Abstract

A nationwide environmental scan and content analysis of hospital-based doula programs

Shelby Wyand, M.Sc., B.A.¹, Sana Rahman, BA², Asli McCullers, BS, MPH³, Sofia Gaxiola⁴, Leyla Robinson, B.S.⁵, Jessica Galarraga, MD, MPH⁶ and Karey Sutton, PhD³
(1)MedStar Health Research Institute, Washington, D.C., DC, (2)Georgetown University School of Medicine, Washington, DC, (3)MedStar Health Research Institute, Washington, DC, (4)Georgetown School of Health, Washington, DC, (5)Georgetown University, Washington, DC, (6)MedStar Health, Columbia, MD

APHA 2025 Annual Meeting and Expo

Background: Black women in the U.S. experience maternal mortality rates nearly three times higher than White women. Doula care has been shown to improve maternal health outcomes and reduce disparities. Despite hospitals increasingly implementing doula programs or services, research on these programs is sparse. Thus, we conducted a systematic review of U.S. hospital websites to assess the availability and structure of doula services.

Methods. A list of hospitals offering labor and delivery services was compiled for each state. Doula mentions were identified through (1) a web-based search combining hospital name and “doula,” and (2) a direct search on hospital websites. We recorded whether doulas were mentioned in any context, the hospital had a doula program, and program details.

Results: Among 3,434 hospitals, 254 (7.4%) offered hospital-based doula programs with regional variation: Northeast 17.3%, West 10.2%, Midwest 7.3%, and South 2.2% (Table 1). Program details were often scarce, with varying structures (e.g., in-house doulas, community partnerships). Most programs were free for patients, often funded by grants, Medicaid, or insurance. Doulas were mentioned on 775 (22.6%) hospital websites. References often appeared within visitation policies and referral sources. Most hospital websites did not clarify whether external doulas were permitted.

Conclusion: The prevalence of hospital-based doula programs varies regionally and has limited online visibility, making it difficult for patients to learn about available services. The lack of clarity on whether doulas are allowed to work at hospitals presents a barrier for doulas navigating policies. Increasing transparency around these programs could improve maternal health outcomes.

Advocacy for health and health education Communication and informatics Public health or related organizational policy, standards, or other guidelines Public health or related research