Outlook: Newsletter of the Society of Behavorial Medicine

Summer 2026

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Doulas and Behavioral Medicine: Supporting Health Across the Perinatal Period

Cara Green; Tisha Fielder; Rhonda Dailey, MD; Natalie Papini, PhD; Kris Zimmermann, PhD, MPH - Women's Health SIG

For the past nine decades, the maternal mortality rate for Black birthing people has exceeded the rate for White, non-Hispanic individuals by as much as threefold.1-2 Black birthing people have long been subjected to mistreatment in labor and delivery, with many clinicians downplaying and dismissing their preferences and concerns. Racism, discriminatory practices, and stress are among the myriad factors contributing to longstanding racial disparities in perinatal outcomes. Black birthing people also experience poorer maternity care, higher rates of postpartum depression, and greater systemic barriers to breastfeeding compared to other racial groups.3-5

A promising approach to help address perinatal inequities is to expand access to doula care. According to DONA International (formerly Doulas of North America), a doula is a professionally trained, nonclinical caregiver who provides continuous emotional, physical, and informational support before, during, and after childbirth to facilitate a healthy and positive experience.6 Doula care is associated with reduced risk of preterm birth; lower odds of low birth weight, cesarean birth, and postpartum depression and anxiety; increased odds of vaginal births after cesarean; higher breastfeeding initiation rates;7-10 and improved communication and feelings of being heard during birth.11

Although the use of the term “doula” is relatively recent, the practice of women supporting other women through pregnancy, labor, birth, breastfeeding, and postpartum recovery has deep historical roots.12-13 Doula care is thus not a new approach but rather a re-centering of long-standing traditions of community-based birth support that may be particularly beneficial to Black mothers navigating biased maternal health systems. In Black communities, this history is closely tied to enslaved African women and later Black “granny midwives”, who provided skilled birth care, emotional support, spiritual guidance, and practical assistance when Black women were excluded from hospitals and formal medical systems.14 These midwives were trusted community birth workers and often served in roles that today may be divided among midwives, doulas, lactation support, and community health workers.

Modern use of the term “doula” began in 1973 by medical anthropologist Dana Raphael to describe supportive companions in pregnancy and childbirth. Doula care arose in response to the medicalization of childbirth in the early to mid-twentieth century, when deliveries increasingly occurred in hospitals rather than at home, and physicians replaced midwives.12-13 In response, research demonstrating the positive outcomes associated with doula care, along with the U.S. women’s movement of the 1970s, contributed to the growth of doulas supporting hospital deliveries, though primarily for those who could afford private services. 

However, for Black women, the medicalization of childbirth was also shaped by racism, sexism, classism, and the devaluation of Black women’s birth knowledge. Doula care for Black birthing people has been revived through community-based doulas, as part of the Black maternal health and the birth justice movement. 

Today, doulas provide support during pregnancy, labor, childbirth, and the immediate postpartum period, and their roles have expanded to include pre-pregnancy, postpartum, full-spectrum, and community-based care (Table 1).6  Despite the evidence, barriers to integrating doulas into the medical model persist, often due to insurance and financial barriers and mistrust between clinicians and doulas.15-17 

There are several things you can do to support doula care in your local community and beyond: 

  • Advocate for Medicaid coverage for doulas in your state. As of June of 2026, 24 states lacked Medicaid coverage for doula services.18 If your state does not cover doula services, contact your representatives. To check doula coverage in your state, visit: https://nashp.org/state-tracker/state-medicaid-approaches-to-doula-service-benefits/
  • Educate others about the benefits of doula care. Post on social media to educate the public on how doulas support perinatal care. DONA International and the International Childbirth Education Association (ICEA) are reputable organizations to follow online and share content. 
  • Advocate for respectful, person-centered care for all birthing people. Listen to and uplift birthing experiences, especially those from historically marginalized communities. Respectful care includes honoring individuals’ autonomy, cultural values, informed choices, and right to feel safe, heard, and supported.

Table 1. Types of doulas providing care in the perinatal period

Term Role
Birth Doula Provides support during the prenatal period, labor and delivery, and the immediate postpartum period to ensure a safe and empowering childbirth experience. Birth doulas work alongside clinical providers to advocate for their clients.
Postpartum Doula Provides physical, emotional, informational, and advocacy support to postpartum clients, their partners, and their infants, emphasizing physical and emotional healing and adjustment to life with a new baby.
Full-spectrum Doula  Provides support for a range of experiences related to reproductive health, including fertility, abortion, and loss.
Community-based Doula Practices within their community to provide culturally concordant care to birthing individuals who are at risk for poor outcomes.

Table 2. Doula Policy and Program Examples

Doula Initiative Description
Medicaid Coverage of Doulas (MPP22-47)19 Michigan established the Medicaid Coverage of Doulas initiative in January 2023, which covers community-based, prenatal, labor and birth, and postpartum doulas. A recommendation for doula service must come from a licensed healthcare provider (e.g., licensed practice nurse, registered nurse, social worker, midwife, nurse practitioner, physician assistant, certified midwife, or physician). Birthing individuals can receive up to 12 prenatal and postpartum visits plus unlimited labor and delivery support. Qualified doulas must have completed doula training approved by the Michigan Department of Health and Human Services. 
Flagstaff Birth Support Fund20 The Flagstaff Birth Support Fund (FBSF) is a 501(c)(3) nonprofit that partners with a for-profit doula organization to offset the cost of doula care and provide low-income and underserved families in Northern Arizona with access to professional birth and postpartum doula care, childbirth education, and early parenting support. Founder Kristen Pearson created FBSF to increase access to doula care for all birthing people, regardless of household income and socioeconomic status. Individuals insured by AHCCCS (Arizona Health Care Cost Containment System) automatically qualify for FBSF, and those not on AHCCCS but experiencing financial burdens can apply for doula services. Through FBSF, clients receive two prenatal visits with a birth doula, unlimited labor support, and one postpartum home visit. Clients receiving a postpartum doula get 18 hours of in-home doula support to ease the transition into parenthood. Over five years, FBSF has served 75+ families who otherwise could not access doula care. 

References:

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  19. Michigan Department of Health and Human Services. Michigan Medicaid Policy Bulletin MMP 22-47. December 1, 2022. Accessed May 25, 2026. https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Assistance-Programs/Medicaid-BPHASA/2022-Bulletins/Final-Bulletin-MMP-22-47-Doula.pdf?rev=b6f3efcea2d641c2bb0075a901257a8f&hash=2BAC687869B918F0C0D3E7D470EDAABF 
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