Once a luxury for moms, doula care is going mainstream

MEMPHIS, Tenn. — Shaquoiya Stewart cradled one of her 6-month-old twins while Shanille Bowens held the other. As they caught up, Bowens asked the question she poses to every mother she supports: "Do you think there's anything you need more support with?"

Bowens is a doula, offering physical and emotional support before, during and after birth. Once considered a luxury, doula care is becoming increasingly mainstream.

The medical establishment, once hesitant, is now more open to doulas as partners to doctors and nurses. At the same time, insurance coverage is expanding, making services more accessible. More than 30 states now reimburse doulas through Medicaid or are working toward it, up from 14 in 2022. Private insurers are beginning to follow suit, including UnitedHealthcare, which launched a new benefit this year. Without insurance, doula services can cost more than $2,000.

This shift is driven by growing research showing doulas can significantly improve outcomes for mothers and babies. Experts say expanding access is a relatively low-cost way to address maternal mortality, which disproportionately affects Black women, who die at more than three times the rate of white women.

"Doulas can benefit everybody," said Sierra Hill of Minnesota's health department. "Especially communities facing inequities."

For Stewart, who is covered by Tennessee Medicaid, Bowens provided steady support through a high-risk twin pregnancy, blood pressure complications, a C-section and postpartum challenges.

"I felt safe. It didn't feel like I was just by myself," said Stewart, a 35-year-old single mother of four. "She was like my homegirl."

Doula care has grown steadily. In 2006, about 3% of U.S. women used a doula during labor. That number has since doubled or tripled, researchers estimate.

Bowens herself discovered doulas more than 20 years ago when she was pregnant with her first child. At the time, she didn't know what a doula was—but the experience inspired her to become one. Today, she runs Naturally Nurtured Birth Services, where she supports clients by answering questions, connecting them to resources, helping them navigate the health system and advocating for their needs.

"Oftentimes, we become lifelong friends with our clients," Bowens said. "We cater to them—every experience looks different."

That personalized care can have measurable benefits, especially for underserved mothers. One study found that socially disadvantaged women who used doulas were four times less likely to have low-birth-weight babies and half as likely to experience complications. Another study found Medicaid patients with doulas had a 47% lower risk of C-sections, a 29% lower risk of preterm birth and were far more likely to attend postpartum checkups.

Those postpartum visits are critical. More than half of maternal deaths occur after birth, often due to complications like infection or excessive bleeding.

Minnesota was among the first states to recognize these benefits, covering doulas under Medicaid in 2014 and later expanding access to allow more visits without prior approval.

"The return on investment is huge," Hill said.

While doulas are not licensed medical professionals, many pursue certification, and states set qualification standards for Medicaid reimbursement.

In Memphis, Bowens' organization is part of a pilot program funded through Tennessee Medicaid and administered by UnitedHealthcare, offering free doula services to eligible members. Similar benefits are slowly expanding in private insurance plans.

"I see doulas becoming more integrated and accepted across the health care system," said Dr. Margaret-Mary Wilson of UnitedHealth Group.

That acceptance extends to hospitals, where attitudes have shifted over time. A decade ago, doulas often faced resistance from medical staff, especially when advocating for patient preferences. Today, collaboration is more common as understanding grows.

At one Minnesota hospital, doulas are now part of a grant-funded program, and patients can receive financial assistance to access their services. Nurses say doulas are increasingly valued members of the care team.

Much of the impact, however, is felt in deeply personal ways.

At a Memphis doula center, Mary Bey sat holding her infant daughter, Ca'Mya, while Bowens checked in on her. As they discussed breastfeeding and sleep, Bey opened up about frequent crying and anxiety since giving birth.

Bey's fears are shaped by loss. Before her daughter's birth, she experienced a stillbirth. Bowens supported her through that grief — staying with her during delivery, visiting her at home and even bringing groceries.

When Bey became pregnant again, she reached out immediately: "Can you still be my doula?"

Throughout the pregnancy, Bowens answered questions, calmed fears and stayed by her side through a scheduled C-section and newborn health concerns. When Bey later worried about an infection, Bowens urged her to seek care—it turned out to be necessary.

Bey credits that support with helping her survive both pregnancies, physically and emotionally.

"She makes you feel like she's family," Bey said. "A friend, a cousin, an auntie, a sister—all of the above."

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