Navigating the health care system can feel like a labyrinth, especially during critical life moments. That’s where doulas step in—not only as a lifeline during labor but as holistic advocates throughout the entire journey. Unlike traditional birth doulas, full-spectrum doulas masterfully navigate insurance hurdles, manage appointments, and connect patients to life-saving resources. Their work spans both perinatal and postpartum care, making them indispensable in today’s complex health care landscape. “Think of us like your maternal guidance counselor,” says Shariah Edwards, a certified full-spectrum doula for Altruism, Inc., a 501(c)(3) nonprofit. “I can’t give you medical advice, but I can give you evidence-based information so that you can make the best decision for you.”
As health care systems grow increasingly intricate, doulas play a pivotal role in expanding access to care, particularly for those navigating systemic barriers like transportation challenges or limited health literacy. Research highlights that respectful, patient-centered care during pregnancy and childbirth—qualities doulas prioritize—significantly impacts trust in the health care system. Involvement in decision-making and being treated with dignity fosters trust, while exclusion or disrespect discourages engagement.
In addition to addressing barriers during pregnancy, doulas fill a critical gap in postpartum care. Too often, the weeks and months following childbirth leave new parents feeling unsupported. Approximately 40% of women do not attend a postpartum follow-up visit, according to the American College of Obstetricians and Gynecologists (ACOG). The United States has one of the highest maternal mortality rates among high-income nations, with significant disparities affecting communities of color, according to the Commonwealth Fund’s report on maternal mortality. Doulas provide continued guidance and emotional reassurance during this vulnerable time, helping to reduce risks like postpartum depression and anxiety. “When we provide individual care to each birthing person, it decreases the chances of the patient becoming another devastating statistic,” explains Edwards. “I don’t want my clients to ever be part of another horror story.”
Core Functions of a Doula
At the heart of their work, doulas champion their clients by amplifying their voices in medical settings. For postpartum patients juggling the demands of a newborn, this advocacy is crucial to helping them focus on their own health needs.
“One of my clients decided to switch health care teams because they weren’t providing the support she needed or respecting her birth plan,” Edwards said. “She felt so much relief after finding a team that truly listened to her. She was able to stick to her birth plan, deliver a healthy baby, and even reconnect with a former colleague who turned out to be her labor and delivery nurse—it was such a special moment.”
Doulas extend their work beyond the clinic, empowering clients to take charge of their health journey. They help with practical tasks like organizing medical records, drafting lists of essential questions to ask providers, and demystifying health system navigation. By attending appointments, they offer support that helps clients feel confident in making informed care decisions.
The need for advocacy is particularly evident for patients facing cultural or language barriers. Consider Fabiola Silva, an immigrant mother whose story was highlighted by Illinois Public Media. Silva struggled to navigate pregnancy care due to a language barrier and cultural misunderstandings. She described feeling dismissed during appointments and unable to communicate her needs effectively, saying, “I just wanted to tell the doctor what I was feeling, but no one could understand me. It made me feel invisible.” Silva’s story reflects the broader need for culturally and linguistically sensitive care, especially as Hispanic mothers accounted for more than 25% of all U.S. births in 2022.
A doula could bridge these gaps by offering language support, ensuring Silva’s concerns were clearly communicated to providers, and helping her understand her care options. Stories like Silva’s illustrate the life-changing impact of having an advocate to navigate a complex and often intimidating health care system.
In addition to offering direct support, doulas connect clients to essential resources such as lactation support, mental health care, and community programs. These efforts ensure postpartum patients not only receive care but also feel valued and respected throughout their recovery journey.
Alongside logistical support, doulas provide patients with the essential knowledge to navigate their postpartum journey. With tailored support and education, they help parents feel prepared and confident in understanding their care plans.
For example, doulas educate new parents on recognizing signs of postpartum depression or anxiety, encouraging them to seek professional help when needed. They also provide guidance on managing common postpartum challenges, such as breastfeeding, sleep routines, and physical recovery. “Before the birth, we work together to plan for the postpartum period,” Edwards said. “I give my clients a Postpartum Care Plan worksheet, and we go through it step by step to make sure they feel supported. We talk about how they’ll care for themselves and adjust to life with a newborn. My goal is to help them feel confident navigating their new normal.”
By offering tailored support and education, doulas help parents feel prepared and empowered, fostering a sense of control and well-being during a pivotal time in their lives.
Doulas play a vital role in bridging patients to essential community resources, such as transportation, food assistance, and social programs. Their deep relationships with local organizations empower patients to access a wide range of support. For example, a doula might connect a new mother to a local food pantry, secure diapers through a nonprofit partner such as Happy Bottoms, or arrange transportation for follow-up medical appointments. “During our first consultation, I ask questions to understand what they need—things like whether they’re struggling to pay bills, dealing with food insecurity, or worried about how they’ll provide for their family,” Edwards said. “These conversations help me provide holistic care, like connecting them to free diapers or introducing them to the Count the Kicks app.”
At the Maternal and Infant Health (MaIH) Center, located in Lexington, Missouri, these connections are central to the care provided, ensuring patients receive the support they need to thrive. The MaIH Center offers comprehensive resources tailored to families, including free diapers, access to mental health services, prenatal exams, and assistance with essential items like car seats and clothing. For patients in rural areas, where barriers such as a lack of nearby health care providers can delay or complicate access to care, doulas make a significant difference. By bridging these gaps, doulas connect families with vital resources and provide the advocacy and support needed to navigate these challenges effectively.
Community partnerships strengthen the impact of full-spectrum doulas and organizations like The MaIH Center. By collaborating with midwives, social workers, nonprofits, and health care providers, doulas create a tailored network of support that addresses each patient’s unique needs. The partnerships not only enhance the effectiveness of individual care but also contribute to a stronger, more cohesive community health system. Together, they ensure that even families facing significant barriers—such as those in rural or underserved areas—receive the comprehensive support they need to thrive.
The Far-Reaching Impact of Doula Advocacy
Systemic barriers affect many patients, but they are particularly pronounced in marginalized communities. Those populations often face challenges like discrimination, mistrust in medical systems, and limited access to affordable care. Doulas bridge these gaps, delivering inclusive and respectful care tailored to patient needs. “During a consultation with a new client, she shared that her OB-GYN had greeted her by calling her a ‘problem child.’ She was shocked and didn’t know how to respond,” Edwards explained. “We talked through her options, and she ultimately decided it was best to switch providers. Now, I’m helping her connect with a midwife who respects her needs.”
While experiences of bias and disrespect highlight the need for advocates, systemic barriers extend far beyond individual encounters. Many patients also face financial hurdles and logistical complexities, which doulas are uniquely equipped to address.
Doulas connect patients facing financial barriers to cost-free community resources or assist them in navigating insurance complexities. They also serve as advocates for patients who have experienced bias or inequity in medical settings, ensuring their voices are heard and their concerns addressed. This work is especially critical given that a 2021 survey by NORC at the University of Chicago found that 59% of the general public believes the health care system discriminates against people to some extent. By fostering a supportive and nonjudgmental environment, doulas build trust and empower patients to take an active role in their health.
In these efforts, doulas provide more than practical support—they help rebuild trust in a health care system that many marginalized populations find alienating.
Doulas foster confidence through consistent, meaningful relationships. Through active listening and compassionate care, they create a safe space where mothers feel valued and respected. In the article ‘Like a Welcoming Committee: Erykah Badu on Becoming a Doula,’ musician and practicing doula Erykah Badu highlights the value of fostering trust with expectant parents. She states, “I think the trust is built in the beginning, when we first meet, and we decide that this is something that we want to do together.”
By fostering trust, doulas not only support individual mothers but also contribute to measurable improvements in health outcomes, making a broader impact on community health.
Patients with care coordination support are more likely to attend follow-up appointments, adhere to treatment plans, and report higher satisfaction with their care. For instance, a report from the Institute for Medicaid Innovation found that women served by doulas breastfed longer, with 74.49% continuing at six weeks compared to 53.43% in the general population. They also saw lower cesarean birth rates, 24%, compared to a CDC sample, 30%. These outcomes improve individual health and reduce strain on the health care system, benefiting communities as a whole.
Beyond improving individual health outcomes, doulas address systemic inequities and drive long-term change in community health. By collaborating with organizations and advocating for policy improvements, they work to advance health care systems that address disparities and improve outcomes. “When doulas team up with community groups and leaders, it’s not just about helping one person—it’s about making things better for everyone,” said Edwards. Collaborations like these lay the groundwork for policy changes that expand access to equitable care.
Empowered by these efforts, communities grow healthier and more informed, fostering systemic change. Missouri and Kansas have recently expanded Medicaid to reimburse doula services, enabling low-income families to access comprehensive prenatal, delivery, and postpartum care. The initiatives highlight doulas’ critical role in reducing maternal mortality and improving outcomes for underserved populations.
Over time, these efforts strengthen the foundation for healthier communities and future generations. Community-based programs supported by doulas often inspire systemic reforms, from expanding access to maternal health resources to improving cultural competency in care delivery. This empowerment goes beyond individual patients, creating systemic change by encouraging collaboration between organizations, driving policy improvements, and fostering long-term health equity.
The Future of Doulas
As the demand for care coordination grows, integrating doulas into traditional health care systems presents a transformative opportunity. The Medicaid expansions in Missouri and Kansas highlight how policy changes can break down barriers, enabling equitable access to vital maternal health services. Building on these successes, professional development initiatives and expanded reimbursement models are critical to ensuring doulas can operate within health care settings more effectively.
“It’s exciting to see more states supporting doulas because it means more people can get the help they need,” Edwards said. “When we have more training and programs like Medicaid paying for doulas, it makes a big difference for families and helps build a healthier future for our communities.”
In addition to these policy advancements, technology is reshaping how doulas connect with and support patients. Tools like telehealth platforms and electronic health records (EHRs) enable doulas to provide consistent, accessible care while reducing logistical barriers for patients. For example, a doula might use a telehealth platform to check in with a new mother struggling with breastfeeding, offering real-time guidance and emotional support without requiring an in-person visit. “Technology makes it so much easier for us to stay connected with the moms we’re helping,” Edwards said. “Even just using video calls, we can be there for someone when they need advice or support, even if we can’t be in the same room. It helps us reach more families and make sure they don’t feel alone.”
Doulas represent a crucial and transformative force within the evolving health care system. Their work extends far beyond traditional support roles, addressing critical gaps in care, building trust, and fostering equity for the populations that need it most. Through their advocacy, education, and resource connection, doulas ensure that patients receive care that is not only accessible but also culturally responsive, personalized, and equity-centered.
“As doulas, we’re not just supporting individual clients—we’re building a world where everyone feels valued and heard in their journey,” Edwards said. “Change starts when we stand together, work together, and believe in a future where equal care is the standard, not the exception.”