Doulas are non-medically trained professionals who provide health education, advocacy, and physical and emotional support for pregnant and postpartum people before, during, and after childbirth. A critical part of the maternity care workforce, doulas are not licensed as clinical providers and do not deliver babies. Nevertheless, the inclusion of doulas on labor and delivery teams is strongly correlated with positive health outcomes, especially for Black birthing people.
“Next birth, I would love to have a doula and be better prepared mentally.“
— Listening to Mothers in California survey (2018) respondent
Empowering Birthing People and Improving Perinatal Outcomes
Research suggests doula care is associated with lower rates of c-sections, birth complications, and preterm births, as well as higher patient satisfaction and rates of breastfeeding. Because doulas center the needs and voices of their clients, doulas can be especially beneficial for birthing people of color, who face the greatest inequities in birthing outcomes.
- Medi-Cal coverage for doulas. In 2023, California’s Medi-Cal program began paying for doula services for the first time, opening the door for doula-attended births and related services for Medi-Cal enrollees. Because Medi-Cal covers 40% of California births, this represents a significant opportunity to advance birth equity.
- An expanding doula workforce. Today, nearly 250 doulas provide support for Medi-Cal enrollees giving birth across the state.
- Tracking doula-attended births. Doulas attended 11% of Medi-Cal births in 2018 and 8% of births covered by private insurance. These numbers climb to 15% of total births for Black mothers.
Californians Are Increasingly Interested in Doula Care
Studies show growing appreciation among mothers for care provided by doulas:
- 57% of women overall express interest in having doula support in a future birth, including 18% who “definitely” want a doula and 39% who would consider it.
- 66% of Black women prefer doula care — the highest rate of any racial/ethnic group — including 27% who say they would “definitely” want doula support for their next birth.
Policy Considerations: What Can State Leaders Do to Continue Expanding Access to Doulas?
- Promote expanded insurance coverage for doula care. Most insurance plans do not cover doulas, which is a major obstacle to birth equity.
- Raise awareness about the doula workforce. As evidence of the positive impact doulas can have on maternity care grows, more information is needed on how to attract people to this workforce and offer adequate compensation.
- Expand training opportunities through doula hubs. Support is also needed to expand doula hubs, which are centralized repositories of resources and training tools that are critical for helping doulas enroll to become Medi-Cal providers.
To learn more:
- DHCS: Doula Services as a Medi-Cal Benefit
- National Health Law Program: California Doula Workforce Analysis 2024 (PDF)
- The CHCF Blog: More Doulas Are Needed in California’s Health Workforce
- CHCF: Listening to Mothers in California survey (2018)
