In 2023, 3.6 million births occurred in the United States, while nearly 98% of those births took place in hospitals, the Centers for Disease Control reported. But for some women, the thought of putting their health in the hands of a medical facility is their worst fear. For Black women, the thought alone can be anxiety-inducing. From medical malpractice to birth inequity, hospital births are becoming the last resort for an increasing number of Black households as doulas stand in the gap. By securing the expertise of a doula, families are regaining hope for their future through the safekeeping of sacred hands. 

For some, the decision to hire a doula—a non-medically trained professional in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth, as reported by the American Pregnancy Association—isn't solely about avoiding a hospital; it’s a decision rooted in Black history, while towering empowerment, heritage, and peace of mind. In a 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.

While doulas are gaining notoriety, the concept isn’t new. During slavery and the decades thereafter, Black families enlisted the help of midwives and doulas during labor, leading these services to be deemed essential for family planning. For those who entrusted their health to doulas, a keen sense of safety and liberty ensued during the labor process and postpartum. In the present day, that sanctuary remains, as some women are taking no chances of systemic inequities, such as not feeling seen or heard, or mortality due to the lack of quality care.

“My biggest reason for wanting to do it differently now is that I actually know better. I understand more. If you don’t know, the hospital is not going to tell you,” says mom-to-be Jazmin Culver, 33, who is five months pregnant with her third child, about her decision to hire a doula. “I have the choice now to decide how my labor goes [and] how my delivery goes. I want to take all the choices that I can to save my life.”

Obtaining the help of a doula resulted from reflecting on the birth of her first child, a traumatic ordeal that disturbs her. Culver —who works as a full-spectrum doula and a certified lactation consultant— suffered an emergency cesarean section because her child was ten days overdue. During her nearly week-long hospital visit, she also needed three bags of blood for a transfusion. After the birth of her child, the infant spent over two days in the Neonatal Intensive Care Unit (NICU).

“That was a lot for a first birth,” Culver says, who ultimately labored for about 26 hours before an epidural was offered. 

While in the hospital during the labor of her first child, she says the unpleasant experience was perpetuated after medical staff neglected to provide essential information that could have promoted the labor process, such as walking or using a medicine ball.

“It wasn't well-informed. It wasn't kind,” she recalls.

Culver also had another cringe-worthy incident with a Black nurse who was “just very dismissive” during her hospital stay.

While needing to have a bowel movement, the nurse said she could not go to the bathroom for privacy and had to use a bedpan instead. “No, poop here because I got to change it anyway,” Culver remembers the nurse telling her. 

“I didn’t know I could change my doctor or nurse. They don’t tell you that,” she says. 

Now with nearly two years of experience as a doula, Culver’s optimism for a safe and healthy delivery has been renewed as she inches closer to her due date. With the advocacy of her labor team –a doula and midwife– she’s planning to birth her daughter at home in water, surrounded by family, something a hospital would advise against due to occupancy protocols.

Culver’s 90-year-old great-grandmother, who “comes from a very different time of parenting and childbirth,” will also be present. This is a moment she is looking forward to the most.

“So for her to be present without anyone giving us grief, that matters to me,” Culver says. “She’s seen so much grief over the years, so to be able to actually witness life—that's important. It's legacy [and] that is safety. That is love. That is tradition. It's a Black family thriving.”