From Healers to Healthcare: Reclaiming Black Birth Traditions in Clinical Spaces
A doula's perspective on why hospital integration must honor ancestral wisdom while transforming modern maternity care
When a doula walks into a hospital labor and delivery unit, they carry more than a rebozo and essential oils. They carry centuries of Black birth wisdom, traditions of midwifery, herbal medicine, and community care that sustained our people long before the medicalization of childbirth attempted to erase them.
The work of integrating doulas into clinical settings isn't just about improving birth outcomes, though the evidence for that is clear. It's about reclamation. It's about resistance. It's about restoring what was systematically stripped away from Black birthing people and recognizing that the path to equitable maternal health runs directly through the traditions we never should have lost.
The Theft of Black Birth Traditions
The medicalization of childbirth in America didn't just change how babies were born. It deliberately dismantled Black midwifery and traditional birth practices, replacing community-centered, culturally-grounded care with a system built on white supremacy and patriarchy.
Black midwives and doulas were once central to the birthing experience. They brought herbal medicine, traditional practices, spiritual guidance, and deep knowledge passed down through generations. They spoke the language of the birthing person and the language of the baby being born into the world. They understood that birth wasn't just a medical event but one that is a sacred transition, a community celebration, a moment of profound vulnerability that required trust, respect, and cultural knowing.
Structural racism systematically pushed these healers out. Licensing requirements they couldn't access. Hospitals that wouldn't credential them. A medical establishment that labeled their wisdom as "primitive" while appropriating their knowledge. The result? Black birthing people were left navigating a system that neither understood them nor valued their lives.
Today, we see the consequences in the numbers: Black women are three to four times more likely to die from pregnancy-related causes than white women (Hoyert, 2025). Even after adjusting for education, income, and health status, the disparities persist. And one of the most glaring examples? Black birthing people are 25-75% more likely to undergo unnecessary cesarean sections, even when clinical risk factors are identical to their white counterparts (Schnell et al., 2025).
Why Doulas Are More Than Support; They're Healers
When I work with a Black birthing person, I'm not just providing "continuous labor support," though that's how the medical literature might describe it. I'm creating a bridge, between biomedicine and ancestral practice, between a fractured system and a whole person, between fear and joy.
Here's what that actually looks like:
I translate. Not just medical jargon into plain language, but cultural context into clinical conversations. When a provider rushes toward intervention, I help my client understand their options and articulate their preferences in ways the medical team will hear.
I advocate. When a Black birthing person says "something doesn't feel right" and is dismissed, which happens far too often, I amplify that voice. I make sure they are seen, heard, and respected in a system that has historically done none of those things.
I restore agency. In a labor room where everyone else has medical degrees and institutional power, I remind my client that this is their birth, their body, their baby. I help them reclaim decision-making power in a space designed to strip it away.
I hold space for joy. Yes, joy. Because despite the narratives of trauma and crisis that dominate discussions of Black maternal health, birth can and should be a moment of profound celebration. My presence says: You deserve to feel empowered. You deserve to feel cared for. You deserve to experience this transition with dignity and delight.
This is the work our ancestors did. And this is what gets lost when hospitals treat doula care as a "nice-to-have" instead of essential.
The Evidence Is Clear: Doula Care Works
The research backs up what Black communities have always known. Among Medicaid beneficiaries, the population most vulnerable to poor maternal outcomes, those who received doula care had 22% lower odds of cesarean delivery compared to matched controls (Kozhimannil et al., 2013).
But here's what the numbers don't capture: the hand-holding during contractions, the reassurance when panic sets in, the fierce protection when a provider suggests an unnecessary intervention, the postpartum visit where we process the birth together and I help connect a new parent to community resources they need.
Doula care works because it addresses what the medical model ignores: relationship, trust, cultural safety, and continuous support.
What Integration Actually Requires
If we're serious about integrating doulas into hospital settings, and we should be, we need to be equally serious about doing it right. That means more than just "allowing" doulas into labor rooms or offering a list of "approved" doulas to patients.
Real integration means:
1. Early Connection and Continuity
The relationship between doula and client can't start when labor begins. In the model I designed for my doctoral work, doulas meet clients before 20 weeks of pregnancy. We build trust over time through regular prenatal visits, not just teaching breathing techniques, but helping clients build their full care network, navigate insurance, address social needs, and develop a birth vision that centers their values and preferences.
By the time we walk into that labor room together, I'm not a stranger. I'm someone they trust implicitly.
2. Cultural Concordance
This matters. A lot. When possible, Black birthing people should be matched with doulas who share their racial identity, language, and cultural background. This isn't about excluding anyone from birth work, it's about recognizing that trust and communication improve when there's cultural alignment, especially for communities that have been harmed by medical systems.
Research confirms this: culturally concordant care improves patient satisfaction, increases engagement, and strengthens outcomes. It allows for shorthand, shared understanding, and the kind of deep relationality that transforms a clinical encounter into true support (Karbeah et. al, 2022).
3. Respect Within Clinical Teams
Doulas shouldn't have to fight to be in the room. We shouldn't have to prove our value or defend our presence. Hospital integration means that labor and delivery staff understand that doulas are part of the care team, with a specific, evidence-based role that complements (not competes with) clinical care.
This requires education. Lunch-and-learns for providers. Protocols that explicitly include doula participation in care planning. Communication structures that ensure we're looped in, not left out.
4. Sustainable Compensation
Birth work is labor. Sacred labor, yes, but labor nonetheless. For doula integration to be sustainable, especially in communities most impacted by maternal health inequities, there must be Medicaid reimbursement and other payment structures that don't leave doulas choosing between financial stability and serving those who need us most.
Right now, only a handful of states reimburse doula care through Medicaid. That needs to change everywhere.
5. Addressing Provider Bias Simultaneously
Empowering Black birthing people through doula support isn't enough if we don't also address the provider bias and systemic racism causing the harm in the first place.
Integration must include provider education on racial disparities, implicit bias training that goes beyond checkbox exercises, and quality improvement initiatives that standardize care protocols and reduce opportunities for bias to influence decision-making.
In our program design, we propose mandatory second opinions before non-emergency cesarean sections for first-time birthing peopl, a practice that has successfully reduced unnecessary C-sections in other countries without compromising maternal or infant safety. We propose "Lunch & Learn" sessions where providers hear directly from Black birthing people about their experiences. We propose quality improvement bundles that create clear, equitable protocols.
Doulas can advocate all day, but if the system itself remains broken, we're just putting band-aids on bullet wounds.
This Is About More Than Birth Outcomes
Yes, I care about reducing unnecessary C-sections. I care about lowering maternal mortality rates. I care about preventing complications and improving clinical metrics.
But I also care about something the medical model often forgets to measure: how Black birthing people feel about their births.
Do they feel heard? Respected? Empowered? Safe? Joyful?
Or do they feel rushed, dismissed, coerced, traumatized?
A Black birthing person who has an unplanned C-section but feels fully informed, supported, and respected throughout the process will have a fundamentally different experience than someone who feels their body was taken over without their consent.
This is what doulas protect. Not just physical outcomes, but dignity, agency, and the opportunity to experience one of life's most profound transitions on one's own terms.
The Invitation
Integrating doulas into hospital settings is an act of resistance against a medical system that has harmed Black birthing people for generations. It's a reclamation of traditions that should never have been stolen. It's a recognition that healing requires more than clinical interventions, it requires relationship, trust, cultural safety, and the wisdom of those who have been doing this sacred work since long before hospitals existed.
For healthcare systems willing to do this work authentically, not performatively, the evidence is clear and the path is mapped. Partner with Black doulas and birth workers. Compensate them fairly. Respect their expertise. Include them as full members of the care team. Address provider bias head-on. And center the voices, values, and visions of Black birthing people in every decision.
For my fellow doulas, particularly those of us who are Black: We are not just providing a service. We are carrying forward an ancestral lineage of healers. Every time we step into a clinical space, we bring our grandmothers and great-grandmothers with us. Every time we help a Black birthing person reclaim their voice in that labor room, we are healing wounds that go back generations.
This work is both sacred and strategic. It's grounded in love and evidence. It's about individual births and systemic transformation.
And it's absolutely essential to achieving the birth justice we all deserve.
Theresa Alphonse, MPH is a doula and public health scholar focused on maternal health equity and birth justice. She designs evidence-based programs that center Black birthing people and integrates traditional birth practices into clinical settings.
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