Before the 1930s, most births took place at home, where pregnant individuals were supported by friends, family, and often a skilled midwife or doula. [1] The term “doula” has evolved significantly within modern reproductive health care. It originates from the Greek word doulē, meaning “female servant,” but today, doulas play a far more complex role than what that definition implies. [2] As we understand their role now, doulas provide emotional support, comfort, guidance, and safety to the people they serve. The definition of a doula has also expanded beyond childbirth to encompass support for abortion, miscarriage, adoption, end-of-life care, gender affirming care, and other major medical events. Fundamentally, a doula is a guide – someone who exists outside the traditional medical system and can act as a companion, advocate, or both for those going through significant life events. 

In modern times, the role of the doula has regained significance, largely in response to the increased medicalization of birth and reproductive health care. Where childbirth was once guided by skilled women with deep-rooted cultural knowledge, the field of obstetrics has become heavily medicalized and predominantly male-dominated. This shift has led to a rise in unnecessary C-sections, a lack of emotional support, and, in some cases, forced sterilizations without the consent of the pregnant individual. [3] In western medicine, the transition from home births to hospital settings occurred between the late 19th and 20th centuries. Medical practices, introduced primarily by men, often failed to prioritize or fully understand the needs of pregnant individuals, reframing birth from a natural, community-involved process into a clinical medical condition. [4] The shift to hospital births also moved the primary support from community, family, and friends to medical staff, who were not required to offer the same emotional, cultural, or holistic support that had previously been central to the birthing experience. [4] As a result, childbirth has become more impersonal, isolating, and at times, alienating for many. Historically, doulas have served as a crucial bridge, connecting medical care with the supportive role of the community.  

Doulas experienced a resurgence in popularity during the 1970s, driven in part by the home birth movement, which raised concerns about childbirth safety. This, along with a growing demand for emotional support, led many pregnant individuals to seek out doulas, contributing to their widespread recognition in the 1980s. [1] In 1992, the organization Doulas of North America was founded, becoming the first organization to train and certify doulas. [1] Research has shown that doula-assisted births offer numerous benefits, including lower rates of interventions (such as cesarean sections and undesired epidurals), shorter labor durations, higher maternal satisfaction, and improved health outcomes for both the birthing person and child. [5] Unlike health care professionals, who often divide their attention among multiple patients, doulas are able to provide continuous, focused support to the individual in their care. 

Disparities in birth outcomes have also fueled the growing popularity of doulas, particularly due to issues of medical mistrust and maternal mortality. Communities of color, especially Black, Indigenous, and Latina mothers, are disproportionately affected by these disparities. They report more delays in care, communication gaps, shorter interactions with providers, and longer wait times compared to white patients. [6] Medical racism plays a significant role in maternal care, leading to dismissive attitudes, inadequate pain management, and preventable complications for people of color. [7] Latina and Black women, in particular, face discrimination rooted in racial bias and socioeconomic factors, which become more pronounced when they are on Medicaid. This discrimination frequently results in medical staff minimizing their pain or offering fewer options for pain relief, leading to substandard care and higher health risks. [8] Medicaid coverage is linked to higher reports of racial or ethnic discrimination in health care; people who have government assisted insurance programs are more likely to report discrimination based on insurance type. [9] They also experience increased mistreatment including ignored pleas for assistance, being reprimanded, unprotected physical privacy, and threats of withheld treatment. [10] Consequently, Black women are four times more likely to die in childbirth than their white counterparts and Latina women are two times as likely to die in childbirth than their white counterparts. [11]   

Doulas play a crucial role beyond childbirth, particularly in supporting individuals through abortion and miscarriage. In the context of abortion, doulas can be invaluable, especially in clinical settings where individuals’ supporting people are often not allowed in the procedure room. Although an in-clinic abortion is a relatively brief procedure typically lasting 15 minutes, a doula’s presence can provide essential support, ensuring the patient feels heard and respected during what can be an isolating and overwhelming experience. Doulas are also instrumental in assisting those self-managing their abortion at home, offering guidance on proper protocols and support strategies throughout the process. Through empathy and dedicated care, doulas empower clients, helping them feel understood and supported during some of life’s most challenging transitions. [12] 

Despite their generally positive impact, doulas face challenges within the medical and legal systems. In some areas, doulas struggle to integrate into hospital settings, and there are often financial barriers to accessing their care. While many volunteer and sliding-scale doula programs exist, those that charge for their services are frequently ineligible for insurance reimbursement, making them inaccessible to low-income individuals and marginalized communities. Additionally, some hospitals restrict the presence or limit the role of doulas in the delivery room, especially during emergencies or high-intervention procedures, which can diminish a doula’s ability to advocate for the birthing person. Doulas also encounter legal limitations, as their advocacy for clients can sometimes conflict with hospital policies or physician preferences. [13] 

Doulas are a testament to the power of compassionate, community-based care in a health care system that can often feel impersonal and inaccessible. Their resurgence is not only a reaction to the medicalization of childbirth and reproductive health care but also a response to the very real disparities that continue to impact marginalized communities. As doulas reclaim and reshape their role in reproductive health, they challenge the limitations of the traditional medical model by centering empathy, support, and patient autonomy. Despite the barriers they face within the medical and legal systems, doulas remain a crucial bridge, connecting modern medicine with the holistic, culturally rooted practices that have always been at the heart of supporting life’s most transformative moments. The growing recognition of their value underscores a broader shift toward more equitable, patient-centered care, one that honors both the medical and emotional needs of all individuals. Empowering doulas, supporting their integration into healthcare, and ensuring their services are accessible to all who need them will be critical steps in creating a more just and compassionate reproductive justice landscape. 

Sources: 

1. https://nmaahc.si.edu/explore/stories/historical-significance-doulas-and-midwives 
2. https://www.motherhoodcenter.com/history-of-doula-care/ 
3. https://www.npr.org/2024/05/28/nx-s1-4977627/rachel-somerstein-invisible-labor-c-section 
4. https://www.sciencedirect.com/science/article/abs/pii/S187151921000065X 
5. https://fourthtrimesterpodcast.com/birth/if-you-dont-have-a-doula/ 
6. https://www.liebertpub.com/doi/10.1089/heq.2021.0033 
7. https://everymothercounts.org/wp-content/uploads/2020/07/everymother-print-2.pdf 
8. https://www.sciencedirect.com/science/article/pii/S0884217524002624 
9. https://www.jabfm.org/content/33/4/580#sec-11 
10. https://www.cdc.gov/vitalsigns/respectful-maternity-care/index.html 
11. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.htm 
12. https://www.plannedparenthood.org/blog/7-different-types-of-doulas-and-what-they-do 
13. https://link.springer.com/article/10.1007/s12116-024-09431-5