Doulas and the Birthing Journey

The birthing journey represents perhaps the most transformative and vulnerable phase of a mother’s life. Unfortunately, many women find themselves navigating this stage of life without adequate familial and social supports, which can impact health outcomes.¹ Other challenges, including inadequate health literacy and limited access to maternity care, are also associated with poor maternal and infant health outcomes.² A 2026 March of Dimes report identified 33 Arkansas counties deemed “maternity care deserts” — counties without hospitals or birthing centers offering obstetric care or without any obstetric providers — highlighting limitations on access to much-needed perinatal supports (see Figure 1).³

Governmental and institutional efforts are underway to provide more comprehensive services for pregnant women and their families, with the goal of improving maternal health outcomes.⁴ These include efforts to develop training opportunities and provide financial support for doulas, professionals who are trained in childbirth and who provide educational, emotional, physical, and other supports to pregnant or recently pregnant women throughout the perinatal experience. In Arkansas, the 2025 regular legislative session brought key wins for doula advocates, with the state establishing a certification process for community-based doulas and a reimbursement path for doula services through the state’s Medicaid program and private insurers.

This explainer explores the role of doulas in the birthing journey, doula training and certification requirements, evidence of outcomes associated with doula services, insurance coverage for doula care, and other efforts to support the expansion of doula services.

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