Session Voices: Amy Stiffarm - Birth of a Bill, SB 319

In conversation with Amy Stiffarm, PhD, MPH, we learn about the creation of Senate Bill 319, supporting and promoting doula care in Montana.

Learn more about the value of doula care, and SB 319, here:

https://hmhb-mt.org/for-partners/doulas-and-birth-workers/

https://hmhb-mt.org/2025-doula-legislative-information/

Interested in supporting SB 319? Details and resources for providing testimony or written comment:  

Hearing date/time: Monday, February 24, 2025, 3:00 PM

Senate Public Health, Welfare, and Safety Committee, Room 317C
Montana State Capitol, Helena MT

Need help with your testimony or written comment? Contact any of the following for more information or support:

Dani Vazquez - daniellevazquez11@gmail.com
Amy Stiffarm amy@hmhb-mt.org
Stephanie Morton - stephanie@hmhb-mt.org

Testifying virtually? Sign up at least two hours before the hearing: http://participate.legmt.gov

Submit written comments: https://participate.legmt.gov

Leave a message for a legislator or committee: Call 406-444-4800

Watch the hearing live: https://sg001-harmony.sliq.net/00309/Harmony/en

Organizations/resources mentioned in this episode: 

Healthy Mothers, Healthy Babies - Montana: hmhb-mt.org

Cultural Safety Toolkit and Indigenous Birth Preference Guides: https://hmhb-mt.org/native-american-initiatives/

Montana Obstetric and Maternal Support (MOMS): https://mtmoms.org/
Yarrow: https://www.yarrowcommunity.org/

Montana Doula Collaborative: https://www.montanadoulacollaborative.org/

Enjoying the podcast? We’d love your feedback and ideas for future episodes! Take our LIFTS Podcast Listener Survey at hmhb-mt.org/survey.

Connect with Healthy Mothers, Healthy Babies

• Website
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For statewide resources to support Montana families in the 0-3 years of parenting, check out the LIFTS online resource guide at
https://hmhb-lifts.org/

Transcript

Speaker 1:  The Montana Legislative Session is underway, and we're diving in to learn more about how it all works and why it's worth paying attention to. We'll connect with experts, advocates, parents, lawmakers, and other champions of Montana families. I'm Emily, and you're listening to Session Voices, a special mother love series.

Today we're speaking with Dr. Amy Stiffarm from Healthy Mothers, Healthy Babies Montana. We'll learn about her work supporting doulas and indigenous birth workers and the contributions that she and others have made towards the creation of Senate Bill 319.

Speaker 2: 0:06

My name is Amy Stiffarm. I'm an enrolled member of the Aani Nation from the Fort Belknap Indian Community and I'm also a descendant of the Chippewa Cree and Blackfeet Tribes. I'm the Native American Initiatives Director at Healthy Mothers Healthy Babies, montana, and what do you do in that role? Mostly, we get to support people who want to work with Native communities within the realm of Indigenous maternal, child health and whatnot. Really, this program got started a few years ago. I had been working as a consultant when I was in graduate school with Healthy Mothers Healthy Babies and we were doing some work with the LIFTS online resource guide and doing outreach and engagement with tribal communities to make sure that the resource guide worked for them, so things like making sure it was searchable by reservation, and we worked with every reservation on that. One great thing that came out of that was including culture as a resource category, and that's something that's unique to Indigenous people that our culture has protective factors against mental health and it's just good for health promotion, and so after that was over, we're kind of like, well, what now? And HMHB? We're like we're ready to put our money where our mouth is pretty much, and we want to keep investing in this work for Native American communities.

Speaker 2: 1:38

I was finishing my dissertation. I was working on the cultural safety toolkit. So with that toolkit created a training for providers to help learn about cultural safety and how to better serve Indigenous families. In Montana we also have done some great work around engagement days or immersion days. With the help of some partners like Yarrow and the MOMS Program, we were able to bring non-Native providers from areas that most Native people have to travel to to get higher levels of health care.

Speaker 2: 2:13

But bringing them to reservations and having them like meet the people, learn about the culture, meet with elders, meet the programs and for a lot of people that's like their first time on a reservation. Meet the programs and for a lot of people that's like their first time on a reservation and so helping develop those relationships and really like building trust. Right now our work we're super focused on promoting and raising awareness about Indigenous birth work. So we just launched some amazing Indigenous birth preference guides you can find those on our website and last year we started convening the Indigenous Birth Worker Network. That kind of came about after there were a lot of Indigenous doula trainings in Montana and just being able to get everybody together who took those trainings, or who was just interested in advocating for birth work and having them come together and be in a space where we can learn from each other and support each other, can you?

Speaker 1: 3:12

explain the distinction between an Indigenous birth worker and a doula, and maybe define a doula as well for those who aren't familiar with the term.

Speaker 2: 3:21

Doula just means a trained non-medical professional and they provide different types of support, like physical support, emotional, informational support, and they do this prenatally, so like during pregnancy and during birth, while you're laboring, and then even in the postpartum. So there are some doulas who focus, maybe like just prenatal, or maybe they just do birth, but some do it all. So there's different kind of levels and I think the key there is that non-medical, so they're not catching babies like a midwife or OBGYN. They're really there to support that birthing process or help with education, all sort of things. But non-medical. And when we're talking about an Indigenous birth worker, it's pretty much the same thing. They provide all of that support too, but they're approaching their work in alignment with cultural values, approaching it in more of a sacred way.

Speaker 2: 4:27

We like to say the word birth work because it's descriptive and like that's how indigenous languages are, they're super descriptive. And doula actually derives from a Greek word that means like female slave, and so we wanted to just recognize that this role of doulas. People think of it as a new thing. It's something that has been going on since the beginning of time in our communities. Before colonization, we knew how to take care of our pregnant people. We know how to take care of someone during labor and after they have a baby. So we're kind of reclaiming these roles in our community, reclaiming the knowledge around it, and Indigenous birth workers have a crucial role in that reclamation of traditional knowledge and practices around pregnancy, birth and postpartum care. So they're really grounded in culture in their work.

Speaker 1: 5:24

In this legislative session. What is the work you're doing related to doulas and birth workers?

Speaker 2: 5:31

There's actually a bill sponsored by Senator Cora Neuman and it's about licensing doulas as a profession through the Department of Labor and Industry doulas as a profession through the Department of Labor and Industry, in hopes that once that licensing program is established, that Medicaid would be able to reimburse doulas. And the bill has some language like it's not mandatory, that Medicaid does that, but they would have the authority to reimburse for doula. And it wouldn't just be Medicaid either. If doulas had a licensing program, other insurances and whatnot would be able to reimburse too.

Speaker 1: 6:10

Can you talk about the process that led to that bill coming to be? We hear a lot about how bills become laws we learn it in elementary school and then we get a refresher during the legislative session but not a lot about how a bill comes into existence in the first place. Can you walk us SB 319 into the world, this bill?

Speaker 2: 6:32

was born really from doulas. Some doulas were having a conversation about the people who need us the most, aren't. We're not able to serve them because there's no way that they can afford doula care or it would have to be volunteer. And you know, more people need access to doulas. So what can we do? The group is called the Montana Doula Collaborative just an amazing group of doulas who just have the biggest hearts and just want to do right for Montanans and get the service to more people. So about three and a half years ago they started hosting meetings with that being the goal of like how do we get more people access to doula care? And so when we started convening the Indigenous birth workers, they got a hold of me at Healthy Mothers, healthy Babies to say hey, we've been doing this work but we want to make sure that we're not excluding Indigenous people in this work and that we're not creating some unintentional harm. Can you help us get more Indigenous people to these meetings? And so you know, sharing that information with people and coming to the meetings. HMHB we're a statewide non-profit and we do a lot of programmatic support. Part of that is convening a lot of different coalitions and we've been trying to find ways to support doulas and uplift their roles and whatnot. And so we had a doula meeting almost a year ago in March, and we brought all of these different doula groups that we knew about. Like there's some who are home visitors through their public health department but they're also trained as doulas. There's a group that has a doula in their clinic, in their hospital, and that's is it's out-of-pocket pay, so that depends on how many prenatal visits, how many postpartum visits and the birth, but it's usually kind of like a set fee for a certain amount of visits and births. So most people who are getting this are people who can afford to pay that. Of course, there's exceptions. A lot of the Indigenous birth workers actually do this for free, for family and for friends and for kind of whoever gets a hold of them and needs them.

Speaker 2: 9:02

We brought a lot of different people, people who were just interested in doula work too, to hear about what everyone was doing. We're like, hey, we know all of you, what's up, what have you been up to, what do you need? And so that was kind of how we ended the meeting of like, well, what do you need from us? Like how can we help you in the work that we do at HMHB and they were very much like we want a way to reimburse for our services so that we can serve people who can't pay out of pocket for these services but who really need it. And so we started meeting with them more. I think, more intentionally about like, okay, what do we need to do? We've helped with some legislative stuff.

Speaker 2: 9:51

Before I say we, as in HMHB, our leadership, would be called to testify or give information on certain bills. Stephanie played a big role for pregnancy extension for Medicaid coverage, so instead of just someone six weeks after birth, now in Montana they're covered for up to 12 months. HMHB was a big proponent in that because we know, like, how important that full year is for care for someone who just had a baby, especially when you're talking about mental health. We just kept meeting and bringing people together and getting the right people, I think, and it just it sort of happens organically, I think, when people hear about it and they want to help and just showing up and talking and figuring out strategy and realized that getting DLI licensing is a step needed to have Medicaid reimbursement, and so once we kind of figured that out Medicaid reimbursement and so once we kind of figured that out.

Speaker 2: 10:56

We were trying to look for somebody to sponsor the bill, and at first that was a little bit hard, because it's not like we're hanging out at the Capitol all day and know these people. But then, luckily, senator Cora Neuman was like hey, I used to be a postpartum doula and I love this, you know. And so we were able to work with her, had she just heard about the work you all were doing, or had someone approached her?

Speaker 2: 11:21

Yeah, people were just emailing people being like, hey, we're looking for somebody. I feel like in some ways, like I'm sure my history teacher would disagree, but in some ways I feel like it's magic. I don't think that was in the schoolhouse rock song about bills, about the magic, but I just like can't believe that we were looking for a sponsor.

Speaker 2: 11:43

And it turns out a postpartum doula who has an extensive background in public health is there as a senator in Montana and is like, hey, I'm going to sponsor this bill. And not only that, but when it was published she got so many co-sponsors and it's a bipartisan issue, so she has co-sponsors that are Republican and Democrat, and in Montana that's a pretty big deal, even the fact that that many people know about doulas over there. We were kind of like, whoa, we might have something here. And so once the bill is published, then you get a hearing. The hearing gets scheduled to get sent to a committee and so with ours, the committee it got sent to is the Senate committee, because Senator Newman is a senator, so it's within a Senate committee on public health, welfare and safety. That's where our bill got sent and that's where we're at right now.

Speaker 1: 

And so when this episode releases, it is Monday and the hearing is this afternoon at three o'clock, is that right?

Speaker 2: 12:51

Yep, the hearing is going to be heard in the Senate committee that I just said, three o'clock in room 317.

Speaker 1: 12:59

If somebody's listening to this episode and wants to get involved in today's committee meeting, what would be some steps they could take? Depending on when you're listening to this, it's possibly not too late right To get over there or to sign up to testify via Zoom. Or If maybe you've missed the meeting or unable to testify, can you speak to some of the different ways that people might get involved if they're interested in supporting this bill?

Speaker 2: 13:21

We're finding people to testify in support of this bill. So when it's in committee and it's first heard, the senator will introduce it and she'll talk about the bill and then the committee will ask for proponents of the bill to testify. So usually you get depending on how many people are there, you'll get about two minutes to provide a testimony. So you wait in line and you address the committee and tell them why you support the bill and why you think they should vote yes, why you support the bill and why you think they should vote yes. And I think that's the most important thing for people to understand is like you learn as you go and I mean I've taken PhD level policy courses and I'm learning more just by doing so. We're gathering people to do testimony, really encouraging people Like, yes, data is important, but I think it's the stories, it's that personal testimony.

Speaker 2: 14:23

When I'm crafting my testimony, pulling up the committee and I'm looking at who's on there, I want them to feel like I wish my wife had a doula, or I wish my daughter had a doula, wish my granddaughter can have a doula. I'm trying to pull at their heartstrings a little bit, and not just to be like fakey, but because that's what it is. You know, like I do wish that. I wish that their grandkids had doulas. You know I want people to have access to this care. I would say, like don't focus so much on the data you know we're they're gonna have that we're to give them handouts. You could always write a testimony that has data in there, but then when you're speaking for your two minutes, just only say part of it, you know, and maybe only your personal, and then you can always hand in that testimony and they'll make copies and give it to everybody.

Speaker 1: 15:15

So somebody who wants to testify. They don't have to be an expert on the stats around what doula care does as far as improving birth outcomes. They can just speak to their personal experience, their personal feelings, and that's a valid form of testimony.

Speaker 2: 15:29

Yeah, did you have a doula and what did that mean for you and your family? Or could you not afford a doula? How did you navigate that? I actually was just talking to my mom this morning. We were talking about her writing in. She's like, well, I want to write the committee and tell them like I am so glad my daughter had a doula, like I didn't even know what the heck that was, but I'm really glad she had one.

Speaker 2: 15:51

And so even things like that, if you can't be there in person, there's a way to testify remotely. We can't be there in person. There's a way to testify remotely. We'll have a link in the show notes on how to do that, because you do have to register at least two hours before the hearing. And even if you're planning to be in person you know montana weather it's kind of crazy. If you're not living in helena or even with I don't know knock on wood, like cold and flu season, might be a good idea to be registered, just in case. And and you won't have to be on camera or anything for that you can literally be in your pajamas and testify when it's your turn. And also, too, if people are really nervous, you can go back and watch different Senate committee hearings, like I just watched the one the other day where they passed the Medicaid expansion bill out. It's just nice to see it, so you can go watch. It might be helpful.

Speaker 2: 16:43

Usually they don't vote right away. They'll have a different hearing and it'll be voted on probably a different day. So afterwards, after this hearing, while they're thinking about it, it'll be really important for people to and this is with any bill to call that committee, email that committee and tell them why you think they should vote yes. So this is the Senate. Once it goes out of the committee, it'll go to the Senate floor and then all the senators everywhere, not just those on the committee, are going to be able to vote on it. So that's when, statewide, whoever your senator is, let them know that you are in support of this and then after that, if it passes, when it passes, once it's done in the Senate, it'll go to the House. So same process it'll be in a committee, there'll be a hearing. If it passes out, then it'll go into the House floor and then you call your representatives.

Speaker 2: 17:35

There's ways to get involved all along the way. And if you don't want to testify or you don't want to supply written comment. You could even just share on social media or like me, like texting your family and calling your family and being like, hey, let's see how you can comment or how can you participate. And if you don't want to do that, then just share the information, because you never know who does. There's been people who've been like, hey, actually I had a doula, can I testify? And it's like, yeah, it would be great and we're helping people at HMHB with all of that, we're putting stuff out on social media, we have a list of how to, and just helping people feel more comfortable with the process.

Speaker 1: 18:12

So if someone needs a little extra handholding or to have the process explained a bit more, have someone look at a draft of a testimony.

Speaker 2: 18:25

Who could they reach out to? Dani Vazquez, who's been helping a lot with providing testimony. She's been sharing her testimony as an example, and we're reaching out to people in our emails. So check your inbox. Maybe you've already got an email from us.

Speaker 1: 18:38

And if not they can, we'll just put some contact info in the show notes. If someone needs, you know, wants to reach out for a little extra help.

Speaker 2: 18:45

Yeah me, Dani and Steph will be helping people all the way up till the hearings.

Speaker 1: 18:49

Okay, great. Anything else that you want people to know about this process?

Speaker 2: 18:54

I keep reminding myself of this. Dani said it last night during our Indigenous Birth Worker Network call and she said try not to be nervous when you go in there. Remember that these guys work for you. They're in this building because of you. You're their constituents and so when you're up there talking they have to listen to you. They're not doing you a favor or allowing you to speak. It's your right to speak and you belong. I think that's important to remember like you belong, your voice matters and you have every right to tell them how you think they should vote part of the process by design.

Speaker 1: 19:41

That's a good reminder. Thank you so much and good luck to Senate Bill 319. We'll all be watching at three o'clock and hopefully some listeners out there will be testifying yeah that'd be great.

Speaker 2: 19:49

Thanks, Emily.

Speaker 1: Mother Love is a project of Healthy Mothers, Healthy Babies, the Montana Coalition, a nonprofit dedicated to improving the health, safety and well-being of Montana families in the zero to three years of parenting. Visit us at hmhbmt.org to learn more about who we are and what we do. Views and opinions expressed in these interviews do not necessarily represent HMHB as an organization. If you have feedback on the podcast or an idea for a future episode, we'd love to hear from you. You can email us at stories at hmhbmt.org. Thanks for listening.