More women are getting support through a doula, especially during the postpartum period, which can last up to one year after the birth of their child. But what support do these professionals provide?
A doula focuses on helping women before, during, and after childbirth.
For Rikki Chapman, CHW, a certified doula and community health worker in New Hampshire’s North Country, being a doula is about giving consistent, reliable support to mothers, often during that postpartum period, which she says can be a particularly vulnerable time.
“I’m asking moms, ‘Do they need help with any housework, what is overwhelming them?’ Helping could be something as simple as walking with them to pick up their mail or watching their baby while they nap. I want mothers to feel supported, have the help they need, and make sure their mental health is okay,” says Chapman, who’s part of the Doula CONNECT program provided by New Hampshire's North Country Health Consortium (NCHC).
And while doulas are not medical professionals, they are in demand at a time when many obstetric units are closing across the country, which can lead to longer travel times to receive care and increase the feelings of isolation that mothers may feel.
“Having someone who can visit you in your home, provide education and emotional support can make women feel less alone,” says Chapman’s Doula Connect supervisor, Rebecca Hill-Larsen, CHW, who also works as the network coordinator for the New Hampshire Rural Maternity and Obstetrics Management Strategies (RMOMS).
In 2023, Dartmouth Health received a four-year grant from RMOMS to improve outcomes for pregnant and parenting mothers in New Hampshire’s North Country.
“Doulas can recognize mental health concerns and make referrals for appropriate, accessible care,” says Hill-Larsen.
Here is how Hill-Larsen, Chapman, and other experts say doulas can help women and why they are so important postpartum, especially in rural America.
Doula demand is growing
More moms are seeking doula services, with demand expected to increase by 8% from 2026 - 2033, according to this report. The postpartum doula segment is showing the most rapid growth. “These moms often need help,” says Chapman. “It can be a very isolating time.”
That sense of isolation can feel especially pronounced as the country’s hospitals become increasingly strained and mothers are having to travel greater distances for medical care.
According to a study in the journal Health Affairs, seven states and federal districts (Iowa, West Virginia, Washington, D.C., Rhode Island, Pennsylvania, South Carolina, and Oklahoma) saw at least 25% of their hospitals close obstetric units between 2010 and 2022.
Since then, closures have only risen, especially in rural hospitals. This study in 2022 estimated that half of all rural counties already lacked obstetric units. Between 2022 and 2025, more than 80 rural hospitals closed their labor and delivery units due to a range of factors, including inadequate insurance reimbursements, workforce shortages, unsustainable costs, declining birth rates, and shrinking rural populations.
In 2024, more than 2.3 million women between the ages of 15 and 44 were reported to live in counties with neither an obstetrician nor labor and delivery services.
How a doula helps new moms in rural America
A doula is non-clinical. That means their role does not involve medical observation, medical diagnosis, or medical treatment. They do not deliver or treat babies, and don’t replace or provide medical care for the mother or the baby.
Doulas can, however, lend a helping hand and provide a sympathetic ear.
“Our experience is that there is more interest in doulas in rural areas than there are doulas to serve them. Rural doulas can be local to a population, providing support close by or even in their home during pregnancy and the postpartum period. Postpartum doulas see their clients more frequently than their medical provider, and they can alert their clients to call their providers if something needs further medical attention,” says Hill-Larsen.
Connecting with a doula can be particularly important for a new mother, given that most typically have only one routine postpartum visit with their provider around six weeks after birth, and some may not be able to make even that visit if their maternal care is far away. In addition, given that about one in seven mothers develop postpartum depression, having a doula who can spot the signs of postpartum depression can be a lifesaver.
How Chapman works
As a certified doula, Chapman completed a training workshop, gained hands-on experience, and passed an exam that tests her knowledge of labor physiology, prenatal and postpartum care, comfort measures, and ethical boundaries. While doulas are not legally mandated to practice with certification, most state agencies and Medicaid programs require it.
For Chapman, most of her time is spent with mothers who remain with her as clients for up to a year after their child’s birth. During that time, she makes it her mission to ensure that the mother feels supported. She keeps lines of communication open, checks in over texts, and makes home visits.
The fact that many mothers engage Chapman after the birth of another child is not surprising to her. She has seen firsthand what the research suggests, namely that doulas can make a big difference in how a mother feels, particularly postpartum.
Findings in reviews like this one of 22 articles describing 21 unique studies are what Chapman witnesses almost daily. Doula care reduces maternal anxiety and improves breastfeeding initiation. Emerging evidence also shows that postpartum medical follow-up is better when a doula is involved.
“Our doula CHWs visit new mothers at home, which is so convenient in those first six weeks when getting out the door feels impossible. We continue to visit for up to 12 months postpartum. It is the visits after the friends and family have gone back to their lives that are so impactful, doubly so if there is no local family,” says Hill-Larsen.
Like other doulas in her network, Chapman is also trained as a community health worker, meaning she has deep knowledge of community resources and can screen for social drivers of health, like transportation barriers and food insecurity.
"There are not many other trips to the hospital that we take where we come home and you have a wound the size of a dinner plate from where the placenta pulled away and society says, 'Hey, not only are you gonna take care of yourself, we're gonna give you a tiny human to take care of too. Good luck. I think we're finally realizing that's kind of ridiculous,” says Hill-Larsen. “We need to be providing mothers the support they need. In rural communities, that support can be particularly hard to get.”
How to get a certified doula
Doulas are certified through organizations like CAPPA (Childbirth and Postpartum Professional Associaiion) or Dona, where you can search for doulas and verify their credentials. There are also location-based platforms like Doulamatch, Bornbir, or Meela. New Hampshire has a voluntary state certification process through the Office of Professional Licensure (OPLC). Local New Hampshire doula options include Holistic Birth and Beyond and Black Lives Matter NH, along with Doula CONNECT.
Many people find doulas through referrals from their obstetrician, midwife, birth center, neighbor, or friends. Nonprofits and federally-funded programs like NCHC's Doula CONNECT are also doing their part to provide needed support for expecting and postpartum mothers.
If you are looking for a private postpartum doula, these services can average $25 to $50 an hour and cost up to $75 to $85 in some metropolitan areas. The good news, though, is that according to the nonprofit KFF health network, more than 30 states now reimburse–or are working to reimburse–doula services through Medicaid or other programs.
Private companies, such as UnitedHealthcare, are also rolling out employer-sponsored doula benefits.
And if you’re an expectant mother or one who has just given birth, living in the catchment served by NCHC (primarily Coos County and North Grafton County), there is even better news: the doula services through Doula CONNECT are provided at no cost.
Additional Resources
- Find out more about midwives and how they are working together with obstetricians in southern New Hampshire.
Learn more about NCMN in this article in Vitals Magazine.
