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Massachusetts is engaged in new efforts to increase access to doula support services, particularly in communities of color. The Betsy Lehman Center for Patient Safety conducted a survey of practicing doulas and hosted focus groups with both doulas and consumers to help inform those efforts. This report summarizes the information and perspectives shared with the Center.


  1. Doulas perform a valuable service and both doulas and consumers cite numerous potential gains from an expansion of services in Massachusetts.
  2. Massachusetts has a foundational group of experienced, dedicated doulas on which to build a more robust network of community-based practitioners.
  3. Doula support services are largely paid out of pocket, making it difficult for doulas to keep costs affordable for consumers while also earning a living wage.
  4. In addition to economic barriers, other factors that complicate efforts to expand use of doula services include workforce development issues and consumers’ lack of familiarity with doula services.
  5. Doulas and consumers call for accessible, equitable doula support services, and a commitment from the health care system to explicitly address racism and discrimination in birthing care.
  6. Limitations of and expense associated with current training and certification standards must be addressed, particularly for doulas who will work with Black birthing people
  7. Credentialing and compensation decisions will impact the effectiveness of proposals to expand access to doula support services.