How Elevating the Role of Doulas Can Transform Maternal Health Outcomes in Louisiana
Senior Program Manager Stephanie Kennedy, MPS, TTS
As the implementation lead for LPHI’s Doula Collaboration Initiatives, I’ve witnessed firsthand how doulas, longstanding community birth workers with deep historical and cultural knowledge, can profoundly impact maternal and infant health. Doulas provide continuous, culturally grounded support that has been shown to reduce medical interventions during pregnancy and birth, shorten labor, improve clinical outcomes for both mothers and babies, and enhance the overall birthing experience for families. Their role is not simply ancillary to clinical care, it is foundational.
Doula care begins with relationship-building, often starting before pregnancy, and continuing through birth and postpartum care. In collaborative and respectful clinical settings, doulas serve as vital connectors between care teams, mothers, and families during some of life’s most joyful and sometimes most stressful moments.
Their support extends well into the postpartum period, addressing physical health through nutritional guidance, education, and referrals for conditions like hypertension and physical therapy. Equally important, doulas nurture emotional well-being by fostering early bonding and supporting breastfeeding initiation and success, factors that have lasting positive effects on family health and economic stability. The value doulas bring to families is undeniable. Yet, significant work remains to ensure equitable access to collaborative doula care. To fully realize the opportunity of doulas supporting transformed birth outcomes, we must continue to expand patient access on multiple fronts.
Doula-Led Engagement
The Louisiana Public Health Institute (LPHI) not only recognizes the value of collaborative doula care, but also emphasizes the importance of allowing doulas and birth workers to lead and define what that care looks like in practice. With support from Blue Cross Blue Shield of Louisiana Foundation and the David & Lucille Packard Foundation, LPHI recently completed the second cohort of our Doula Collaboration Community of Practice (CoP): Building Stronger Relationships Between Doulas and Clinical Providers.
This CoP brought together doulas, birth workers, individuals with lived experience, and clinicians to co-develop system-level policies and strategies that strengthen collaboration between doulas and clinical care teams. We drew on the expertise of both Louisiana-based and national partners to guide the development and implementation of these strategies, including Birthmark Doula Collective, The Amandla Group, Saul’s Light, Sista Midwife Productions, Community Birth Companion, Deley’s Healing Hands, Dr. Kenneth Brown of LAMMICO, and Health Leads.
Through this work, participants deepened their understanding of how collaborative doula care improves maternal and child health outcomes and reduces disparities. They also identified actionable strategies to enhance communication and coordination between doulas and medical providers, and developed processes to support seamless care across the maternal health continuum.
Health System Engagement
While the Doula Collaboration Community of Practice successfully created a doula-led space to develop practices that improve access to collaborative care, lasting transformation requires active engagement and commitment from Louisiana’s health systems.
Health systems must work in partnership with doulas and other birth workers to co-design workflows and protocols that preserve doula autonomy, clearly define scopes of practice, and foster respectful, collaborative environments. These efforts are essential to ensure doulas are not seen as peripheral participants, but as integral members of the care team whose presence enhances the birthing experience and improves outcomes.
Policy
Louisiana offers a compelling example of how policy momentum can drive meaningful change in maternal and child health outcomes through the integration of collaborative doula care. Years of advocacy and education, led by groups like the Mama+ Policy Group, have paved the way for formal recognition of doula services by insurance providers and hospital systems. This progress reflects a growing statewide acknowledgment that access to collaborative doula care is essential to advancing equity and quality in maternal healthcare.
These policy shifts represent a critical step forward. By expanding reimbursement pathways and creating new partnership opportunities, they help strengthen and sustain the doula workforce, ensuring that more families can benefit from this vital support.
Payor Engagement
While the value of doula care is undeniable, especially when it comes to the lives and well-being of mothers and babies, it’s also important to recognize the financial benefits of investing in this model. Insurance providers that support access to collaborative doula care can realize significant cost savings by preventing expensive interventions. Robust evidence from randomized trials, observational studies, and Medicaid-focused analyses demonstrates a strong return on investment: lower cesarean section rates, fewer neonatal intensive care unit (NICU) stays, reduced complications, and shorter hospital stays after birth.
The creation of Louisiana’s Doula Registry Board was a pivotal step in enabling reimbursement for doula services. However, it is now up to insurance providers to establish and maintain sustainable credentialing and reimbursement systems. Medicaid and private payer contracts must reflect the true value of continuous labor support, ensuring that reimbursement is fair, predictable, and accessible.
Equally important is clear communication from insurers to patients. Families need to know that doula services are covered and how to access them - because when they do, outcomes improve across the board.
Data-Driven Results
Access to timely, high-quality data is essential to sustaining and scaling collaborative doula care. Data is critical for evaluating impact, refining care models, and driving continuous quality improvement. Ongoing investment in data infrastructure, like the Louisiana Maternal & Infant Data Collaborative, is key. This database aggregates electronic health record data from pregnancies within Ochsner and LCMC health systems, offering valuable insights into doula service utilization, clinical outcomes, and patient experience. By systematically collecting and analyzing this information, we can better understand the benefits of doula care and use that evidence to inform future strategies for equitable, effective maternal health interventions.
It’s important to note that the strategies, successes, and lessons learned in this work and written above have not been developed through my thoughts and actions alone. These words, successes, and strong foundations for collaborative doula care are grounded in the wisdom and expertise of the doulas, advocates, and women with lived experience who, whether they know it or not, guide my and LPHI’s implementation strategy and practice of transforming birth outcomes in Louisiana. A few of these incredible thought leaders, doulas and advocates include Dr. Victoria Williams of Birthmark Doulas, Meshawn Siddiq who leads the Maternal & Child Health work at the City of New Orleans Health Department, one of my colleagues and advisors at LPHI, Alysia Davis, my good friend and collaborator, Shanika Thompson, who inspired my work in advocating for quality maternal healthcare for Black women nearly a decade ago through her birthing experience, and the doulas who dedicated offered their time, talent, and expertise to our Community of Practice.
My close collaboration with doulas and advocates leaves me deeply optimistic about the future of maternal healthcare. Doulas bring with them a wealth of community-rooted and ancestral knowledge about pregnancy and birth. Wisdom that, when honored, can lead to safer births, healthier infants, and more resilient women and families. And while I’ve passionately advocated for the integration of collaborative doula care, I must also emphasize that doulas alone cannot solve the deep disparities in maternal health outcomes. Addressing the systemic racism embedded in our healthcare systems and the communities they serve is essential, ensuring that we aren’t inviting doulas into replicating inequity by joining collaborative care teams, but rather becoming co-creators in a transformed future of healthy birthing. Supporting doulas is not a niche initiative, it is a public health imperative and a pragmatic, equity-driven strategy to improve outcomes and reduce costs across our communities.
Are you interested in learning more about integrating Doulas into your health systems? Follow up directly with me at skennedy@lphi.org