Zone 5: Shifting the Culture of Birth

🌀 About this zone

the vital role of doulas

New Jersey continues to face a maternal health crisis, with rising rates of preventable deaths and reports of mistreatment during birth—especially among Black birthing parents. Many arrive at hospitals anxious and unsure, often delaying care due to fear and mistrust. Community doulas help shift this reality by providing consistent, culturally grounded support. Their presence improves outcomes and helps restore trust, but they are working within a system still in urgent need of reform.

Centering Consent and Empowering Parents

Doulas play a vital role in protecting consent during labor. They help parents understand their options, ask questions, and feel confident in making informed decisions. Their steady presence reduces stress, improves communication with medical staff, and helps ensure that birthing people remain active participants in their care. This work supports better outcomes and more respectful, affirming birth experiences.

Changing a Culture, Together

The culture of maternal care still allows bias, pressure, and even coercion to shape birthing experiences. Doulas often witness parents being dismissed or pressured into procedures they did not consent to. While doulas work to interrupt these harms, they cannot change the system alone. Real progress requires healthcare providers to partner with doulas, respect their role, and commit to the deep, collective work of dismantling racism and rebuilding trust in maternal care.

📷 Photo captions

Images from right to left:

  1. Ahshayla coaches an expecting client through exercises on an exercise ball.
  2. Ahshayla provides hands-on comfort to her client, massaging her while on an exercise ball.
  3. Erica uses physical touch to help her client connect with her body.
  4. Erica provides a postpartum massage to her client
  5. Juju demonstrates how she educates expecting mothers and assures them that they are capable of labor and delivery.
  6. A laboring parent at St Joseph’s Health is outfitted with a TENS unit (transcutaneous electrical nerve stimulation) to help manage their pain.
  7. Jacquelyn and a parent in labor.
  8. Nora uses a wet cold compress on a laboring parent’s neck and back as the parent was experiencing hot flashes.
  9. Nora helps a laboring parent breathe through contractions..
  10. A healthy and beautiful birth.
  11. A family is born as parents and newborn share their first moments together.
  12. Ahshayla breastfeeds her child.
  13. Jaelyn, a teen mom, comes home to her family after working at a job her doula Juju helped her find.
  14. Harmony continues to spend time and provide maternal care to the families she has supported.

🎧 Additional audio stories

Tyisha (nurse) - True care comes when hospitals and doulas work as a team for the person giving birth

🔎 Learn more: Building Stronger Support Systems

Explore these tools, reports, and studies to learn how hospitals, policymakers, and communities are strengthening support for doulas—and building a better future for birth.

Additional doula and policy resources

HealthConnect One: Doula Medicaid Reimbursement Resources

Information and strategies for including community-based doulas in Medicaid reimbursement efforts.

Guide for Hospital Doula Policy Creation (NJ Health Care Quality Institute)

A practical guide for hospitals to build inclusive policies that formally integrate doulas into birth teams.

Doula FAST Tool (HealthConnect One)

An easy-to-use planning tool for healthcare systems, funders, and communities to expand doula programs.

Getting Doulas Paid (HealthConnect One)

A deep dive into advancing sustainable Medicaid reimbursement models for community-based doulas.

Time Use Study 2023 (Doula Data Consortium & SisterWeb)

Research quantifying the real time doulas dedicate to care, emphasizing the need for fair compensation.

Preeclampsia Foundation - Doula and Patient Education

Educational resources on how doulas support early detection of complications like preeclampsia.

Research informing this exhibit

Listening to Mothers in California Survey Report (2018)

A landmark study documenting maternity care experiences and disparities based on race, language, and insurance status.

Giving Voice to Mothers Study (2019)

A national survey highlighting mistreatment during childbirth, especially among Black, Indigenous, and Latina women.

Evidence on Doulas: Continuous Support for Women During Childbirth (Cochrane Review, 2017)

A major review confirming that continuous support from doulas leads to better birth outcomes.

The Cost-Effectiveness of Community-Based Doula Programs (Health Affairs Blog, 2019)

Analysis showing how investing in community-based doulas reduces expensive interventions and saves Medicaid dollars.

Black Mamas Matter Alliance - Research and Resources

A collection of reports and tools to address Black maternal health inequities through systemic change.

CDC Maternal Mortality Rates Report (2023)

Up-to-date national data revealing persistent racial disparities in maternal mortality.

Birth Equity Framework - National Birth Equity Collaborative

A framework outlining how to create birth equity by addressing systemic racism and centering community needs.

March of Dimes: Nowhere to Go - Maternity Care Deserts Report (2022)

A report mapping maternity care access gaps and highlighting the impacts of service deserts across the U.S.

SisterSong: Reproductive Justice Resources

Essential resources linking reproductive justice to equitable, respectful maternal health care.