Beyond the Birth Room

After writing Part 1 of this blog, I tried to sleep, but I couldn’t. My brain was replaying the hourly rates for doulas that I touched on in the previous blog. I kept going over the math because the math wasn’t mathing. As the head of household for most of my life, it has been very humbling to make less than my child. I’ve honestly had enough of walking around with soggy lashes from crying. Since I couldn’t fall asleep, I headed down a rabbit hole of all rabbit holes. We’re going to dive deep.

Birthwork is shaped by the people who do it, their lived experience, their communities & the systems that either sustain or confine them. I wanted to center this discussion about doulas themselves, who they are, how they work & what it takes to keep showing up for families in a system that wasn’t built with them in mind. I’m just being honest, I wish that weren’t the case.

Birthworker is another word for doula, someone trained to support families through pregnancy, birth & postpartum. Which brings me to the doulas doing this work on their own, community-based, independent doulas holding it down in their own communities. This conversation is also inclusive of community-based doula programs.

Unlike hospital-affiliated or agency-based doulas, community-based doulas often work independently or within grassroots programs that serve the neighborhoods they come from. Their care is grounded in cultural understanding, trust & accessibility, meeting families where they are & centering those who have been historically overlooked by the traditional systems in place.

Many independent doulas aren’t backed by agencies, hospitals, or grants. We’re small, community-based businesses, often women of color, parents & caregivers ourselves. We don’t have hospital affiliation or institutional funding. We do this work because the families who need the most support often have the least access to it & because we love it. Like in love, love it.

Hiring a community-based doula sustains a local ecosystem of care. The money families invest in a doula goes directly back into the community, feeding families, funding continuing education, paying local taxes, keeping small businesses above water & ensuring the next generation of community-based doulas see this work as sustainable, not sacrificial.

For expectant parents that wish to work with a doula & their private rate feels out of reach, ask about sliding scales, payment plans, or community-supported options. If you can afford the full rate, pay it proudly knowing you’re helping build something bigger. You’re helping to preserve birthwork as a profession rooted in equity, dignity and ancestral & indigenous traditions.

Who’s Doing This Work?

Age & Experience

The majority of doulas are not entry-level workers. They’re mid-career professionals that transition into birthwork after years of caregiving, parenting and/or professional experience.
Workforce data from Zippia shows that over 52% of U.S. doulas are over age 40 (Zippia Demographics, 2024).
According to Zippia, most doulas in the United States identify as white, accounting for about 60% of the workforce. Around 16% identify as Hispanic or Latino & approximately 9% identify as Black.

Doulas have always played a vital role in maternity care but are not included in official data that defines the U.S. maternal health workforce. Because of this, there is no national system tracking how many doulas exist, who we serve, or clear data on race, location, or practice type. Until doulas are recognized in workforce reporting, the national picture of maternal health will remain incomplete (HRSA, 2024).

Race, Representation & Gaps

Multiple studies (including the University of Washington CHWS report, PLOS ONE 2023 & IMI/MACPAC 2023 findings) confirm that:

Community-based doulas that are a part of grassroots programs, public-health projects, Medicaid & working independently in underserved neighborhoods are predominantly BIPOC. They come from the same cultures, neighborhoods & experiences as the families they support.
Nationally, hospital-based, agency & higher-priced private doula providers are predominantly white & serve higher-income populations (MDPI, 2022).

Data shows that BIPOC doulas are concentrated in community centered care while private & institutional spaces continue to reflect longstanding gaps in representation.

A rapid-response brief from the University of Washington confirms the trend “Until recently, a majority of those served by birth doulas, and doulas themselves, identified as White and cis-gendered.” noting an urgent need to expand access to & support for BIPOC doulas (UW Center for Health Workforce Studies, 2022).

At a recent New York Coalition for Doula Access (NYCDA) meeting, it was shared with us that Black doulas made up 57% of attendees, the highest representation in the room.

Representation Changes Outcomes

Evidence has shown that doulas improve experiences & outcomes, especially for expectant families of color.
A study found that non-Hispanic Black women supported by a doula were 2.7 times more likely to receive respectful care compared to those without one. For Asian & Pacific Islander women, the odds were 2.3 times higher (Mallick et al., 2022).
Community-based doula programs, often led by Black & Brown doulas serving their own neighborhoods, have been shown to improve how families experience pregnancy & birth.
Beyond the data, families describe feeling more seen, heard & respected when supported by doulas who understand their cultural & community context (Supported by findings in BMC Pregnancy & Childbirth (2025), PLOS ONE (2022), and the Institute for Medicaid Innovation (2020)).
Nationally, only about 6% of births include doula support (Kozhimannil et al., 2017). Current estimates suggest that only about 6-10% of people giving birth in the U.S. work with a doula (Bornbir).
That means most families, especially low-income & BIPOC families, still go without care proven to make birth safer & more supported.

The Workload

Community-based doulas don’t clock in & out. Many programs estimate up to 100 hours per family, accounting for prenatal sessions, labor, postpartum support & connection to social services (Medicaid Innovation Collaborative Report, 2020).
NYC’s Department of Health reports that in one of its community-doula programs, Citywide Doula Initiative, 80% of clients identified as Black and/or Latina, even though these groups make up less than half of all birthing people citywide (NYC DOH Doula Report, 2024).
The people showing up to serve the most marginalized are the same ones absorbing the heaviest financial, emotional & logistical load, often while earning less than $10 an hour once expenses are accounted for (see previous blog).

The Citywide Doula Initiative (CDI) connects expectant families with free or low-cost doula services within the five boroughs of New York, through community organizations that have supported the care of their communities for years. Services are provided to communities experiencing the highest health & socioeconomic inequities in NY. These organizations include:

Ancient Song Doula Services (Brooklyn)
Caribbean Women’s Health Association (Brooklyn with city-wide service)
By My Side Birth Support Program (Brooklyn)
HoPE Doula Care Program (Queens)
Community Health Center of Richmond (Staten Island)!!!!

Visibility

Search engines & doula directories are not neutral. This blew my entire mind. The same algorithms that decide who shows up first in a Google search or who’s featured on a directory can reinforce racial bias. The way digital systems work shapes healthcare access, search visibility & online marketplaces. Studies have shown that algorithmic systems in healthcare & other fields often reproduce inequities. From misidentifying Black patients’ needs to prioritizing profiles with higher web traffic & longer institutional ties. (PubMed, 2019; JSTOR, 2018; PMC, 2024)

When visibility is filtered through bias, sustainability can take a hit. Every click, referral, or booking that gets diverted by an algorithm is potential income lost for a doula who’s already underpaid & overextended. Our survival as community-based doulas shouldn’t depend on systems finally deciding to see us, value us, or make space for us. In 2025, being respected for the work we’ve always done shouldn’t be revolutionary.

The next time you’re searching for a doula, go beyond the first few names that pop up. Scroll, read, & choose with intention. Visibility isn’t always a measure of value, sometimes it’s just the algorithm algorithming. Sponsored listings are often prioritized, pushing smaller businesses further down search results.

community based doula models

Research consistently shows that community-based doula models produce better outcomes because the relationships are rooted in trust, shared identity & community understanding. Studies link this model of care to stronger engagement with prenatal visits, smoother postpartum recovery & lower rates of perinatal mood & anxiety disorders.

A 2019 study of community doulas working with low-income Black women found that these doulas provided expanded services like home visits, resource navigation & culturally grounded emotional support, all elements clients described as essential to feeling seen & respected (Wint et al., 2019).
The Institute for Medicaid Innovation reported that community-based models offer high-value care by addressing social determinants of health & fostering the kind of cultural trust that can’t be replicated through institutional frameworks (Medicaid Innovation, 2020).
A Commonwealth Fund issue brief echoed this, showing that community-based perinatal models, including doula care, were linked to reduced birth complications, fewer low-birthweight outcomes & improved maternal health for people of color & low-income families (Commonwealth Fund, 2021).
The Medicaid & CHIP Payment & Access Commission (MACPAC) found that community-based doulas who share lived experience with their clients deliver the most meaningful & measurable impact, while agency or hospital-based models often lack that alignment (MACPAC/IMI, 2023).

Choosing a community-based doula is choosing care that meets families where they are, sees them fully & fills in the gap where the system has failed. For Black & Brown expectant families, it can be the difference between being heard & being dismissed, between just moving through the perinatal period & being transformed by it.

that was a lot, wasn’t it?

Community-based doulas are the backbone of equitable birthwork. They bring representation, trust & continuity, everything the medical system lacks.

Supporting independent doulas means keeping birthwork in the hands of the people it was always meant to serve-the community. You’re also investing in the people who make reproductive justice a living practice-work that’s deeply rewarding, but also emotionally & physically demanding.

Your support uplifts the next family. And the next generations.

That’s all for now, friends. I say that like I didn’t write a thesis. I’ll be great if I don’t see another citation this year! I wrote these back-to-back blogs in October so I can take this off my shoulders & rest during the month of November. I have been out-of-office since August. I continue to join my committee members to make things better. I have my families that I love deeply, who are expecting their babies next year. And my doula mentorship program that I’m really looking forward to. Oh & the meeting with the man with the tight paints :)

I hope the close of this month brought you peace. I finished these blogs just in time to greet the trick-or-treaters!!!!! Happy Halloween :)

As always, thank you for your continued support.

-Anjanette

References-Part 1 & 2