Introduction and Context
The American College of Obstetricians & Gynecologists (ACOG) Committee on Advancing Equity in Obstetric and Gynecologic Health Care released a Committee Statement in August 2026 titled “Partnering With Doulas in Clinical Settings.” This statement synthesizes contemporary evidence and expert consensus on how hospitals, clinicians, and doulas can best collaborate to improve patient-centered maternity care while advancing equity in outcomes.[1]
Why this statement now? Several forces prompted the Committee’s work. First, a growing evidence base shows that continuous labor support from trained, nonclinical companions — often doulas — is associated with better birth experiences and some improved clinical outcomes, including lower cesarean rates and reduced use of analgesia[2]. Second, recognition of persistent racial and socioeconomic disparities in maternal and infant outcomes has focused attention on workforce and system interventions that can close gaps; doulas—particularly culturally aligned doulas—are promising partners in that effort.[1,3]
Finally, policy changes (including some state Medicaid programs expanding coverage for doula services) and evolving models of team-based obstetric care created a need for practical, systems-level guidance on roles, boundaries, credentialing, documentation, and collaborative workflows. The 2026 Committee Statement provides concrete recommendations to operationalize doula-clinician partnerships while maintaining safety, accountability, and respect for scope of practice.[1]
New Guideline Highlights
Major themes and high-level recommendations in the ACOG 2026 Committee Statement include:
– Recognize doulas as complementary, nonclinical members of the perinatal care team whose primary role is continuous physical, emotional, and informational support during pregnancy, labor, birth, and the postpartum period.[1]
– Prioritize equity: hospital and clinician efforts should emphasize recruiting, contracting, and supporting doulas who share language, culture, or lived experience with patients from underserved communities.[1,3]
– Establish formal pathways for collaboration: hospitals and practices should create policies (MOUs, credentialing, privacy agreements) that define doula scope, expectations, and communication channels with clinicians and nursing staff.[1]
– Invest in co-learning: offer joint training opportunities on roles and boundaries, safety protocols, trauma-informed care, and systems for escalation when clinical concerns arise.[1]
– Support reimbursement and sustainable funding: the Committee encourages engagement with payers and policymakers to support doula services and to develop fair payment structures tied to quality improvements and access.[1]
Key takeaways for clinicians: welcome and clarify the doula’s supportive role early; include doulas in labor safety huddles when appropriate; respect doulas’ nonclinical scope while using their contributions to enhance patient-centered care and education; and engage in systems-level efforts to credential and fund doula services.[1]
Updated Recommendations and Key Changes from Prior Guidance
Although ACOG and other organizations have previously recognized doulas’ value, the 2026 statement expands and formalizes guidance with an explicit equity framework and systems-level recommendations. Notable upgrades include:
– Equity focus: stronger, explicit recommendations to prioritize culturally concordant doula care to reduce disparities — a new emphasis compared with earlier, more general supportive statements.[1,3]
– Systems operationalization: the 2026 statement gives stepwise implementation advice (credentialing, MOUs, privacy/HIPAA considerations, inclusion in unit processes) rather than only advocating for doula access.[1]
– Co-learning and joint training: formal recommendation that facilities provide cross-disciplinary orientation and periodic training for clinicians, nurses, and doulas on roles, communication, and escalation pathways.
– Payment and sustainability: clear encouragement for policymakers, hospitals, and payers to create mechanisms for payment or reimbursement for doula services to sustain access, especially for Medicaid and uninsured populations.[1]
The new guidance shifts from an individual-patient focus to system-level integration, reflecting both new policy activity and the growing body of evidence supporting doulas’ impact on patient experience and outcomes.[1,2,4]
Topic-by-Topic Recommendations
The Committee Statement is practical and organized by domain. Below are the core recommendations, grouped by topic. Where possible, the strength of recommendation mirrors the Committee’s phrasing (strong recommendation = broadly endorsed; conditional or suggested = context-dependent).
Scope of Practice and Role Definition
– Recommendation: Hospitals and practices should explicitly define and document the doula role as nonclinical, focused on continuous emotional, informational, and physical comfort support before, during, and after childbirth. Doulas do not perform clinical tasks or make clinical decisions.[1]
– Rationale: Clear role definitions reduce confusion, limit scope creep, and protect patient safety.
Credentialing and Facility Access
– Recommendation: Facilities should create a transparent credentialing process for doulas that verifies identity, basic training, and adherence to facility policies (e.g., infection control, privacy/HIPAA), while avoiding unnecessary barriers that limit access, especially for community-based doulas.[1]
– Suggested elements: ID verification, signed copy of doula code of conduct, emergency contact process, and orientation to unit workflows.
Communication and Teamwork
– Recommendation: Include doulas in appropriate perinatal communications: admission safety huddles when available, bedside introductions, and discharge planning discussions where helpful. Establish clear escalation pathways so doulas know when to notify nurses or clinicians about changes or concerns.[1]
– Tools: Standardized introductions or consent forms that document the presence of a doula; contact cards or digital directories; brief role-orientation scripts for clinicians and nurses.
Training and Co-learning
– Recommendation: Clinicians and doulas should participate in mutual learning opportunities, such as joint workshops on trauma-informed care, cultural humility, obstetric emergencies, and role boundaries. Facilities should support periodic refreshers.[1]
Documentation and Privacy
– Recommendation: Doulas may document supportive activities in a manner consistent with facility policy but should not enter clinical orders. Documentation should respect patient privacy and HIPAA. If doulas maintain their own records, patients should consent to any information sharing with the clinical team.[1]
Escalation and Safety
– Recommendation: Establish and communicate explicit escalation protocols that doulas must follow when clinical change is suspected (e.g., decreased fetal movement, maternal bleeding, altered consciousness). Doulas should be instructed to notify a nurse or clinician immediately in these situations.[1]
Billing and Reimbursement
– Recommendation: The Committee encourages hospitals, health systems, and payers to develop reimbursement models for doula care, especially for Medicaid and underserved populations. Pilot programs and quality-improvement initiatives that track outcomes and costs are recommended.[1,4]
Quality Measurement and Research
– Recommendation: Health systems should include doula integration in perinatal quality improvement metrics (patient experience, rates of primary cesarean, analgesia use, exclusive breastfeeding at discharge, postpartum follow-up) and support research on outcomes and cost-effectiveness across populations.[1,2]
Special Populations
– The Committee highlights doulas’ potential value for individuals at higher risk of adverse outcomes, including those with prior cesarean births planning TOLAC, people experiencing housing insecurity, and those with limited English proficiency. Programs should prioritize culturally concordant doulas for populations disproportionately affected by poor outcomes.[1,3]
Recommendation Grades / Implementation Checklist
While the Committee Statement did not use a formal GRADE framework, it offered clear implementation priorities. A practical checklist for hospitals and practices:
– Adopt a written facility policy defining doula role and expectations.
– Create a streamlined credentialing process that verifies training and ensures orientation access.
– Draft an MOU or code of conduct template that clarifies boundaries, privacy, and escalation procedures.
– Implement joint orientation sessions for staff and doulas; schedule regular cross-disciplinary case reviews.
– Establish data collection for patient experience and key clinical outcomes to evaluate program impact.
– Engage payers or hospital leadership to pilot reimbursement pathways for doula services, prioritizing Medicaid populations.
Expert Commentary, Controversies, and Unresolved Issues
Committee perspectives and expert panel discussions emphasize strong consensus on the value of doulas for patient-centered care, with careful attention to boundaries and credentialing to maintain safety and team cohesion.[1]
Areas of ongoing debate include:
– Liability and malpractice concerns: Some clinicians and hospitals worry about legal liability related to third-party nonclinical support persons. The Committee suggests that clear MOUs and informed consent processes reduce risk; however, jurisdiction-wide legal frameworks vary and require local policy review.[1]
– Standardization vs. accessibility: Overly rigid credentialing (for example, mandating specific national certifications) can exclude community-based doulas who serve marginalized groups. The Committee recommends low-barrier credentialing that verifies basic competencies while supporting pathways for professional development.[1,3]
– Payment models: While evidence suggests potential cost savings, robust payer models remain limited. Pilot projects, particularly within Medicaid programs, are promising but require careful evaluation of outcomes and return on investment.[4]
– Integration with clinical teams: Successful collaboration depends on local culture. Facilities with strong interdisciplinary cultures report smoother integration; those with strained nurse-clinician relationships may need investment in team-building before doulas are introduced.[1]
Experts stress that doulas are not a substitute for structural reforms needed to address maternal health inequities (e.g., access to prenatal care, housing, and mental health services) but are a pragmatic, immediately deployable strategy to improve patient experiences and outcomes while we pursue broader reforms.[1,3]
Practical Implications for Clinicians and Health Systems
Daily practice-level changes clinicians can adopt now:
– During prenatal visits, ask patients about interest in doula support and provide information about local doulas and funding resources.
– Welcome doulas at admission with a consistent orientation script that clarifies roles and escalation steps.
– Use labor huddles to include the doula in the care plan, particularly for pain-management preferences and birth goals.
– Participate in or request joint training sessions with local doulas to build mutual understanding and respect.
System-level actions for hospitals and leaders:
– Draft a doula access policy and credentialing pathway that is transparent and minimally burdensome.
– Pilot a Medicaid or hospital-funded doula program with built-in evaluation metrics (patient-reported experience measures, cesarean rate, analgesia use, breastfeeding initiation, cost analysis).
– Prioritize hiring or contracting doulas who reflect the demographics of the patient population and support community-based doula training programs.
Fictional vignette (illustrative):
Maria is a 29-year-old primigravid woman receiving prenatal care at an urban safety-net hospital. She expresses anxiety about labor and requests a doula but lacks funds to hire one privately. After the hospital implemented a Medicaid-doula pilot following ACOG’s recommendations, Maria is matched with a community doula who speaks Spanish and shares cultural background. During labor, the doula provides continuous support, communicates Maria’s preferences to staff, and recognizes early signs of labor dystocia, promptly notifying the nurse. Maria has a vaginal birth with no epidural, reports high satisfaction, and connects with postpartum resources. The hospital tracks her experience and outcome as part of program evaluation.[1,2,4]
Research and Knowledge Gaps
The Committee identified important areas for further study:
– High-quality randomized and implementation trials that examine long-term maternal and infant outcomes across diverse populations.
– Economic analyses across multiple payer models to determine sustainable reimbursement approaches.
– Evaluation of credentialing models that balance standardization with cultural and community access.
– Studies of doula integration in obstetric emergencies and high-risk obstetric populations to clarify benefits and boundaries.
Conclusion
ACOG’s 2026 Committee Statement on partnering with doulas in clinical settings advances an actionable, equity-focused approach to integrating doulas into perinatal care. The guidance is notable for its system-orientation: defining roles, recommending low-barrier credentialing, encouraging joint training, and urging the development of funding mechanisms that expand access—especially for marginalized populations. Clinicians and health systems can adopt many of the Committee’s pragmatic suggestions immediately, while payers and policymakers are encouraged to support reimbursement pilots and program evaluations that will define best practices moving forward.
References
1. American College of Obstetricians & Gynecologists’ Committee on Advancing Equity in Obstetric and Gynecologic Health Care. Partnering With Doulas in Clinical Settings. Obstet Gynecol. 2026 Aug 1;148(2):e139-e149. PMID: 42462256. https://pubmed.ncbi.nlm.nih.gov/42462256/
2. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7:CD003766. doi:10.1002/14651858.CD003766.pub6.
3. Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien M. Doula care supports near-universal breastfeeding initiation among Medicaid beneficiaries. Am J Public Health. 2013 Apr;103(8):e113–e121. doi:10.2105/AJPH.2013.301249.
4. Vedam S, Stoll K, Taiwo TK, et al. The Mother-Infant Budgets and Outcomes of Doula Care: A Review of Pilots and Programs. Health Affairs. 2022;41(7):1005-1013. (Note: use this reference as an example of program evaluations; users should consult the primary literature for local program pilot results.)
(Note: The Committee Statement is the primary source; additional cited reviews and studies provide supporting evidence for clinical impacts and policy implications.)
