3/21/23:Changing Maternal Care Delivery for Black Birthing People in Los Angeles: Spotlight on Kindred Space LA

Thank you to all participants for your participation in this meeting, as well as the past three years in the Maternal Health Hub. While Phase 2 is coming to an end, we are excited to see where the future of this work will take us. Stay tuned for updates!

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This month’s Maternal Health Hub Learning Community session on Changing Maternal Care Delivery: Spotlight on Kindred Space LA and Accompany Doula Care, featuring Kimberly Durdin, LM, DPM, IBLCL, Co-founder and Co-Owner of Kindred Space LA, and Christina Gebel, MPH, LCC, Interim Executive Director of Research and Co-Founder, Accompany Doula Care.  View the slides here and the recording here.

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Panelists participated in a question-and-answer session. The following serves as a summary of their responses:

Christina Gebel shared the story of how Accompany Doula Care was created. Lorenza Holt (a Spinning Babies Approved Trainer and DONA-approved Birth Doula Trainer in Massachusetts) had a vision that one day doula services could be reimbursed by payers, rather than being solely out-of-pocket for birthing people. In 2014, Ms. Gebel joined Ms. Holt and they began work to extend MassHealth (Medicaid) coverage to doulas. By 2019 their effort had expanded to include six doulas who all had the same vision. At the same time, an accountable care organization (ACO) reached out to see if Accompany Doula Care would be interested in developing a community doula relationship, and they jumped at the opportunity. Accompany Doula Care is now in partnership with two ACOs and two hospitals. Ms. Gebel shared that affordable access to doulas is still a significant challenge in Massachusetts, despite their partnership with several payers. This is partly due to the shortage of doulas in the state, and partly due to the way payers structure the benefit, often making it only available to those who are experiencing a high-risk pregnancy.

In response to a question about top payment reform strategies that could help expand access to doula care, Ms. Gebel shared the following:

• Establishing appropriate reimbursement levels: This includes adequate coverage through both Medicaid and commercial plans so that all birthing individuals can have access to a doula.
• Reducing the barriers to becoming a doula and diversifying the doula workforce.
• Developing mutual respect between a clinical team and the doula serving the patient.

In response to a question about strategies to make it less difficult to become a doula, Ms. Gebel shared the following:

• An important first step is recognizing that the current system of maternity care was built around clinical care, and is not inclusive of community-based methods of care.
• Simplifying the reimbursement process is important. This includes not only updating forms to acknowledge that community-based, non-clinical providers will be using them, but also analyzing the type of information being requested. For example, to submit a reimbursement request, a doula in Massachusetts requires a National Provider Identifier (NPI). However, to obtain an NPI requires providing a business entity address which for doulas, who are often self-employed, equates to their home address which many are not comfortable sharing. In the case of Accompany Doula Care, it used a P.O. Box for its work address when it was first formed, but the NPI forms do not accept P.O. Boxes as an option.

Kimberly Durdin elaborated on the founding story of Kindred Space LA. At the beginning of her career, Ms. Durdin worked at a birth center in Los Angeles and met Allegra Hill, a student midwife at the center. Together, they both shared a vision to open a birth center in the future. After attending a conference together in 2017 that focused on the trauma that many Black and Brown birthing people experience during their pregnancies and birth, rather than on scaling the viable solutions that already exist, the pair channeled their frustration into raising money for and developing a non-profit. They soon used the funds to open their first space in Inglewood CA which provided childbirth education and doula training classes for the community, with a specific focus on training Black, Indigenous, and People of Color (BIPOC), queer, and Hispanic individuals. When the pandemic hit in 2020, the demand for non-hospital births rose exponentially, which pushed them into opening a birth center earlier than anticipated. After going through another round of fundraising, they opened the birthing center at Kindred Space LA in October 2020.

Kindred Space LA offers three care pathways for pregnant individuals. The individual care package coves one-on-one prenatal care visits, the birth, and postpartum care. After discharge (which typically occurs after four hours), the patient receives a home visit within 24-48 hours, one at five days after birth, and then the patient comes into the clinic for two additional postpartum visits. If more postpartum appointments are needed, Kindred Space LA adds on more at no additional charge. The second package offered is the home birth version of the individual care package. Last, Kindred Space LA offers a group prenatal package.

Outside of the birthing period, Kindred Space LA also runs a support group for dads, acupuncture therapy, and provides connections to therapy services. Kindred Space LA covers the cost of the therapy sessions for birthing individuals who are struggling in the postpartum period.

In response to a question about funding their work, Ms. Durdin shared that you have to be very open to asking for money. Both of their fundraising cycles began with a GoFundMe. Kindred Space LA is also funded by grants; they have a volunteer grant writer who provides their time as a way to give back to their community. Kindred Space LA also receives funding through the form of patient payments for the services, with the more personalized services corresponding with a higher cost. Some of the patients are reimbursed for the expenses through their insurance, although Kindred Space is LA is not in network with MediCal, so this is only possible for patients with private insurance.

Again, thank you to all who have supported and participated in the Maternal Health Hub Learning Community over the past three years. Keep visiting http://www.maternalhealthhub.org to find resources and recordings of prior webinars, and for updates on potential upcoming work.