A growing share of Americans, especially in rural areas, . At the same time, American at higher rates than in any other high-income country.
As a result, many U.S. health care providers and policymakers are .
We believe – care workers who provide nonmedical support before and during pregnancy, labor, birth and the postpartum period – may be a part of the solution.
We are a specializing in high-risk pregnancies and breastfeeding and a focused on reproductive health and health care disparities.
As hospitals adopt and , doulas are becoming .
But there are still significant barriers to access, including awareness, costs and challenges to full partnership with doulas in hospitals.
What a doula offers
Pregnancy, birth and the postpartum period are , and many parents-to-be and new parents find it can be difficult to navigate. Doulas advocate for their clients, . They can also help address .
Doulas do not perform clinical tasks, such as giving medical advice, making medical decisions, providing prescriptions or delivering babies. Rather, they provide nonmedical support. This will look different depending on the type of doula parents hire.
assist people who are trying to get pregnant. They offer emotional support throughout the fertility journey, complementing the medical care, diagnostics and interventions provided by fertility doctors.
During pregnancy and labor, birth doulas help their clients and those that may be . They also , such as positioning and breathing assistance, massage, words of encouragement, coaching, education, continuous presence and other forms of comfort. They offer direct emotional support through the .
Postpartum doulas offer extended support to new parents and infants in the immediate days, weeks or months after delivery. They educate parents and act as a and such as diapers, feeding support and housing needs. They may help with supporting a new mom’s infant feeding goals, , sibling care and processing their births.
Full-spectrum doulas offer support throughout pregnancy, delivery and up to six months after birth. Still others offer bereavement services for parents experiencing pregnancy loss, such as abortion, miscarriage and stillbirth.
This sort of holistic care can be invaluable, even for women with access to good medical care. Several months ago, one of us (Adetola) helped a patient find a postpartum doula. She was an educated woman with insurance and access to top medical care. She was suffering the effects of postpartum depression and anxiety despite all the therapy and medical resources offered.
She later wrote that, for her, “the support of my postpartum doula was invaluable in my recovery. My doula provided me with the support I needed in caring for my baby for me to care for myself. Not only did she care for my baby for me to rest, but she helped me with breastfeeding.”
Doula training
As of August 2025, in the U.S. California has the highest concentration at 7.5%, while West Virginia has the lowest concentration, 0.1%. These numbers may not reflect hospital-based or nonprofit-affiliated doulas, or those not formally registered.
In the U.S., more than 100 independent organizations provide doula training. Some of the larger organizations include , and the . Doula training typically covers , stages of labor and birth, and postpartum support. It also includes coursework on how to build a business as well as infection prevention and control.
Some organizations provide online or in-person courses, and doula training can also be done through apprenticeships. While certifications or licenses are not required to practice, various state Medicaid programs mandate training and certification .
Better outcomes with doula support
The services that doulas offer can of many doctors and nurses.
Maternal health outcomes in the U.S. in comparison to other high-income countries.
But studies show that a doula-clinician partnership improves key components of maternal health care, such as better , and .
Having a doula present in the lead-up to delivery, at the delivery or both is associated with lower rates of and and fewer .
Doula support is also associated with improved , , , , and .
After birth, infants born with a doula present have , an taken exactly five minutes after birth. Parents who received doula support have .
Doula support has also been shown , particularly those rooted in and .
And beyond all the health benefits for parents and infants, research shows that doulas can reduce .
Funding sources for doula support
Unfortunately, despite all of these benefits, many U.S. families struggle to afford doula care. Private insurance . Clients can pay out of pocket using a . They can also pay for these services using extended benefits such as flex or health savings accounts.
The cost , experience level and service package. Out-of-pocket costs for comprehensive birth doula services can across the U.S.
As of September 2025, , were actively reimbursing Medicaid coverage for doula care.
Only two states – – currently require that private health plans cover doula care. However, Colorado, Virginia, Illinois and Delaware are in the process of implementing doula coverage in . to continue efforts to require doula coverage for private health plans.
and provide free or low-cost doula care through grants or donations. These programs usually prioritize low-income families. In New York City, free or low-cost doula support is available through the which serves Medicaid-eligible families, teen parents and residents of priority neighborhoods.
Moreover, some hospitals and birth centers employ doulas or work with them as part of their maternal care teams.
Finding a doula
When , you’ll want to consider their training, certifications and experience. You will also want to know how available they are, what services they offer and their fees and payment methods.
In addition:
- Consider asking your health care provider or hospital for recommendations for doulas in the community.
- Look into doula directories, such as , , and the . Also, check to see whether your state has a doula directory, like those in , and .
- Ask for recommendations from friends, family or local parenting groups.
- Check local community boards, birth centers and drugstores for any doula advertisements.
- You might also connect with doulas at birth or parenting classes.
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