Doula care around pregnancy and childbirth was once considered to be something accessible only to those with substantial financial means. Hiring a private doula around pregnancy and delivery can cost thousands of dollars. But according to the National Health Law Program , 26 states as well as the District of Columbia now cover doula care via Medicaid, with an additional 7 states in the process of implementing this coverage. While doula care has generally thought to simply provide basic emotional support, a study published in the April 2026 issue of JAMA Network Open assessed multiple objective measures of the benefits of perinatal doula care.

Birth doulas are trained professionals who work with pregnant individuals before, during, and after delivery, assisting in providing both physical and emotional support throughout labor and delivery, and often in the early newborn period. While not medically trained, there are various doula training certifications either through private or hospital-based entities. Most private insurers do not cover the cost, but Medicaid coverage continues to expand, from 10 states in 2023 to 26 currently and likely soon to 33.

A study published in Cureus in 2023 reported specific benefits to presence of a doula during the labor and delivery process, including reduced incidence of cesarean section, which is often considered to serve as a marker for improved birth outcomes. In addition, the report found increased use of breastfeeding and better advocacy for child safety measures. It did not particularly measure mental health outcomes for the mother, which was assessed in the recently published study.

The current study reviewed 22 previously published studies, most of which were randomized clinical trials, on the impact of doula care during labor, delivery and the early time period after birth. The most notable findings, after compilation of all accessible data points from these studies, included reduced maternal anxiety, improved postpartum follow up, and higher incidence of breastfeeding in the early newborn period. They did not find significant impact on frequency of cesarean section or pain reduction during labor and delivery.

While there was limited consistency on the presence of a doula on the impact of postpartum depression, the reduction in maternal anxiety was much more consistent. The impact of maternal anxiety both during labor and in the hours and days after delivery can play an important role on maternal bonding to the newborn as well as in interest in pursuing breastfeeding. While these factors are not direct links to postpartum depressive symptoms, reduction of anxiety in particular may later be shown to reduce maternal depression in the newborn period.

Doula care can also span much wider than just the labor and delivery process, including prenatal support and support in the days or even weeks after delivery. As publicly funded insurance is addressing only hospital-based doula care, inequities in access to doula care for the weeks before and after delivery will likely remain for the foreseeable future. Studies that continue to highlight objective outcomes that benefit maternal and child health based on inclusion of a birth doula may lead to expanded coverage of care by both private and public insurers.