Pregnant person being examined

There is a growing interest in making doula care more accessible in the United States. A legislative scan found that from 2015-2020, 73 doula-related state legislation bills were proposed and 12 of which became law. As of February 2024, 12 states and Washington D.C.’s Medicaid programs reimburse for doula services. Rhode Island is currently the only state to require private insurance to cover doula services. As increasing access to doulas services remains a bipartisan issue and a priority of the Biden-Harris administration, it is imperative that health services researchers understand doula scope, practice, and benefits.

What is a doula?

DONA International defines a doula as “a trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.” It is important to note that there are many types of doulas: birth doulas, abortion doulas, death doulas, bereavement doulas, grief doulas and more. When people refer to ‘doulas’, they are frequently referring to birth/postpartum doulas.

Is a doula the same thing as a midwife?

No. Midwives and doulas often work alongside each other as members of the birthing team but they are different in scope and practice. The biggest difference is that a midwife is a medical professional, whereas a doula is not. Depending on a midwife’s licensure and state of practice, they can assist with childbirth at varying capacities. A doula is a non-medical professional that provides support to the birthing person.

Why is there increased interest in doulas?

Doula care has existed for generations in countless cultures. In the 70s/80s in the U.S., there was an emergence of doula service utilization by white affluent women. In recent decades, there has been an evidence-based and community-based push to increase doula services access for the most marginalized. There is a plethora of literature that has concluded that attendance of a pregnancy and birth by a doula yields better outcomes. This includes: lower anxiety and depression rates, reduction in non-medically indicated c-sections, reduction in preterm birth/low birth weight, increase prenatal visit attendance and increase in breastfeeding rates, among other benefits. Moreover, doula care has shown to be cost effective. 

What doula related research is being presented at #ARM24?

I am most excited to check out the poster ‘Expanding Access to Doula Care in Medicaid Among Women at Higher Risk for Maternal Morbidity: Results of a Propensity Score Matched Analysis’. As attention and momentum to doula care continues to rise, studies like this are imperative to demonstrate the need and benefit of access to doula care. As noted in the abstract, “This study contributes to the knowledge base on this topic by offering the most geographically diverse population analysis in the U.S. to date, which is important given the wide variance in state policies and programs that provide doula coverage “. 

I am also looking forward to the presentation titled ‘Utilization Trends in Medicaid-Reimbursed Doula Services and out-of-Pocket Cost Savings in Maryland’. While important to advocate for increased access initiatives- reimbursement, workforce development etc., we must also ensure that doula care is being accessed and utilized through these streams. The findings of this presentation provide local insight regarding utilization and implications of services.

I highly recommend that you check out the full agenda here, to see the other presentations and posters occurring at #ARM24. You can search the full online agenda for the keyword ‘doula’ to find the relevant presentations.

Kene Orakwue Headshot
Committee Member, Member

Kene Orakwue, M.P.H.

Ph.D. Student - University of Minnesota - Twin Cities

Kene Orakwue, M.P.H. [she/they] is a health equity scholar, activist, and practitioner. Grounded by Black femi... Read Bio

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