From the Arkansas Advocate:
Michelle Patton of Bentonville had a plan for the birth of her first child. She wanted a natural birth without induced labor, an epidural or a Cesarean section unless medically necessary, she said.
But when her blood pressure spiked almost three weeks before her baby’s due date, doctors told her she needed to be induced and deliver immediately. Her son was born Jan. 28 by C-section, which required an epidural.
The Pattons’ doula, Robin Mero Butler, gave them the support they needed when their birth plan “was completely flipped upside down,” said Andrew Patton, Michelle’s husband.
“That 20 minutes before the procedure was pretty tough for me,” he said. “I was going through it, and [Butler] was really helpful, keeping me from losing it.”
Doulas provide emotional, physical, educational and logistical support to parents-to-be and serve as middlemen between them and other medical professionals.
A growing number of parents nationally are relying on doulas as a part of their birth plans and to help them navigate a complex health care system. A 2025 Arkansas law aimed to make doula services more affordable in an effort to address the state’s poor maternal health rankings.
Delays implementing the law have frustrated both doulas and parents like the Pattons, who said they were grateful to be able to pay $1,200 out of pocket for her services.
When Butler told them that their private insurance plan wouldn’t cover doula care as they expected, the Pattons were initially concerned they wouldn’t be able to afford it, they said.
"I just want to know what to tell people. Is there any hope this year, or do these families need to come up with a big chunk of money if they want doula care? Or do they need to forfeit the doula care?"– Robin Mero Butler, a doula from Carroll County
The rulemaking process
The Healthy Moms, Healthy Babies Act of 2025 requires both Medicaid and private insurance plans to cover doula services. Additionally, Act 965 of 2025 gave the Arkansas Department of Human Services until Dec. 31, 2025 to put forth rules for Medicaid coverage of doula care.
DHS did not meet the deadline, and the Arkansas Insurance Department has not finalized its private insurance coverage rules for doulas. Both sets of rules will require approval from state lawmakers.
Pregnant Arkansans of all income levels “built their birth plans around that promise” from the state that doula services would be covered in 2026, said Butler, who’s based in Carroll County.
The delayed coverage is also a concern for providers, said Annie Hill, who runs the Bright Blessings doula service based in Cabot.
“I won’t be able to sustain myself indefinitely without the structure that these families were promised,” Hill said.
DHS released the Medicaid rules for a public comment period on Sunday, agency spokesperson Gavin Lesnick said. After public comment ends March 9, the U.S. Centers for Medicare and Medicaid Services has up to 90 days to review and approve all rules related to Medicaid.
The Arkansas Legislative Council must approve the rules before they go into effect, but any changes made during public comment or the federal review will delay the council’s vote, Lesnick said.
Support from state officials
“Working through the kinks” of a policy that requires federal approval is “always complicated,” said Republican Sen. Missy Irvin of Mountain View, who sponsored both laws on doula coverage.
Irvin and Greenwood GOP Rep. Lee Johnson both said the bureaucratic delay doesn’t minimize the fact that state officials and insurance providers support the policy.
“With government, things always take a little longer than we want to, but I think it’s important that we get it right,” said Johnson, a practicing physician and Act 965’s other sponsor.
Knoxville Republican Rep. Aaron Pilkington said the delay in doula coverage is “very, very frustrating.”
“I think we’d rather get something out on the board and change it if there are issues than wait until everyone’s happy with it before we put it out there,” said Pilkington, the primary House sponsor of the Healthy Moms, Healthy Babies Act.
Insurance coverage for doula care was among the recommendations from a task force Republican Gov. Sarah Huckabee Sanders created in 2024 to improve Arkansas’ maternal health care landscape. Sanders “looks forward to [the] speedy review and approval” of the rules, her spokesperson Sam Dubke said Thursday.
The delay is a disappointment for Butler, who remembers feeling hopeful when she watched Sanders’ news conference announcing the Healthy Moms, Healthy Babies Act last year.
“I just want to know what to tell people,” Butler said. “Is there any hope this year, or do these families need to come up with a big chunk of money if they want doula care? Or do they need to forfeit the doula care?”
Last year, the University of Arkansas for Medical Sciences’ Doula Expansion Initiative provided free care from doulas in training to pregnant residents of 41 counties, including Lonoke and Carroll counties. Butler said her participation in the initiative inspired her to turn her doula training into a business.
UAMS and the Doula Alliance of Arkansas are among the “key stakeholders and partners” working with DHS on the delayed Medicaid rules, Lesnick said.
Maternal health care gaps
Arkansas consistently has among the nation’s highest maternal and infant mortality rates, and Black Arkansans face even more systemic barriers to care. The rate at which Black women in Arkansas die during childbirth or within a year of giving birth more than doubled from 1999 to 2019, according to a study published in the Journal of the American Medical Association.
Michelle Patton said these statistics are why she wanted a doula to advocate for her.
“I feel like a lot of people forget how deadly labor and pregnancy are, especially C-sections,” she said.
The Pattons live in a metropolitan area with multiple birthing hospitals, but rural Arkansans often have to drive long distances to give birth.
Doula care will be vital for Lauren Barber, she said, if something goes wrong during her planned home birth in July and if she needs to be transferred from Eureka Springs to a delivering hospital.
Fifty-three of Arkansas’ 75 counties, including Carroll County, do not have a delivering hospital. Seven hospitals have closed their labor and delivery units since 2020. Paramedics have seen an uptick in the number of deliveries being performed in ambulances.
The median drive time from a Carroll County residence to a delivering hospital is an hour and 12 minutes, the second-longest of any county in the state, according to the Arkansas Center for Health Improvement.
Barber is on Medicaid, and she said the uncertainty of whether doula care will be covered by July makes budgeting for birth difficult.
“The [state’s] intention is a step in the right direction, but it would be nice if the follow-through also came along behind that,” she said.
Arkansas is one of 46 states whose Medicaid programs either cover doula care or have active plans to cover it, according to the National Health Law Program, a low-income health care advocacy group.
Making sure Arkansans on Medicaid can access maternal health care is a primary purpose of the Healthy Moms, Healthy Babies Act, said Sanders, Pilkington and other state officials last year.
The law created presumptive Medicaid eligibility for pregnancy. There are 6,950 Arkansans on Medicaid plans specific to pregnancy, and this does not account for all pregnant Arkansans on Medicaid since other coverage plans include prenatal care, Lesnick said.
However, low-income Arkansans tend to delay seeking health care as rural areas lose providers, and this increases the risks of maternal and infant mortality, Hill and Butler both said.
“Our work exists because these gaps exist, and these gaps are costing people their lives here in Arkansas,” Hill said. “And if this [coverage] delay contributes to one death? Well, that’s even one death too many.”
