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; I breathed with intention on each contraction and performed hip contractions throughout the night, when it was finally time to help her turn 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 twinge of pain that she didn’t do it alone.
Our relationship had been growing for months. We first met during her second trimester at a coffee shop. We talked about her past birth experiences, what she expected from 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 felt more uncomfortable due to the “growing pains” of pregnancy. My client’s partner and I explored how he could support her in this phase by helping with stretches and using a stretching exercise 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 was communicating her preferences to her care team if she couldn’t, making sure her favorite music was playing, or pushing her hips with me.
Like any pregnant person, she would continue to have unique and specific needs even after giving birth. Together we created a postpartum plan that included who would visit, how she would rest, and even who would make dinner while she recovered.
In my opinion, a doula is an essential piece of the reproductive healthcare puzzle in a time when labor and delivery units are closing nationwide. This is especially true in places like my rural hometown Alabamawhere historically marginalized communities live and access to care is limited. Doulas step in to provide culturally responsive support, a gap that many physicians cannot fill. Yet many people do not fully understand what we do.
What does a doula do?
The work of Doulas is often misunderstood. Some people think of us as luxury add-ons or “birth hippies,” fringe figures in the field of labor and delivery. Alternatively, we are often mistaken for midwives, who provide clinical care in addition to providing emotional and physical support.
Our role is different: Doulas traditionally provide emotional, physical and informational support during pregnancy and up to three months after delivery. Some doulas provide support for up to a year after birth. We are trained professionals who provide continuous, personal support. Our role is to walk with birthing people through one of life’s most vulnerable transitions, providing 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 a gynecologist, my medical training has only increased my understanding and appreciation for the unique care doulas provide to patients.
The word “doula” means “female servant” and is of Greek origin. They provide support during pregnancy, birth and postpartum and almost always work together with doctors or midwives. Many states have no mandatory training or certification requirements and doulas are not licensed. But many doulas choose to undergo hours of professional training provided by a doula training organization. This training is then followed by the opportunity to become certified, which involves lectures, exams and continuing education.
Doulas meet pregnant people where they are. This might include discussing past traumas that may impact their work experience, role-playing how to set boundaries with their family, or talking about fears about pain, control, or judgment. We investigate how a parent wants to feel in the birthing room, in general in a hospital, birth center or at home. We write into their birth plan the elements that would make them feel most comfortable, whether that is soft music, quiet encouragement or dimmed lights and warmth.
I can guide a client during childbirth Spinning Babies Techniques–gentle movements and positions to help the baby reach 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 become overwhelming.
After birth, I help people recognize signs of postpartum depression, discuss feeding options for babies, and make practical plans for daily life: who does the laundry, who cooks dinner, who checks in.
Doulas support single parents and couples. We help people with supportive families and those without. Our patients are PhD students and people without a diploma. Birth makes no distinction in intensity, unpredictability or vulnerability.
Different types of doulas
There are different types of doulas.
Fertility doulas help families navigate the path to parenthood, while birth and postpartum doulas specialize in support during pregnancy, birth and postpartum, including breastfeeding. Abortion doulas provide support before and after termination of pregnancy and after a miscarriage.
Despite what TikTok or social media might suggest that most doulas are not anti-drug, anti-hospital, or anti-intervention. On the contrary: we work together with nurses, midwives and doctors.
And we recognize that some people in labor require complex medical care or intensive medical care. For example, someone with heart disease may need early epidural anesthesia to prevent further strain on the heart due to an increase in heart rate. Additionally, they may also require assisted delivery with forceps or a vacuum for the same reason.
We support thoughtful, shared decision-making that helps them feel both safe and autonomous during pregnancy, birth and postpartum. Yet many people carry trauma from previous birth experiences, especially in medical settings where they felt powerless or rejected. Some communities are affected by unsavory historical events, which have led to a well-deserved distrust in the medical system.
Many doulas also carry similar burdens. Our profession suffers from outdated stereotypes, and we know that some physicians view us as combative, overly emotional, or unnecessary. We manage these challenges while supporting clients who often face self-judgment and racial bias.
Offsetting these racial biases is especially critical in places like the Deep South, where I study medicine. In states like Alabama, the The maternal mortality rate is among the highest in the country. Black birthers experience significantly worse maternal and child outcomes than their white counterparts. This is true regardless of income or education; it reflects deep-seated racism in the medical system, in access to care, and in the way people are treated by healthcare providers.
Doulas make childbirth safer
Research of Evidence-based birthan organization that helps people make informed decisions about childbirth shows that continued labor support from doulas is associated with a 39 percent decrease in the number of births by cesarean section, a 15 percent increase in the number of spontaneous vaginal births, and a 10 percent decrease in the use of pain medication.
Having a doula can also shorten labor by an average of 41 minutes and reduce birth dissatisfaction by 31 percent.
Culturally competent doula support, especially for Black, Latinx, and Latinx birthing people, can play a critical role reducing the differencessuch as premature and low birth weight births, and maternal mortality. Yet doula care remains out of reach for many people who need it most. About half the 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 started in 2022 with the Citywide Doula Initiative (CDI), a pilot to provide free doula care in historically underserved communities, in an effort to increase doula access and use in neighborhoods including the Bronx, the municipality with the highest maternal mortality.
Early results show that CDI doulas attended 884 births in 2024, and that doula support among New York residents increased from 4.9 percent in 2022 to 6.1 percent in 2024. Of those who reported having a doula in the Bronx, only 83 percent reported receiving that support during labor – highlighting the persistent disparities facing the community.
We know that doula care works. It can even save money And improve birth outcomes by reducing expensive premature births and caesarean sections.
We know that expectant parents deserve more than a hospital room and rotating staff. We believe they deserve someone who gets to know your story, your fears, your values and your joy. A birth should be safe, but it can be so much more than that. It must be supported, honored and justified.
That’s what doulas do.
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