A Doula’s Reaction to ACOG Statement Number 31
The American College of Obstetricians and Gynecologists recently released Committee Statement Number 31 on partnering with doulas in clinical settings, offering a clear and long-overdue endorsement of our collective work.
The document validates much of what we champion at Global Doula Project: doulas provide essential, non-medical, evidence-based support across the full spectrum of life’s major transitions. In our organization, we embrace birth, postpartum, loss, and death doulas alike because we believe no one should navigate transformational life events alone.
There is so much in this statement that I can genuinely celebrate and appreciate. I was thrilled to see ACOG explicitly acknowledge that while much of the available data centers on labor support, the proven benefits of doulas and the committee’s recommendations apply to various types of doulas across the entire continuum of care. This is a massive win for full- spectrum advocacy. We also deeply appreciate ACOG’s thoughtful discussion on multiple pathways into the profession. By affirming that a lack of formal certification does not make someone unqualified, the college honors traditional, community-rooted, and ancestral birth traditions that provide invaluable insight into local birth culture.
Seeing ACOG recommend that clinicians welcome doulas into patient appointments, issue identification badges so doulas are treated as valued team members rather than mere visitors, and establish channels for mutual issue resolution shows an encouraging commitment to real collaboration.
I especially appreciate the conflict resolution point as much of my recent work has been focused on restorative justice approaches to birth and reproductive healthcare.
Despite these positive statements, reading ACOG’s recommendations leaves an obvious question: OBGYNs should do these things, but will the systems they exist within actually allow them to?
The article states that obstetrician-gynecologists should create synergistic, respectful teams that include doulas in ways that benefit patients and the workplace. While the recommendation itself is sound, directing these expectations toward individual clinicians misses the mark. Clinical staff are already severely stretched thin, which is part of the reason doulas and support teams are so desperately needed in the first place. Hospital and office policies frequently restrict OBGYNs and midwives from connecting with outside organizations. Expecting a busy doctor to plan collaborative outreach assumes they have a capacity they simply do not possess, and believing they can do it on their own will keep healthcare stuck in its current pattern.
The systems we operate within restrict collaboration, not the individual providers. ACOG provides a list of what clinicians should do, but fails to answer how to do it within current institutional frameworks. Real solutions require practice managers and administrative leaders to step up and build structural bridges. For instance, a practice manager could easily schedule and host a doula luncheon with the birth center team, taking that administrative burden off the clinical staff. Medical offices could also utilize their waiting rooms to educate patients by playing videos about the full spectrum of doulas. They do not even have to take on the burden of creating those themselves. Initiatives like the 4th Trimester Project offer great waiting room videos. Content featuring content that covers full-spectrum care would ensure inclusivity for all patients entering an OBGYN space, including those in need of fertility, abortion, loss, or bereavement support.
Systemic friction also complicates the practical implementation of doula access and Medicaid integration. One encouraging shift we have seen is Medicaid pregnancy care navigators actively referring patients to doulas, likely because doula support is now a recognized benefit and navigators can connect clients with vetted providers. However, major administrative hurdles persist. Birth workers attempting to utilize these programs face delayed reimbursements, claim denials, and confusing third-party billing vendors.
Hospitals often respond to calls for integration by establishing institutional screening or credentialing programs, but these measures frequently morph into costly pay-to-access vendor systems. Treating independent doulas like commercial medical representatives forces small-business birth workers to pay annual registration fees ranging from $100 to over $300, submit to drug screenings, and navigate third-party compliance software like Symplr or Vendormate. These fees destroy profit margins for sole proprietors and disproportionately price out community-based doulas who serve low-income, Black, and Indigenous families. It is a stark double standard that hospitals enforce these commercial entry barriers on non-clinical support personnel while requiring no such fees or background checks for a patient’s family member or partner.
These contemporary institutional barriers directly mirror the historical pushout of Black “granny midwives” in the early twentieth century.
When state regulation and licensure pathways were introduced under the guise of safety and standardization, they were intentionally structured to be expensive, exclusionary, and aligned with white-led medical institutions. Traditional Black midwives, who held generations of ancestral knowledge and served their communities with deep devotion, were systematically priced out, delegitimized, and legislated out of existence. Today, when health systems and states mandate costly compliance platforms, expensive certifications, or rigid accreditation models that ignore community mentorship, they repeat this exact pattern of institutional gatekeeping. Enforcing a single, medicalized standard of legitimacy risks erasing culturally rooted birth workers and severing marginalized families from the advocates who understand them best.
Ultimately, the burden of navigating these rigid systems falls entirely on the doulas themselves. Doula trainings routinely teach birth workers to familiarize themselves with local birthing centers, take childbirth education classes, or bring muffins and business cards to the nursing station to introduce themselves. Meanwhile, hospital staff are rarely encouraged to reach out and familiarize themselves with community practitioners.
Doulas are forced to tread lightly, adjust their approach, and avoid creating waves because the risk of getting banned means losing the ability to support clients birthing at that facility.
While ACOG’s vision of mutual respect is a welcome conversation starter, true collaboration cannot happen until healthcare systems stop requiring doulas to do all the adapting, dismantle administrative gatekeeping, and actively adjust their own structures to welcome community birth and death workers as equal partners in care.