Doulas Are Essential: The Non-Clinical Birth Professionals Who Improve Outcomes, Reduce Trauma, and Address Disparities
In today’s maternal health landscape, birth doulas are often misunderstood, undervalued, and miscategorized. Though we are not clinical providers, our presence during pregnancy, birth, and postpartum measurably improves health outcomes, enhances safety, and reduces cost and trauma. And yet, in a healthcare system that prioritizes credentials rooted in Western clinical training, doulas are too often seen as peripheral—even when we’re central to safe, supported, physiologic birth.
As doulas, we work from a different—but equally critical—framework. We are trained, experienced, and professional. We are not medical staff—but we are essential support providers, and our impact is backed by science, public health data, and decades of client experience.
This article is a comprehensive guide to what doulas do, why our work matters, and why insurance companies and health systems should be advocating for—not questioning or limiting—doula care.
What Birth Doulas Actually Do
Birth doulas are non-clinical professionals who provide continuous, holistic support during pregnancy, labor, and the early postpartum period. Our work includes:
Emotional support: We help clients feel calm, safe, and empowered—before, during, and after birth.
Physical support: We offer hands-on comfort measures—counterpressure, massage, positioning, breath work, and movement.
Informational support: We explain procedures, help clients explore their options, and promote informed consent.
Partner support: We guide partners to support effectively, reducing their stress and strengthening family bonds.
Creating a safe, grounded environment: Doulas hold emotional and energetic space in the birth room, which allows the birthing body to labor more easily and physiologically.
We do not perform any clinical tasks. We do not check dilation, administer medications, monitor fetal heart tones, or make medical decisions. That is the work of nurses, midwives, and doctors. Our work is fundamentally different, and that’s the point.
Why Physiologic Birth Requires Emotional Safety
Birth is governed not just by mechanics, but by hormones—especially oxytocin, which drives contractions, and endorphins, which ease pain. These hormones are released only in states of safety and calm. When a birthing person feels afraid, unseen, or unsafe, the body produces adrenaline, which slows or stalls labor—a phenomenon known as “failure to progress.”
What happens next is well-documented: a cascade of interventions—Pitocin, epidurals, cesareans—that often lead to trauma, longer recovery, and higher costs. While interventions can be lifesaving, their routine use often reflects a system that doesn’t support physiologic labor.
Doulas help protect the natural hormonal flow of labor by offering continuous presence, calming support, and emotional safety—something no one else in the room is trained or resourced to do.
The Evidence: Doulas Improve Outcomes
The data on doula support is extensive. A 2017 Cochrane Review—one of the gold standards in health research—analyzed over 15,000 people across 26 randomized trials and found that continuous labor support, especially from a trained doula, resulted in:
39% lower risk of cesarean
15% more likely to have a spontaneous vaginal birth
10% reduction in use of pain medications
Shorter labors by 41 minutes
38% lower risk of a baby with a low 5-minute Apgar score
31% decrease in dissatisfaction with the birth experience
These numbers are too large to ignore. They demonstrate that doula care prevents complications, increases satisfaction, and shortens recovery time—while saving health systems thousands of dollars per birth.
A single avoided cesarean can save insurers $5,000 to $10,000. Multiply that across hundreds of births, and the value of doula care becomes irrefutable.
Doulas and Trauma Prevention
Birth trauma is real. Up to 45% of birthing people describe their births as traumatic. This trauma is linked to:
Postpartum depression and anxiety
PTSD
Breastfeeding complications
Challenges bonding with the baby
Avoidance of future pregnancies
Doulas help prevent trauma by:
Supporting informed consent
Mitigating fear, confusion, and overwhelm
Helping clients feel heard and respected
Offering continuity and reassurance in an often chaotic hospital system
This trauma-informed approach is not a luxury—it’s a public health intervention.
Addressing Racism in Maternity Care: The Role of Doulas
The maternal health crisis in the U.S. is deeply shaped by systemic racism.
Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women.
Black and Indigenous infants are significantly more likely to die before their first birthday.
These outcomes persist across income and education levels—meaning they are not due to individual behavior, but to institutional racism and medical bias.
Doulas, especially doulas of color, help disrupt this pattern.
We:
Advocate for clients in real time
Help ensure consent is informed and respected
Recognize and respond to cultural and systemic factors
Offer support that is culturally competent and grounded in lived experience
Community-based doula models led by and for Black, Indigenous, and other communities of color have been shown to reduce:
Preterm birth
Low birth weight
Cesarean deliveries
Postpartum depression
“The presence of a culturally competent doula can mean the difference between life and death for many birthing people navigating a biased system.”
— Black Mamas Matter Alliance
Doulas Are Non-Clinical Professionals—And That Is a Strength
In our healthcare system, there is a tendency to value only those with clinical credentials—doctors, nurses, midwives. But this mindset overlooks a truth that birthing families know deeply:
Not all essential care is clinical.
Doulas are trained professionals who bring an entirely different skill set:
Physiologic birth knowledge
Trauma-informed support
Cultural humility and equity-focused advocacy
Partner coaching
Nervous system regulation and emotional grounding
Most doulas train for years, take continuing education, and build expertise through mentorship and practice. We often face steep barriers just to be allowed in birth spaces—spaces where our presence is proven to make birth safer.
We deserve to be seen as equals in the birth team, not because we do what doctors and nurses do—but because we do what they can’t.
Why Insurance Companies Should Cover Doula Care
Covering doula care is not just a feel-good decision—it’s fiscally smart and evidence-driven.
When doulas are integrated into care teams:
Cesarean rates drop
Intervention use decreases
Birth satisfaction increases
Maternal mental health improves
Racial disparities shrink
Overall costs go down
Several states (like Minnesota, Colorado, Oregon, and New York) already offer Medicaid reimbursement for doulas—and results show better outcomes at lower cost.
Private insurers should follow their lead. Denying doula coverage is denying a proven, preventative, cost-saving service that could help solve the maternal health crisis.
Final Thoughts
Doulas are not medical providers—and that is exactly why we are essential. We work outside the clinical model to hold space for what it can’t always reach: safety, trust, emotional regulation, advocacy, physiologic birth, and trauma prevention.
We are not nurses. We are not doctors.
We are doulas.
And birth is safer, stronger, and more sacred when we are in the room.
References
Bohren, M. A., et al. (2017). Continuous Support for Women During Childbirth. Cochrane Database of Systematic Reviews.
Kozhimannil, K. B., et al. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health.
Gruber, K. J., et al. (2013). Impact of Doulas on Healthy Birth Outcomes. Journal of Perinatal Education.
Black Mamas Matter Alliance. (2020). Advancing Holistic Maternal Care for Black Women Through Policy.
Dekker, R. (2022). Evidence on Doulas. Evidence Based Birth®.
Strauss, N., Giessler, K., & McAllister, E. (2015). Doulas and Medicaid: Integrating Non-Medical Support into Maternal Care. Journal of Law, Medicine & Ethics.
Taylor, J. (2021). Structural Racism and Maternal Health Disparities: A Human Rights Analysis. Georgetown Law Journal.
