The Short Answer: Like many holistic care practices today, there is a valid concern that doulas are at risk of being “gentrified” in the sense that they will become more inaccessible as they grow more popular. 
But here’s the truth: Anyone who is planning a family, starting a family, or is looking to make a significant change that could affect their reproductive health can access a doula!
The Longer Answer:
Despite popular media images of doulas (and doula patients) that are not particularly diverse, doulas can be for anyone and everyone! Birthing people from every walk of life and with every type of family structure can benefit from doula support at any stage of pregnancy and family planning. The key is identifying a doula — and a community of care overall — who is compassionately attuned to your lived experiences, cultural preferences, and educational and emotional needs. If you are a member of a minoritized group, a doula whose identity aligns with yours could be a key player in helping you to receive the most fair and empowering treatment possible within and beyond institutions of maternal/reproductive health care.
A Brief History of Doulas and Access
According to the CDC’s National Vital Statistics 2013 report, 98.6% of women in the U.S. give birth in hospitals, surrounded by licensed medical staff and an array of sterilized tools and medications to facilitate the process. But once upon a time, hardly a century ago, births that were facilitated primarily by doulas were the more common (and far more accessible) option.
The option to give birth in a hospital only became mainstream in the 1930s, before which doctor-assisted births were considered luxuries reserved for the upper classes. Doctors became distinguished from midwives because of their medical school training, and this — combined with the fact that doctors were primarily white and male, midwives primarily female and of varying ethnicities — led the public to place more trust in obstetricians and the formal medical institutions that they represented.
Doctor-assisted hospital births became so predominant that other considerations, such as a person’s cultural, financial, or linguistic needs, were relegated to seemingly less important statuses. This potential gap in holistic care prevails to this day: even if a hospital is physically reachable, labor and delivery is a highly vulnerable event where patient advocacy is critical.
Having a member of a care team that considers, incorporates, and preserves the identity-related needs of a birthing parent and their family can minimize stress and improve birth outcomes, and this is where doula care can be an important — and sometimes essential — facet of the birth experience.
There is an abundance of evidence suggesting that doulas can greatly enhance the physical and emotional well-being of parents and infants, some of which can be found in the additional resources below and in Doula Roll Call: Part 1.
Doulas Today
Organizations such as DONA International are leaders in evidence-based birthing support, and they offer a pretty comprehensive search portal that identifies doula training and care programs around the world. There are a number of doula organizations that were founded with the specific cultural practices and needs of racial, ethnic, and gender minority communities in mind, and that are further committed to training doulas from underrepresented populations. If you feel called to learn more about becoming a doula, especially if you are bi/multilingual or identify as a person of color, then consider doing an internet search for culturally sustaining doula education programs near you.
Beyond helping prospective doulas find trainings that match their geographic, financial, and time capacities, pregnant people and their families can use platforms such as DONA International to find birth and postpartum doulas who can meet their needs on their preferred timelines (and who perhaps even match their cultural identities).
The price tags for doulas can range from several hundred to a few thousand dollars, with significant variation based on your city/state of residence and the caliber of services needed. But don’t let these numbers daunt you! Community-based organizations and some hospitals may offer discounted, sliding-scale rates, or free services based on your circumstances. Further, doula services are eligible for reimbursement with flexible spending accounts (FSAs), health reimbursement accounts (HRAs), and even health savings accounts (HSAs). 
The main caveat is that you may need a Letter of Medical Necessity to receive an HSA reimbursement.
With this said, very few states have made the necessary strides to cover doula services within private insurance plans. Without the expansion of private coverage, options for full-spectrum doula care still remain limited for families and communities who might need them most.
The Bottom Line: The physical, emotional, and informational care that doulas provide should not be far-flung luxuries with limited availability. In fact, multilayered and holistic care for pregnant people is a right, and we must make space within the reproductive health realm to support doulas in upholding this right. Overall, doulas are key actors in bridging the gaps in birthing inequities.
Stay safe, stay well!
Those Nerdy Girls
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Additional Resources:
Doulas: Who Are They? (Doula Roll Call: Part 1)
The growing movement to expand private health insurance coverage to include doula care
The National Health Law Program’s Doula Medicaid Project
The Power of Doulas to Improve Health Equity
How can doulas help address racial disparities in care?
The Importance of Inclusive and Affirming Doula Care for the LGBTQ+ Community
Locating the right doula for you via DONA International
Finding financially accessible doula support
**Regional training for prospective BIPOC (racial/ethnic minority) doulas
**Database for finding and connecting with certified BIPOC birth workers across the U.S.
** A quick internet search will reveal several more training programs and databases for minoritized families and birth workers, so don’t feel limited when identifying the services that work best for you!
