sabadosa, and Lovely could not be reached for comment on Thursday, Friday, Saturday, Sunday, Monday, or Tuesday.
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