Doula Integration Toolkit // Background and Context for Doula Integration

Background and Context for Doula Integration

Use tools in this section to understand why doulas are an evidence-based strategy to improve perinatal care, the role of the doula, and doula training and certification pathways. Examples of state doula landscape survey reports are included.

These resources lay the foundation for a more integrated approach for doula services.

The Importance of Doulas

New York City Department of Health and Mental Hygiene:

The State of Doula Care in NYC 2023

“Consistent evidence shows that doula support is associated with improved birth outcomes and a better labor and birth experience, including fewer cesarean deliveries, greater likelihood and duration of breastfeeding, improved mother-baby bonding, and reduced rates of postpartum depression.”

New York City Health and Hospitals:

NYC Hospital Doula-Friendliness Guidebook

Provides a myriad of resources for hospitals specific to doula integration including: Literature review of doula support, a doula-friendly policy example, and communication examples that describe the benefit of doula support.

Missouri PQC:

Integrating Doula Care Into Clinical Care Settings: A Guidance Resource for Health Care Organizations and Clinicians

This resource defines the doula role and provides overview of the benefits of doula care.

California Maternal Quality Collaborative:

Partnering with Doulas to Improve Perinatal Outcomes and Promote Birth Equity

Powerpoint deck and companion webinar, slides 20-26 presenting doulas as “essential changemakers in birth outcomes.”

Prenatal-to-3 Policy Clearinghouse Evidence Review:

Community Based Doulas

Reviews the evidence supporting community doulas and limitations of information on community based doula models.

Pregnancy: Society for Maternal-Fetal Special Statement:

Transforming the Maternity Care Team Model

SMFM statement that identifies doulas as core members of the maternity care team


Doula Role and Care Models

Primary Maternity Care:

Doula Job Description

This document provides a sample job description for a doula working within a medical practice.

California Maternal Quality Care Collaborative:

Toolkit to Support Vaginal Birth and Reduce Primary Cesareans

This toolkit covers the role of the doula, and what they do and don’t do, and doula care models.

California Maternal Quality Care Collaborative webinar:

Doulas: Including Practice Into Hospital Care

Provides background on doula role and training

New York City Department of Health and Mental Hygiene:

The State of Doula Care in NYC 2023

New York Coalition for Doula Access put together several Principles of Doula Support in a Hospital that outlines what a doula does, does not do and what is found in a doula-friendly hospital.

Healthy Mothers, Healthy Babies Coalition of Georgia:

A Doula’s Scope of Practice

Brief guide to doula “do’s” and “don’ts” to clarify the scope of doula services.


Doula Landscapes

Primary Maternity Care and Health Equity Solutions:

Doula Landscape Analysis and Implementation Plan

Overview of Connecticut doula landscape and provides details of HUSKY Health Medicaid doula provider integration strategy based on Connecticut’s alternative payment model for maternity care.

Betsy Lehman Center for Patient Safety:

Expanding Doula Support Services in Massachusetts: Considerations for Successful Implementation

Provides qualitative and quantitative results from a doula survey conducted in Massachusetts including doula demographics and patient and doula experiences. Concludes with recommendations for doula programs and doula certification.


Doula Training and Certification

National Health Law Program:

Doula Medicaid Training and Certification Requirements: Summary of Current State Approaches and Recommendations for Improvement

Provides qualitative and quantitative results from a doula survey conducted in Massachusetts including doula demographics and patient and doula experiences. Concludes with recommendations for doula programs and doula certification.

Explore other sections in our Doula Integration Toolkit