A growing share of Americans, especially in rural areas, are losing access to reproductive health care . At the same time, American women are dying during or after pregnancy at higher rates than in any other high-income country.
As a result, many U.S. health care providers and policymakers are looking for ways to improve maternal care .
We believe doulas – 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 physician-researcher specializing in high-risk pregnancies and breastfeeding and a Ph.D. candidate in sociology focused on reproductive health and health care disparities.
As hospitals adopt more favorable policies and states expand insurance coverage for doula services , doulas are becoming part of the mainstream U.S. maternal health system .
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 vulnerable times , and many parents-to-be and new parents find it can be difficult to navigate. Doulas advocate for their clients, helping them voice what they need . They can also help address mistreatment and guide them to appropriate resources .
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.
Fertility doulas 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 identify normal symptoms and those that may be urgent warning signs . They also provide labor support , 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 validation of clients’ experiences and emotions .
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 bridge to mental health services and additional resources such as diapers, feeding support and housing needs. They may help with supporting a new mom’s infant feeding goals, integrating the infant into the family , 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.”
