xFor pregnant families, a hospital might be the obvious choice for care during the moments before, during, and after delivery. For Black families who have been unfairly treated in these facilities, hospitals are becoming the last choice, while alternatives such as doulas are becoming increasingly sought after. Doulas —non-medically trained professionals who provide prenatal, labor, and postpartum emotional and physical support to expectant moms– have been in existence since before slavery and were pivotal to safe and healthy labor. Today, widespread communities are reflecting on their ancestral roots during pregnancy care to safeguard moms and families from racial disparities that shadow traditional health facilities. During Black Maternal Health Week, we are highlighting the brave hands that advocate for Black life during its most precious moments. 

Approximately 3.6 million women give birth each year in the United States, and nearly 98% of those births occur in hospitals, according to the Centers for Disease Control. On the contrary, there were reportedly 2,232 registered doulas in the U.S. in 2025, while California led with 7.5%, as cited by The Conversation. That’s roughly 167 doulas for the 395,295 babies predicted to be born that year in California, according to a birth report from the state’s Department of Finance. In another 2024 report cited by Bornbir—an online hub that connects families with pregnancy and postpartum care—approximately 6%- 10% of expectant mothers used the services of a doula.

As demand for doulas grows, a shift is evident. In 2024, “499 doulas and 37 doula groups had registered their services with Medi-Cal providers in California,” as reported by the National Health Law Program. Then in 2025, the California Healthcare Foundation determined that, “66% of Black women prefer doula care, including 27% who say they would ‘definitely’ want doula support for their next birth.”’

As of March 2025, Medi-Cal has registered 1,354 doulas. 

For Keesha Hernandez, 40, a full-spectrum doula, she met the demand head-on during the COVID-19 pandemic after members of her family complained about unfavorable healthcare experiences. 

“I knew this was for me, and I was going to fight for families in medical spaces, as well as helping families to know that they can have informed decision-making at home and in birth centers,” she says on her decision to become a doula.

Still, for those considering a doula for the first time, it might be challenging. Hernandez says it's a decision grounded in quality of care that is respectful and humane for all parties involved.

Hiring a doula means “that you will be seen [and] you will understand what you want to do with your birth, your pregnancy, and even with your postpartum,” Hernandez explains. “A doula means that you can make choices that are informed, and you can lean on the support of doctors, midwives, and doula birth workers to help you make choices.

As Hernandez puts it, “A doula means liberation, freedom, and resilience in spaces that were not made for us.”

While hospital environments become more dismal for Black families who face systemic hurdles there, doulas are not anti-hospital care. Instead, their approach is client- and patient-centered, with support from medical staff to achieve the best possible outcomes.

“People think that doulas are going into the hospital space with their client and not listening to doctors or not taking a collaborative care approach,” she says. “That's not true. Doulas are coming into spaces, leaning on the support and medical expertise of nurses and doctors.”

During her six years in the birth space as a doula between New York and California, Hernandez’s perspective on life has been impacted. As she graciously helps bring new life, her own life has blossomed. 

“This line of work has had me questioning my whole life. The way that I see myself and the way that I connect with my family. I've had so much healing with my mother because of this job. I've had so much connection to my grandmother,” Hernandez says. “So it's been a beautiful expression of life on this path.”