The Doula Divide: How Cost and Other Barriers Leave Many Mothers Without Doula Birth Support
Key takeaways:
Despite the well-known positive impacts of doulas, a new GoodRx survey found that only 11% of new mothers had a doula present during childbirth.
One main barrier to accessing doula care is cost. Doula fees for childbirth can range from $382 to $1,352.
Nonwhite mothers report higher rates of wanting a doula present but not being able to access one. Cost was the most significant barrier.
More parents are turning to doulas for childbirth, seeking these trained professionals for emotional and physical support. From easing labor pain to offering expert guidance, doulas are transforming the birth experience — leading to shorter labor, fewer medical interventions, and happier moms.
However, the majority of those giving birth do not use doulas. In fact, a recent GoodRx survey reveals that only 11% of new mothers had a doula during pregnancy and childbirth.
Here are some of the reasons why mothers may not use doulas, and why different groups may face different challenges when trying to hire one.
Doulas are often unaffordable, though costs vary by state
For many, the cost of hiring a doula is simply too high. The average minimum fee for doula services during childbirth ranges from $382 to $1,352 according to data sent to GoodRx from DoulaMatch. Insurance rarely covers these costs, leaving most new mothers to cover the full price.
What’s more, the cost of a doula can vary significantly across the country. Average minimum fees can range from as low as $382 in Montana to around $1,300 in New York and California. States like Mississippi ($707) and South Dakota ($442) offer more affordable services, while Connecticut ($1,209) and Washington ($1,232) have higher costs.
Who’s missing out? Disparities in doula access
Our survey found that nonwhite mothers were more likely to report wanting to see a doula but being unable to. This was the case for 24% of Black and American Indian and Alaska Native (AI/AN) mothers.
The GoodRx survey highlighted several key barriers to having a doula. These barriers differed by race.
For many women, the availability and convenience of hiring a doula is a roadblock. In fact, 40% of new mothers cited availability, timing, or convenience as the primary reason they couldn’t see a doula. This reason is especially common among white non-Hispanic mothers, 46% of whom listed timing or convenience as their main barrier.
However, financial concerns remain the main issue for many nonwhite groups. Financial strain was the biggest hurdle for 37% of Black and AI/AN mothers and 41% and 46% of Hispanic and Asian mothers, respectively.
Doulas can offer much-needed support to mothers
Women who are able to hire a doula often report a dramatically different experience giving birth than those who are not. Only 3.7% of new mothers who had a doula said they didn’t feel supported during labor and birth. That’s compared to 7.35% of women who wanted to but couldn’t access a doula, and 6.6% of mothers who neither sought nor received doula care.
Similarly, having a doula present increases the likelihood of a mother feeling like her birth plan was respected. Only 6.6% of women with doulas felt their birth plan was disregarded, compared to 11.46% of those who wanted a doula but didn’t get one.
The path forward
Access to doula care is important for improving maternal health. But we need to address the barriers preventing women — especially women of color and lower-income families — from using this service.
Calls for expanding Medicaid to cover doula services have been gaining traction. Some states have already taken steps to offer reimbursement for doula care. In the map below, you can see the states that are beginning to expand access to doulas. Read more about each state’s efforts here.
Despite these efforts, we need more widespread change to ensure that all mothers, regardless of race, income, or geography, can benefit from the emotional and physical support that doulas provide.
Methodology
Survey: Our survey was run through Qualtrics from October 26, 2023 to November 15, 2023. We collected and analyzed a total of 1,015 responses. The survey screened in people who gave birth up to 24 months prior to the date of the survey and were at least 18 years of age. We also required that they saw a healthcare professional for their pregnancy, labor and birth, and post-birth care. We oversampled specific race groups (American Indian, Alaskan Native, and Black Americans) to ensure that we captured sufficient responses by race.
To obtain nationally representative numbers, we created weights based on the race and ethnicity reported in the survey. Our weights were created using the race and ethnicity shares reported by the American Community Survey (ACS) 2022 5-year estimates (Table B03002: Hispanic or Latino Origin by Race). To evaluate the representativeness of our weights, we calculated the share of our weighted sample by region and by income groups in comparison to national shares using ACS 2022 5-year estimates (Tables B01003: Total Population and Table B19001 Household Income in the Past 12 Months (in 2022 Inflation-Adjusted Dollars). The comparisons can be found here.
Doula fees: This analysis reports state-level average minimum fees for certified birth doulas using data acquired from DoulaMatch.com. Data is current as of July 2024. Only doulas who are classified as a “birth doula” or “birth and postpartum doula” were included in this analysis. DoulaMatch.net is a fee-for-service database, and therefore the fees for the listed doulas may not fully capture the entire doula population, especially community, outreach, and volunteer doulas or doulas specifically employed by hospitals or other programs.
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References
DoulaMatch. (2024). Homepage.
Doula Medicaid Project. (n.d.). Current state efforts at expanding access to doula care.
Sobczak, A., et al. (2023). The effect of doulas on maternal and birth outcomes: A scoping review. Cureus.
