Once considered a luxury available only to those who could afford it, doula care is becoming increasingly mainstream in the United States. Doulas provide physical and emotional support before, during, and after birth, complementing the work of doctors and nurses. With insurance coverage expanding rapidly, parents from all economic backgrounds can now access these services.
More than 30 states now reimburse doulas through Medicaid or are in the process of doing so, up from 14 in late 2022, according to the National Health Law Program. Private insurers are following suit, with UnitedHealthcare launching a new benefit this year. Without insurance, costs can exceed $2,000, but mounting research shows doulas can significantly improve maternal and infant health outcomes, particularly for Black mothers, who die at a rate more than three times higher than white women.
Shanille Bowens, a doula and founder of Naturally Nurtured Birth Services in Memphis, Tennessee, helps clients navigate the health system and advocates for them. One client, Shaquoiya Stewart, a 35-year-old single mother of four, credits Bowens with guiding her through a high-risk pregnancy with twins, including blood pressure issues, a C-section, and postpartum baby blues. “I felt safe. It didn’t feel like I was just by myself,” Stewart said.
Research supports the benefits. A study comparing socially disadvantaged mothers found those with doulas were four times less likely to have a low-birth-weight baby and two times less likely to have birth complications. Another study showed Medicaid recipients with doulas had a 47% lower risk of C-sections and a 29% lower risk of preterm birth. “The return on investment is huge,” said Sierra Hill, maternal care access coordinator for Minnesota’s health department, which expanded doula coverage in 2024.
Despite the growth, doulas are not mandatory licensed, though states set qualification standards for Medicaid reimbursement. Pilot programmes, like one in Memphis involving UnitedHealthcare, are offering free doula services to members. As doula care becomes more accessible, experts believe it can help reduce maternal mortality and address health disparities.
