The History of Doulas: From Ancient Traditions to Modern Maternal Advocacy
The presence of a supportive, knowledgeable companion during childbirth is far from a new concept. Long before the term "doula" became part of modern maternal care, women across cultures and generations were guiding, comforting, and advocating for one another during labor and postpartum recovery. Today’s doula movement is rooted in that history, and continues to evolve as a response to both personal needs and systemic gaps in healthcare, especially for Black mothers and marginalized communities.
At Enrich Health, we believe that understanding the history of doulas deepens our appreciation for their role in today’s maternal health landscape and highlights why their services are more needed than ever.
Ancient Origins: Women Supporting Women
The word “doula” originates from ancient Greek, where "doulē" meant a woman who serves. In ancient Greece, these women attended to laboring mothers by offering emotional and physical support something still central to the doula's role today.
But the concept of women helping women through birth existed across many ancient cultures. In Africa, Asia, and Indigenous communities, childbirth was rarely a solitary medical event. Instead, it was a communal experience, often overseen by a network of women—mothers, grandmothers, midwives, and traditional birth attendants-who provided guidance, comfort, and cultural wisdom.
These early “doulas,” though unnamed, were trusted figures in their communities. They passed down knowledge through oral traditions and helped normalize birth as a powerful, sacred, and life-giving experience, not just a clinical procedure.
Colonialism, Medicalization, and the Marginalization of Traditional Birth Workers
As Western medicine began to formalize childbirth in hospital settings during the 18th and 19th centuries, traditional practices were often pushed aside or vilified. In the U.S., this shift especially impacted Black midwives and community birth workers, whose roles were devalued in favor of predominantly white, male physicians.
With the rise of obstetrics and hospital births, the focus shifted from personalized support to medical intervention. The emotional and cultural aspects of birth were deprioritized, and women often gave birth in environments where they had little agency or comfort.
During this period, many Black midwives — sometimes called “granny midwives” — continued to serve rural Southern communities. They played an essential role in reducing maternal mortality in underserved populations, despite systemic racism and a lack of formal recognition. Their legacy directly influences today’s Black doula movement, which seeks to reclaim and re-center culturally rooted birth support for Black women.
The Emergence of Modern Doulas in the 20th Century
The term “doula” re-emerged in the 1960s and 70s, thanks in part to the work of medical researchers like Dr. John Kennell and Dr. Marshall Klaus. Their studies showed that continuous, non-medical support during labor led to better outcomes: shorter labor, less need for interventions, and greater maternal satisfaction.
This research helped establish the foundation for the modern doula profession. The 1980s and 90s saw the rise of formal training programs and certification bodies like DONA International, the Childbirth and Postpartum Professional Association (CAPPA), and others, which aimed to professionalize and standardize the role of doulas.
These modern doulas were trained in labor comfort techniques, emotional coaching, birth education, and advocacy, offering consistent support before, during, and after childbirth, while working alongside medical providers.
Doulas Today: Supporting Informed, Empowered Birth
Today’s doulas are more than supportive companions. They are advocates, educators, and protectors of emotional well-being during a time when many women, especially Black women, still face systemic barriers to safe care.
Doulas provide:
Emotional and physical support during pregnancy, birth, and postpartum
Help with birth planning and navigating hospital environments
Techniques for pain management and labor positioning
Support with breastfeeding and early newborn care
A voice when medical decisions feel rushed or unclear
This kind of consistent, patient-centered support can dramatically reduce the need for cesareans, lower anxiety during labor, and improve maternal satisfaction. Studies consistently show that women supported by doulas feel more in control and more respected throughout their birth experience.
Why the History of Doulas Matters for Black Maternal Health
The maternal health crisis in the United States disproportionately affects Black women. Black mothers are nearly three times more likely to die from pregnancy-related complications than white mothers, according to the CDC.
This disparity is not just about access. It’s also about how Black women are treated in the healthcare system, being dismissed, ignored, or not believed. Black doulas and culturally aligned birth workers help close this gap by providing the kind of personalized, respectful care that the system too often fails to deliver.
The modern Black doula movement is deeply tied to historical resistance. It draws inspiration from the wisdom of granny midwives, community aunties, and Black maternal advocates who offered care long before hospitals did and in many ways, with better outcomes.
At Enrich Health, we are proud to support and collaborate with doulas who share our values of equity, advocacy, and compassion.
The Professionalization of Doulas: Training and Certification
While doulas are not medical professionals, many pursue certification through reputable organizations. Programs often include coursework on childbirth physiology, cultural competency, ethics, and trauma-informed care. Certification also typically requires attending a number of live births and submitting client evaluations.
Popular doula certifying organizations include:
Some states — like New York, Minnesota, and Oregon — are now moving toward Medicaid reimbursement for doula care, recognizing its value in improving outcomes and reducing disparities.
Looking Ahead: Doulas as a Standard in Maternal Care
As awareness grows about the power of emotional and cultural support in birth, doulas are increasingly being integrated into hospital and community birth models.
Organizations, nonprofits, and health systems are working to expand doula access for underserved families, especially those in marginalized communities. Meanwhile, Black-led doula collectives and training programs are reclaiming this tradition and restoring it to its roots.
At Enrich Health, we hope to see a future where every pregnant person, regardless of race, income, or background, has access to the kind of care that uplifts and respects them fully.
FAQs: Understanding Doula History and Modern Care
What is the origin of the word “doula”?
The term “doula” comes from the Greek word doulē, meaning "female servant" or "woman who serves." It was adopted in the 20th century to describe trained labor support professionals.
When did doulas become common in the U.S.?
The modern doula movement began in the 1970s, following research that highlighted the benefits of continuous birth support. By the 1990s, doula organizations began formalizing training and certification.
Were there doulas before hospitals existed?
Yes. Across many cultures, women have supported other women during childbirth for centuries. These traditional birth attendants are considered the early versions of today’s doulas.
How are doulas different from midwives?
Midwives provide clinical care (monitoring vitals, delivering the baby), while doulas focus on non-medical support: emotional guidance, advocacy, and comfort techniques.
Are doulas covered by insurance?
Some private insurance plans and Medicaid programs in select states now cover doula services. Coverage varies widely, so it’s important to check with your provider.
Conclusion: Honoring the Legacy, Expanding the Future
The history of doulas is rich, resilient, and deeply rooted in community care. What began as a tradition of women supporting women has grown into a powerful, evidence-based profession that improves outcomes and restores dignity to the birth experience.
At Enrich Health, we recognize that the future of birth care depends on reclaiming what was lost: trust, connection, community, and personalized support. By honoring the role of doulas and offering our patients doula support, especially in Black and marginalized communities, we take another step toward healing, equity, and empowerment in maternal care.
If you're preparing for pregnancy or supporting someone who is, we encourage you to learn more about how doulas — and their legacy — can guide your journey.