Hospital facilities are the intersection of life and death, equipped with bright minds that perform the medically impossible at times. In some cases, those very minds can be oriented with prejudice that can make hospital visits unfathomable for Black families. Racial bias and disparities that prevent Black patients and families from receiving equitable care are plaguing the healthcare system. And as Black families experience labor, some hospitals are leading with poor quality, making patients feel unseen and unheard. As more Black families report these failures within the healthcare system, the demand for doulas is on the rise. During Black Maternal Health Week, we’re raising awareness of the significance of doulas, a phenomenon established centuries ago, while marking ancestral legacy and pride.

In 2023, 3.6 million women gave birth in the United States, while nearly 98% of those births occurred at a hospital, 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, according to a report from the State of California Department of Finance.

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. 

Standing in that gap is Curtrelle Rawls, 34, a registered nurse who also doubles as a full-spectrum doula. She’s witnessed the harsh realities that Black families have faced in hospitals, and for her, it’s an unsettling reality.

“We still see the bias towards Black families in general from moms to fathers. The question of, ‘Is this your husband, or is this just your baby's daddy? Is this your mother? Who's going to take care of the baby? Do you have food?”’ says Rawls of overheard conversations on the hospital floor. “And it's an assumption made instead of caring for the family in totality. “They're still making assumptions about the Black family structure in these facilities and these spaces.”’

During her first experience as a doula nearly 2 years ago, Rawls remembers how “the atmosphere changed” upon entering the room of her client. It was an empowering moment that made the expectant mom feel supported and protected.

“The staff changed. They started treating her differently because somebody was there to advocate for her and her partner. The whole environment changed,” she recalls. 

After that, “the birth was beautiful,” Rawls says. “You never forget your first birth. You never forget the tears that you shed [and] the tears that the mom shed.”

With nearly a dozen combined years in the medical space, Rawls understands the toils Black families may face, leading her to “fight” on their behalf. As a pseudo-member of the client’s family, it’s an honor and a privilege she bravely submerges herself in as an advocate.

When a 24-hour delivery notice arrives, she ensures, “I am in the headspace mentally [and] physically to remain present and understanding, knowing that sometimes you may have to go fight.”

While her objective is “to be the calm for the family,” she understands that having that skill in her toolbox is always an added benefit.

“We never go with the expectation that our clients aren't going to be listened to or that their needs are not going to be met, but we prepare ourselves for that moment. I have to make sure that you actually have this family's best interest as the center of care. It's a necessary part of the job. We want to go to the hospital and support beautiful birth and hold space for [the] mom, and the family to make sure [the] baby comes to Earth's side healthy and in a joyous environment.”

Fully immersing oneself in labor with an expectant mom requires undistracted time and attention. Whether results are favorable or not, the laborious deed is a momentous journey for all involved, especially for a doula. After labor, Rawls says she turns to self-care by hiking and connecting with her village for reassurance. 

“I call on my village more to be held because you hold people mentally, emotionally, and physically in that space when you come out of it,” she explains. “I find that we also need that extra holding, whether it is a physical hug or a mental hug, especially depending on how the birth has gone. Having my village around me has been the most helpful because they get it. They get that you are carrying the weight of an entire family’s dynamics at times on your shoulders in those birthing spaces.”