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From Silence to Support: How Doula Care Can Destigmatize Maternal Mental Health

Motherhood is often framed using this narrative of a “strong mother”—of self-sacrifice, resilience, perseverance, and unwavering devotion. They are expected to give endlessly, to find joy in every sleepless night, and to cope quietly with the unexpected realities of their new identity. While this narrative is often celebrated and even romanticized, it leaves little room for acknowledging the very real mental health challenges that many birthing people face.

Doula Therapist Care And Treatment

In reality, maternal mental health conditions are incredibly common, with one in five birthing people experiencing a perinatal mood and anxiety disorder (PMAD) such as depression, anxiety, post-traumatic stress disorder, and psychosis.1 Among communities of color, these numbers are even more alarming, as Black and Indigenous individuals are more likely to experience maternal mental health issues but less likely to receive care.2 Despite its prevalence, maternal mental health remains shrouded in silence and shame. New parents are expected to push through their struggles, perpetuating this harmful belief that seeking help is a sign of weakness or failure.

Recently, there has been a shift towards integrating maternal mental health support in non-traditional healthcare settings. In particular, doulas have become powerful allies in improving maternal outcomes by providing emotional, educational, and physical support during pregnancy, childbirth, and the postpartum period. In fact, a 2022 study by Falconi et al. showed that women who received doula care during childbirth had roughly half the odds of postpartum depression or anxiety compared to those who did not receive doula care.3 As non-clinical professionals, doulas are uniquely positioned to close gaps in maternal mental health care by destigmatizing conversations and normalizing help-seeking.

How Doulas Can Help Destigmatize Mental Health4

  1. Creating safe spaces for expressing vulnerability: Oftentimes, birthing individuals are reluctant to admit that they’re struggling out of fear of being dismissed or labeled as a “bad parent.” By building close, trusting relationships that are rooted in open communication and respect, doulas create spaces where birthing individuals feel supported enough to share their fears and worries without judgment.
  2. Raising awareness and providing education: Doulas can help address myths and misconceptions around maternal mental health conditions by educating birthing individuals on what to expect during the perinatal period. For example, hormonal dips following childbirth can lead to mood swings, exhaustion, and feeling overwhelmed—commonly known as the “baby blues.” These changes are typical during the first two weeks, although they can escalate into serious mental health conditions.5 Especially in communities of color where conversations around mental health can be taboo, doulas can normalize these experiences, reducing fear and shame. Doulas are also knowledgeable about available mental health resources and can connect birthing individuals to licensed professionals, support groups, and crisis interventions, reducing barriers to care.
  3. Recognizing early warning signs: In perinatal settings, screenings for mental health conditions are widely inconsistent and vary in frequency, implementation, and follow-up. Unlike clinical providers who have limited time with patients, doulas interact with birthing individuals longer and more frequently throughout the perinatal period and can assist with identifying early signs of mental health issues, such as intrusive thoughts, loss of interest in activities, and withdrawal from family and friends, as well as referring them to timely, appropriate services.
  4. Advocating for culturally responsive, person-centered care: Doulas play a vital role as advocates for birthing individuals, ensuring that their voices, needs, and concerns are heard and respected. This is especially important for historically marginalized communities, such as Black and Indigenous groups, that have experienced systemic racism, discrimination, and mistrust in medical institutions.6 Doulas understand that different stigmas affect specific communities, and by providing culturally responsive support, they ensure that an individual’s background, beliefs, and lived experiences are recognized and reflected in their care.
  5. Supporting partners and families: In addition to supporting birthing individuals, doulas can also provide education and support to partners and family members. Doulas can offer guidance on how to recognize warning signs, facilitate conversations around mental health, and provide emotional support to their loved ones. By including partners and family members in these discussions, doulas can strengthen a birthing individual’s support network, ensuring that they receive the help they need.

The State of Doula Care in the U.S. and New York State

While the benefits of doula care are well-established, there is still much work to be done in making it accessible and affordable for all. As of April 2025, roughly half of U.S. states require or are in the process of implementing doula care coverage for Medicaid members, while several states are working to implement coverage in private insurance plans.7 In New York, there have been significant strides to increase access to doula services. Launched in 2018, the Doula Services Pilot Program laid the groundwork for Medicaid members to receive doula care at no cost.8 Currently, all New York State Medicaid enrollees are eligible to receive doula services (up to eight visits) during pregnancy and for 12 months postpartum. In addition, enrolled doulas are reimbursed by fee-for-service up to $1,500 in New York City and $1,350 in the rest of the state. More information regarding the Medicaid doula care benefit can be found here.

Despite recent progress, greater efforts are needed to expand doula services across New York. Nearly half of the births statewide are covered by Medicaid, yet in April 2025, there were only 214 Medicaid-enrolled doulas, most of whom are concentrated within the New York City and Buffalo regions, leaving more rural areas underserved.9, 10 In addition, policymakers and insurers need to work together to mandate coverage under private plans, ensuring that all birthing individuals—not just those enrolled in Medicaid—have access to doula services. Lastly, all healthcare and social support providers have a duty to educate their patients about doula services, particularly the availability of the NYS Medicaid doula benefit. Doulas are vital in reshaping the current state of maternal mental health, and expanding access is a powerful step towards destigmatizing mental health conditions and improving outcomes for all.

Isabella Hou, MPH (she/her), is a Project Coordinator within the Office of Prevention and Health Initiatives at the New York State Office of Mental Health. She can be reached via email at isabella.hou@nyspi.columbia.edu.

References

  1. Clarke DE, De Faria L, Alpert JE, The Perinatal Mental Health Advisory Panel, The Perinatal Mental Health Research Team. Perinatal Mental and Substance Use Disorder: White Paper. Washington, DC: American Psychiatric Association; 2023 [Available from: https://www.psychiatry.org/maternal].
  2. Hill L, Rao A, Artiga S, Ranji U. Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. KFF. October 25, 2024. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/.
  3. Falconi AM, Bromfield SG, Tang T, et al. Doula care across the maternity care continuum and impact on maternal health: Evaluation of doula programs across three states using propensity score matching. EClinicalMedicine. 2022;50:101531. Published 2022 Jul 1. doi:10.1016/j.eclinm.2022.101531.
  4. 6 Ways that Doulas Can Support Maternal Mental Health. MMHLA. August 12, 2024. https://www.mmhla.org/articles/six-ways-doulas-can-support-maternalmentalhealth.
  5. Carlson K, Mughal S, Azhar Y, et al. Perinatal Depression. [Updated 2025 Jan 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519070/.
  6. Quiray J, Richards E, Navarro-Aguirre Y, et al. The role of doulas in supporting perinatal mental health – a qualitative study. Front Psychiatry. 2024;15:1272513. Published 2024 Feb 29. doi:10.3389/fpsyt.2024.1272513.
  7. Herbert K. Private Insurance Coverage of Doula Care: Spring 2025 State of the States. April 21, 2025. https://healthlaw.org/private-insurance-coverage-of-doula-care-spring-2024-state-of-the-states/.
  8. New York State Doula Pilot Program. New York State Department of Health. https://www.health.ny.gov/health_care/medicaid/redesign/doulapilot/index.htm.
  9. Births Financed by Medicaid by Metropolitan Status. KFF. https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/.
  10. Medicaid Doula Services Town Hall. New York State Department of Health, Office of Health Insurance Programs, Bureau of Maternal and Child Health Policy. May 13, 2025. https://www.health.ny.gov/health_care/medicaid/program/doula/docs/town_hall/2025-05-13.pdf.

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