by Liliana Watkins and Sophia Gonzalez
From the author
The following paper and website provide insight into the history of doulas, the roles they play in reproductive care, and their usage of social justice frameworks and advocacy models help mediate failings of the medical-industrial system. Through interviews with practicing doulas and OB/GYNs, as well as resource maps by state, we examine the modern role of doulas in healthcare.
The term doula is derived from the ancient Greek word doulē, which translates to ‘female slave.’ This word was first adopted by Dana Raphael in the 1960s, who used it to describe women that provide postpartum support for their communities, including mothers, sisters, grandparents, healers, and midwives. The meaning of this word has evolved over time, and, in many ways, so has the role of the doula. Regardless, the primary purpose of the doula, that being to provide maternal support, has persisted. The following paper provides insight into the history of doulas, the roles they play in modern reproductive care, and their usage of social justice frameworks and advocacy models help to bridge the gaps in modern medical care. Through an analysis of patient narratives and interviews with practicing doulas, we aim to challenge the stigmas present in the medical system that undermine the historical and present role of doulas in health care.
In order to understand the integral role doulas play in modern reproductive care, their historical significance must be acknowledged: modern doula practices emerged from the birth work historically provided by Black and Indigenous women within their communities. In seventeenth century United States, enslaved women cared for others lacking access to privileged care. These birth workers were often viewed as spiritual community healers, and provided pre-, intra-, and post-partum technical support, and also played key roles in the maintenance of birthing records.
After emancipation in the nineteenth century, most doctors refused to provide care for Black patients, so Black women continued to seek support from doulas. However, simultaneously, the gynecological practices that would later become “modern” reproductive medicine were being developed through experimentation on enslaved women. This torture, by men like Dr. Marion Sims, formed birthing and reproductive health practices that consolidated medical authority to male doctors. With these, birthwork was no longer communal, nor focused on the wellbeing of the mothers.
Around the turn of the 20th century, the rise of biomedicine marked the United States’ rejection of traditional, symptom-based care. Western society quickly deemed these experimental, “scientific” practices the most objective and valid form of medical care. White, male physicians seized control of women’s bodies and medical autonomy, and, in doing so, trumped the traditional community care that was built by Black and indigenous doulas and midwives. The shift was drastic. In the year 1990, approximately fifty-percent of births were attended by midwives or doulas, largely in African American and immigrant communities. By 1930, these “alternative” care practitioners were only present at fifteen percent of births. Officials blamed Black doulas’ supposedly “nonscientific” methods for undesired pregnancy outcomes, and used legislation and public health campaigns to limit their practices. Community-informed medical care, especially the work of doulas, was branded as dirty and unscientific so that a male-dominated biomedicine could appear modern, scientifically-backed, and natural. Soon enough, biomedicine became hegemonic, and the white coat became a symbol of Western biomedical superiority. As such, all other care workers were marginalized— especially doulas.
With this widespread shift in attitude, alongside restrictive, state-controlled abortion legislation, came a shift in the services doulas provided. Instead of solely helping birthing patients, doulas began helping patients seeking abortion services. One example of their impact is the work of The Jane Collective, an underground abortion network that emerged out of Chicago in the nineteen sixties. This network sought to provide medical care for women seeking to terminate their pregnancies. The collective started when a nineteen-year old University of Chicago student helped her sister’s friend find a doctor who was willing to perform an abortion. Growing patient demand drove members of the collective to begin performing abortions alongside formally-trained doctors. Then came an influx of doulas, who provided critical technical and emotional support. Lauren Mitchell and Mary Mahoney, the authors of The Doulas: Radical Care for Pregnant People, write: “What we were most struck by…was how much support and care was exchanged between the members of Jane and their clients who had little to no anesthesia to offset the pain.” This, again, emphasizes the importance of whole-person, educational and emotional support through medical experiences. Doulas provide exactly that.
Nearly two decades later, in 1994, came the Reproductive Justice (RJ) movement. Pioneered by twelve Black women of color, RJ advocates sought to redefine reproductive care, and recognized the failings of previous abortion-advocacy efforts that served primarily middle-class white women. Bridging and redefining existing feminist work, RJ advocated for reformation of all care, evaluating clinical, legislative, and institutional practices through a lens of social justice. Regarding childbirth and reproductive care;
- “The reproductive justice movement promotes the idea that, in a lifetime, a person might experience the full spectrum of reproductive health decisions, that these decisions are linked to other intersecting factors in their life, and that any decision made should be respected and protected.” Mahoney, M., & Mitchell, L. (2016).
Due to their role as community-responders, as well as medical advocates, doulas are uniquely positioned to facilitate this work. Though doulas are most recognized for their role in childbirth, their modern practice spans a much wider range of pregnancy outcomes and medical experiences. Later in The Doulas, Mahoney and Mitchell describe full-spectrum doulas who provide emotional and technical support across pregnancy, birth, adoption, abortion, and death. Their doula care model strongly reflects reproductive justice principles:
- “Racism can distort a birthing or adoption experience. Transphobia can lead to the denial of vital healthcare. Prejudice against immigrants can divide families through deportation. Misogyny can reduce pregnant women to walking wombs without rights. These are all reproductive justice issues, and doulas are the birth justice wing of our movement. Doulas understand the unique nature of each person’s situation. At the same time, they comprehend the systemic factors that affect these experiences, such as race, age, English proficiency, citizenship, gender identity, class, and the host of integrative—not additive— forces that contour pregnancy experiences. They don’t shy away from naming oppressions—white supremacy, colonialism, xenophobia, homophobia, transphobia— yet they are not there to preach, but to serve. Their actions to support each and every pregnant person speak louder than any polemic on reproductive oppression or the medical industrial complex.” Mahoney, M., & Mitchell, L. (2016).
By these tenets, doulas are able to help patients reclaim autonomy denied by cold, sometimes dehumanizing medical practices. Moreover, through education, comfort, and advocacy, they are uniquely positioned to support every individual’s reproductive experience in the context of the social conditions that shape it.
One community doula organization that works to address racial inequities is Chicago Birthworks Collective (CBC). CBC connects BIPOC families with doulas from the community who support and advocate for them during pregnancy, birth and postpartum. CBC was founded by Tayo Mbande and her mother, Toni Taylor. Tayo had her first child soon after graduating from college, and then her second child two years later. Both of her pregnancy and birth experiences were positive; she says: “things had gone much better for me than a lot of people who were older than me, had a greater socioeconomic status than I did, had been married longer than me.” Despite the fact that Tayo did not work with a certified doula, she remarks: “My mom played the role of doula. Everyone needs one of these. She answered all my questions. She was physically there for me. She labored with me during both labors. And so when it all started to connect for me that I had a doula twice, I was like, yeah, every person deserves one of these.” It was then that Tayo realized the importance of having a community member who can support you, advocate for you, and aid you. Tayo continued:
- “People need to understand that doulas are not an inaccessible commodity. They are people who belong to the community. Doulas are people who are from a community who have extensive birth and perinatal knowledge, knowledge about pregnancy, birth, postpartum, parenthood, and they should be a part of the community. That should be your neighbor. That should be your auntie. That should be your grandma or your cousin or whoever in the community that you go to when someone’s pregnant to ask questions.” (Interview with Tayo Mbande)
In recent years, doula services have become more accessible. For example, in 2021, the California Momnibus Act was passed, which sought to support BIPOC Medi-Cal members facing systemic discrimination and inequities in the healthcare system by including coverage for doula services. As a result, doulas have been working within the hospital setting more frequently:
- “Doulas exist in the community, and birthing people are bringing this part of their community to the hospital, consistently. Hospitals see how beneficial it is. So make space for the doula there. I do think that there is lots of room for hospital systems and healthcare networks to accommodate doulas, welcome them, embrace them, support them. And not just toy with the idea of encompassing them. You know, like we own y’all. Y’all are a part of us now. No, we actually belong in the community.” (Interview with Tayo Mbande)
Despite their entrance into the hospital, doulas are still community-focused careworkers whose work directly contradicts the medical industrial complex, rightly so.
In Writing at the Margin, medical anthropologist Arthur Kleinman states: “[suffering] is a defining quality of the experience of being human… So too is medicine, as organized therapeutic practice (the process of care), fundamental to what is deeply human in experience amid the vast diversity of cultural worlds.” Since Kleinman wrote this in the nineteen nineties, comprehensive medical care and well-being have become a luxury only the most wealthy can afford. This opposes many doulas’ ideals for their work, envisioning a practice built fully in cooperation with their communities. Ideally, like early feminist organizations, these doula-patient relationships wouldn’t be transactional, instead cooperative, where communities offer full, provisional support for their doulas. However, in a capitalist society, doulas must be compensated for their work. Comprehensive insurance coverage has the potential to increase access to community doulas, but this coverage is far from universal. As of 2025, public and private insurance policies for doula support vary significantly by state: while some, like California, Arizona, and Louisiana, publicly fund doula services, others may only mandate coverage of one or two post-partum visits. And some states, such as Idaho, Wyoming, and Alabama, resist mandating any public or private coverage altogether.
Doctors, doulas, and prospective parents appear to agree; receiving support from doulas should not be a luxury, nor a service which requires payment out-of-pocket. Dr. Laura Norell, OB/GYN at San Francisco Kaiser Permanente, argues further, that advocacy from doctors is necessary for doulas to gain access to hospital settings. She says, “Doctors are complacent with insurance. They assume a patient’s insurance will cover things, so they don’t need to advocate for them. If you don’t tell people that they can get access to resources, how are they supposed to know?” The solution to expansive, informed care is information-sharing and generation of a network of doulas for communities, from communities, all alongside major advances in insurance coverage. Towards this end, groups across the country, such as the Doulas for All Coalition and Doula Medicaid Project, advocate for comprehensive access to all doula services,
including and beyond childbirth.
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