Montana is launching a statewide effort to train and support birth doulas, with a focus on Indigenous communities where pregnant women sometimes drive 150 miles to reach a hospital with a labor ward.

The state health department is seeking a contractor to develop the doula workforce and build partnerships with Montana's seven tribal nations. The initiative comes as maternity care has collapsed across rural Montana: 45 of the state's 56 counties are now considered maternity care deserts, with no hospitals offering obstetric services, no birth centers, and no OB-GYNs.

For tribal communities, the stakes are particularly high. Indigenous women in Montana are two to three times more likely to die from pregnancy-related causes than white women, according to CDC data. Several reservation hospitals have shuttered their maternity wards in recent years, including Blackfeet Community Hospital in 2018, forcing expectant mothers to travel hours for delivery.

Doulas are trained professionals who provide continuous physical and emotional support during pregnancy, labor, and postpartum—distinct from medical providers. Research shows doula support reduces cesarean rates and improves breastfeeding outcomes. At least 14 states now cover doula services through Medicaid, though Montana does not yet.

The program emphasizes tribal sovereignty and Indigenous leadership rather than importing outside models. Montana's tribes—including Blackfeet, Crow, Northern Cheyenne, Fort Peck, Rocky Boy's, Salish-Kootenai, and Little Shell—operate their own health systems and have insisted on self-determination in maternal health services.

Montana's maternal mortality rate jumped 36 percent between 2018 and 2021, part of a national crisis that has made the U.S. the most dangerous developed country for childbirth. Rural hospital maternity units have closed steadily since 2010 as declining birth rates and insurance reimbursement rates made obstetric services financially unsustainable.

The state's Early Childhood and Family Support Division posted the request for proposals on March 19. The selected contractor will design training programs and coordinate with tribal health systems to create a network of community-based doulas.

Montana currently has no doula licensure, no unified training standards, and no insurance coverage for doula services, making this foundational infrastructure work.