What Is a Doula?

This story is part of our Campus Dispatch series. Read the rest of the stories in the series here.

I had been with my pregnant client for hours at our local hospital—breathing with intention through each contraction, performing hip squeezes through the night, when, finally, it was time to help her pivot when her birth plan no longer matched her birth reality.

My client was tired. She was powerful. She was doing it. And I was there to remind her, with every surge of pain, that she wasn’t doing it alone.

Our relationship had been growing for months. We met for the first time during her second trimester at a coffee shop. We talked about her past birth experiences, what she expected of me as her doula, and her ideal birth plan. Over the next few weeks, we continued our communication virtually. She would check in after prenatal appointments, and I would provide her with resources on breastfeeding and anything else that would help her thrive.

Later in the pregnancy, I paid her a home visit. For days, she’d been more uncomfortable, dealing with the “growing pains” of pregnancy. My client’s partner and I explored how he could support her during this stage by helping with stretches and by using a Rebozo cloth to ease her discomfort. This was the perfect setting to then explore with him how he wanted to support her during labor, whether that be communicating her preferences to her care team if she wasn’t able to, making sure her favorite music was playing, or tag-teaming hip squeezes with me.

Like any pregnant person, she would continue to have unique and specific needs after giving birth. Together, we crafted a postpartum plan that included who would visit, how she’d get rest, and even who would make dinner while she recovered.

In my view, a doula is an essential piece of the reproductive health care puzzle at a time when labor and delivery wards are closing nationwide. This is especially true in places like my hometown in rural Alabama, which is home to historically marginalized communities and limited access to care. Doulas step in to provide culturally responsive support, a gap that many doctors cannot fill. Yet many people don’t quite understand what it is we do.

What does a doula do?

Doulas’ work is often misunderstood. Some people see us as luxury add-ons or “birth hippies,” fringe figures in labor and delivery. Alternatively, we’re often mistaken for midwives, who provide clinical care on top of offering emotional and physical support.

Our role is different: Doulas traditionally offer emotional, physical, and informational support during pregnancy and up to three months postpartum. Some doulas offer support up to one year after birth. We are trained professionals who provide continuous, personalized support. Our role is to walk with birthing people through one of life’s most vulnerable transitions, offering guidance, reassurance, and a grounded presence every step of the way.

My journey with parents was an ordinary part of my work as a doula. Now, as a fourth-year medical student with plans to become an OB-GYN, my medical training has only deepened my understanding and appreciation for the unique care doulas provide patients.

The word “doula” means “female servant ” and comes from Greek origin. They provide pregnancy, birth, and postpartum support, and almost always work alongside doctors or midwives. Many states don’t have mandatory training or certification requirements, and doulas aren’t licensed. But many doulas elect to undergo hours of professional training provided by a doula training organization. This training is then followed by the option to become certified, which entails readings, examinations, and continuing education.

Doulas meet pregnant people where they are. That might mean discussing past trauma that could affect their labor experience, role-playing how to communicate boundaries with family, or talking through fears about pain, control, or judgment. We explore how a parent wants to feel in their birth space—generally, a hospital, birthing center, or at home. We write into their birth plan the elements that would help them feel most at ease—whether that’s soft music, quiet encouragement, or dim lights and warmth.

During labor, I might guide a client through Spinning Babies techniques—gentle movements and positions to help the baby achieve the optimal position for an easier birth—or translate medical terminology in real-time. I might encourage a partner to step in and help advocate for the birthing person’s needs when things get overwhelming.

After birth, I help people recognize signs of postpartum depression, discuss infant feeding options, and create practical plans for daily life—who’s doing laundry, who’s cooking dinner, who’s checking in.

Doulas support single parents and couples. We help people with supportive families and people with no family. Our patients are PhDs and people without diplomas. Birth doesn’t discriminate in its intensity, its unpredictability, or its vulnerability.

Different kinds of doulas

There are several types of doulas.

Fertility doulas help families on the journey to parenthood, while birth and postpartum doulas specialize in support during pregnancy, birth, and after delivery, including lactation. Abortion doulas provide support before and after pregnancy termination and after miscarriage.

Despite what TikTok or social media might suggest, most doulas aren’t anti-medicine, anti-hospital, or anti-intervention. Quite the contrary: We work alongside nurses, midwives, and physicians.

And we recognize that some birthing people require complex or high-intervention medical care. For instance, someone with a heart condition may require early epidural anesthesia to prevent further heart strain caused by an increase in heart rate. Furthermore, they may also require an assisted delivery with forceps or a vacuum for the same reason.

We support thoughtful, collaborative decision-making that allows them to feel both safe and autonomous throughout pregnancy, birth, and postpartum. Still, many people carry trauma from previous birth experiences, especially in medical settings where they felt powerless or dismissed. Some communities are impacted by unsavory historical events, which have led to well-earned mistrust in the medical system.

Many doulas, too, carry similar burdens. Our profession is burdened by outdated stereotypes, and we know some doctors see us as combative, overly emotional, or unnecessary. We manage these challenges while supporting clients who are often dealing with their own layers of judgment and racial bias.

Offsetting this racial bias is especially critical in places like the Deep South, where I am in medical school. In states like Alabama, the maternal mortality rate is among the country’s highest. Black birthing people experience significantly worse maternal and infant outcomes than their white counterparts. This is true regardless of income or education; it reflects entrenched racism in the medical system, in access to care, and in how people are treated by providers.

Doulas make birth safer

Research from Evidence Based Birth, an organization working to help people make informed decisions about birth, shows that continuous labor support from doulas is associated with a 39 percent decrease in cesarean-section births, a 15 percent increase in spontaneous vaginal births, and a 10 percent decrease in the use of pain medication.

Having a doula present can also shorten labor by an average of 41 minutes and decrease birth dissatisfaction by 31 percent.

Culturally competent doula support, especially for Black and Hispanic and Latinx birthing people, can play a critical role in reducing disparities, such as pre-term and low-birth weight births, as well as maternal mortality. Yet doula care remains out of reach for many of the people who need it most. About half of states require Medicaid to cover doula care. Rhode Island and Louisiana are the only states that require both Medicaid and private insurance plans to cover doula services.

That’s why New York City in 2022 started the Citywide Doula Initiative (CDI), a pilot to provide free doula care in historically underserved communities, in an effort to increase doula access and utilization in neighborhoods, including the Bronx, the borough with the worst maternal mortality.

Initial results show CDI doulas attended 884 births in 2024, and doula support among NYC residents increased from 4.9 percent in 2022 to 6.1 percent in 2024. Of the people who reported having a doula in the Bronx, only 83 percent reported receiving that support during childbirth—which highlights the ongoing disparities the community faces.

We know doula care works. It may even save money and improve birth outcomes by reducing costly preterm and cesarean births.

We know that expecting parents deserve more than a hospital room and a rotating set of staff. We believe they deserve someone who learns your story, your fears, your values, and your joys. Birth should be safe, but it can be so much more than that. It needs to be supported, honored, and equitable.

That’s what doulas do.

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