The Relationship Between Regulation and Care Access in the Doula Industry

Abstract

Birth doulas are unregulated service providers in the United States, who provide informational, emotional, and physical support before, during, and after birth. Currently, the United States has the highest maternal mortality rate amongst the most developed nations, as well as a serious racial gap, with Black women being twice as likely to die due to pregnancy-related complications when compared to White women. Birth doulas can help close the gaps with trained support and advocacy. Since over 40% of the births in the US are covered by Medicaid, providing birth doula services to Medicaid recipients could result in improved birth outcomes. These improvements include decreased maternal mortality rates, decreased cesarean delivery rates, and an increase in maternal satisfaction with the birthing experience. This literature review will lay out a brief history of birth and birth attendants, the impacts birth doulas have on birth outcomes, regulation of birth doulas, barriers to access, the current state of Medicaid covered doula care, and a recommendation for policy development.