In the United States, the Department of Defense just announced new benefits for military families.  Effective January 1, 2022, military personnel and their dependents in the United States and the District of Columbia covered under many TRICARE insurance plans will be eligible to receive care from certified birth doulas, certified lactation consultants and certified lactation counselors.  These benefits will be provided as part of the benefits package under TRICARE,  which is the health care plan available to people in the military.  Overseas families will have these benefits made available to them on January 1, 2025.

These additional benefits are being added as a demonstration package for a period of five years.  During this time, the impact of adding these providers and services will be evaluated regarding cost, quality of care and maternal and fetal outcomes for families who receive benefits under the TRICARE umbrella.  If indications show positive outcomes, the additional benefits will become permanent.

Birth doulas

The evidence on birth outcomes with the addition of birth doulas to support the family has been consistently positive for several decades. (Bohren, 2017)  Higher birth satisfaction, less babies needing NICU care, shorter labors, lower cesarean rates, less requests for pain medications and fewer operative vaginal deliveries are the well-known benefits of having a trained labor support person on the birth team.

These outcomes improve maternal and fetal outcomes and also result in cost-savings to the health care programs and families. (Kozhimannil, 2013)  In 2019, the American College of Obstetricians and Gynecologists (ACOG) stated in the Approaches to Limit Interventions using Labor and Birth, Committee Opinion 766, that “in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”

Lactation consultants and counselors

Breast/chestfeeding counseling is acknowledged as a preventative service by the U.S. Preventative Services Task Force and should be made available to pregnant and new families in order to support lactation.  The benefits of human milk for the infant include reduction in the risk of developing asthma, obesity, Type 1 diabetes, less ear infections, lower rates of sudden infant death syndrome, fewer digestive issues and more.  For the lactating parent, ovarian and breast cancer is reduced along with Type 2 diabetes and hypertension. (CDC, 2021)

What are the provided benefits for labor support

Pregnant families will be able to receive up to six visits from a certified labor doula during the prenatal and postpartum period along with continuous support during labor and birth.  The doula must be certified by one of five international certifying organizations.  There are additional requirements that the doula must meet in order to provide services to military families that will be covered under the TRICARE demonstration model.  You can find these requirements here.  Each prenatal or postpartum visit will be reimbursed at a rate of $46 per visit.  Labor and birth support will be reimbursed at a rate of $690.  These rates will be adjusted for inflation and cost of living changes.  Community births (home and birth center) and hospital births are both covered.

What are the provided benefits for lactation support

Families will be able to access up to six lactation sessions per birth event.  This benefit includes group lactation support sessions and prenatal breast/chestfeeding education. These group sessions and classes will count as one of the six permitted visits. Here are the requirements for providers to be able to offer lactation support under the TRICARE program.

How will success of the program be evaluated

According to the Department of Defense, the labor support and lactation support programs will be evaluated by using historical data between people who use the services and people who do not and also compared against nationwide statistics.  Claims data will be used to obtain information on cesarean rates, epidural rates, labor and birth interventions, infant ear infections respiratory and asthma concerns and other benchmarks.  Cost savings will be evaluated by determining the cost of the program against cost savings of improved maternal infant outcomes.

Conclusion

This five year demonstration program provides well deserved and evidence-based benefits to military families who are growing their families.  Many military parents face additional challenges of being separated from their partners and other support due to deployments and duty assignments.  Having the support of a birth doula to provide resources and a continuous presence during pregnancy, the labor and birth and the postpartum period along with lactation support and education from qualified lactation providers will go a long way to helping military families have a positive experience and improved outcomes.  If you are a perinatal professional working with military members or their dependents, make sure that you are sharing information about these benefits so they can participate in this demonstration project.  You can find out more about the new benefits from the Federal Register here.

References

American College of Obstetricians and Gynecologists. (2019). Committee opinion No. 766 (replaces committee opinion No. 687, February 2017): Approaches to limit intervention during labor and birth. Obstetrics and Gynecology, 687(2), e164-e173.

Bohren MA, Hofmeyr G, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6

CDC. “Breastfeeding: Why it Matters.” Retrieved November 1, 2021, from https://www.cdc.gov/ breastfeeding/ about-breastfeeding/ why-it-matters.html

Kozhimannil, K. B., Hardeman, R. R., Attanasio, L. B., Blauer-Peterson, C., & O’brien, M. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American journal of public health, 103(4), e113-e121.

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