Potential Benefits of Increased Access to Doula Support During Childbirth

There is a large unmet demand for doula care among American women, many of whom would likely benefit substantially from the evidence-based benefits associated with continuous labor support.^4,15 Only 6% of women reported having support from a doula when they gave birth in 2011 or 2012, up from 3% of women in 2005.¹⁶ However, our findings indicate that over 40% of women are not aware of doula care, which translates into approximately 1.6 million women of the 4 million US women who give birth each year. Of those who are aware of what a doula is and the type of care they provide, 27% indicated that they would definitely want this type of support, which would mean an additional 1 million US women using doulas each year. Based on the findings from this analysis, if these women’s odds of nondefinitively indicated cesarean were lowered by 80% rather than elevated by 70%, the result could be an improvement in quality, safety, and a decrease in costs of childbirth. Identifying barriers to doula access is a crucial step in addressing this unmet need. While the survey data used in this analysis did not contain details on why women who wanted a doula did not have access to this service, prior research indicates several potential barriers and challenges; the most salient of which is concern about the out-of-pocket expense.^5,15,20,22 Especially for families with low incomes or limited savings, doula services at costs ranging from several hundred to several thousand dollars,18 may be perceived as unaffordable in the context of other expenses related to childbirth and infant care (eg, car seats, diapers, feeding supplies) as well as changes such as loss of income during unpaid maternity leave.^18,20 Additional barriers might include logistical challenges, such as distance from a doula for rural women, objections from husbands/partners or family members, or cultural issues, such as seeking but not finding a doula with a similar heritage or linguistic background.^5,15,20