7 Things To Consider Before Investing in the Doula Space

Adonica Shaw
9 min readDec 5, 2023

--

Investing in companies that provide doula services presents a unique opportunity to align financial growth with the growing demand for comprehensive maternal care.

Whether due to the national conversation around maternal health disparities, or demands for improved health equity practices, recent years have witnessed a remarkable surge in awareness and appreciation for the crucial role doulas play in supporting expectant parents through their childbirth journeys. Before making investment decisions, it is imperative for potential investors to consider a myriad of factors, including the optics amongst doula providers, societal trends driving the demand for doula care, the evolving regulatory landscape, and the financial sustainability for the doulas and the ventures they work with.

In this article, I’ll relay 7 pieces of key information that investors should carefully weigh, while leveraging relevant data and insights to help you navigate the nuances of the burgeoning doula care industry.

1. Any Clinical Reporting Structure of the Doulas Should be Carefully Considered

There’s a number of reasons that could be attributed to the upsurgence in doula advocacy. But for the sake of this article, we will consider the two that are the most widely discussed which are

  1. According to the CDC, Black mothers are 2.6 times more likely to die during childbirth compared to their white counterparts.
  2. The fact that despite spending more money per capita on maternal health than any country in the world, the U.S. ranks 62nd in maternal deaths. It is the only high-resource nation with a consistently rising maternal mortality rate, where disparities are rampant.

What this data conveys is two-fold; the need for doulas isn’t just a black maternal health issue, and perhaps what’s more concerning, is the fact that that there’s nothing that indicates these poor outcomes worsened to their current state only recently. So have the poor outcomes been there all along? Have the issues been underreported?

There’s a strong possibility.

Based solely on the data, it means the doula workforce will probably witness things that may have gone unreported, or underreported by the very people who have been there all along. The issue that arises here is what will companies do protect them if they need to speak up and do you want your investment to protect one party over the other? Asking practical questions like, “Is the lead person for the doulas clinical or not, and will they feel safe conveying what they saw to that person?” will give you the opportunity to decide where you stand during the diligence process.

From an investing perspective, it is unlikely they will be able to move the needle effectively to improve outcomes if they are expected to report harm to the people who could be causing it. So how will you measure improved outcomes? Moreover, will you provide legal defense for doulas that do speak up to protect patients? Will the image of the brand suffer if it protects patients over providers?

Recent statistics illuminate the challenges faced by doulas in reporting issues during the labor and delivery process, revealing concerns about intimidation and fear of professional repercussions. According to online studies by several Doula Advocacy and Research groups, 45% of doulas refrained from reporting critical incidents due to perceived intimidation, with 60% expressing apprehension about potential job or reputation loss. These figures emphasize the delicate position doulas occupy, balancing advocacy for patient well-being with navigating the complexities of the healthcare system.

The need for creating supportive environments that empower doulas to communicate openly about observed issues is underscored by the data, ensuring optimal care for expectant mothers and fostering transparency within maternity care settings.

In a broader context, the dynamics of unreported intimidation within the healthcare sector, as revealed by a recent survey about workplace bullying and intimidation, add another layer to the issue. The studies indicate that 65% of non-clinical staff members experience intimidation from physicians, with only 25% of these cases officially documented. This significant underreporting trend, potentially rooted in power differentials and fears of professional repercussions, unveils a concerning pattern. Moreover, the study highlights that non-clinical staff’s hesitation to report intimidation is often linked to worries about job security, with 78% expressing concerns about negative consequences.

2. More than ⅓ of Doulas Carry an Additional Designation. Which Could Make it Hard to Say All Outcomes are Strictly Non-clinical

The prevalence of doulas holding multiple designations has become a notable trend within the maternal healthcare landscape.

A survey conducted by Doula Trainings International reveals that approximately 35% of practicing doulas hold more than one certification. While in some cases the extra designation may be related to lactation support, nutrition, childbirth education or pelvic floor health, this doesn’t mean that that is all of the training that doula may have. Some doulas are also midwives, nurse practitioner, chiropractors, etc., which technically makes them clinical.

This means you may have results which are influenced by clinical training so it’s imperative to make sure the outcomes you’re investing in are in fact all non-clinical, if that’s what’s being advertised.

If they are clinical outcomes, and a patient has an expectation that a doula who doesn’t have additional clinical training can provide the outcome that has been advertised, you may run into legitimate claims that the patients were mislead by internet data, or marketing materials that mis attributed the limitation of non clinical doula care.

3. Doulas and Midwives Share a Complicated History. It’s Important to Know the Law By State

The history of midwives and doulas is intricately woven into the tapestry of maternal healthcare, marked by both progress and challenges. Midwives, who have been traditionally associated with assisting women during childbirth, have existed for centuries across various cultures. However, the legal landscape surrounding their practice has been complex and diverse. In the United States, the regulation of midwifery varies significantly from state to state, leading to a fragmented system where midwives may face different legal constraints and requirements depending on their location.

Additionally, the emergence of doulas, non-medical professionals who provide emotional and physical support during childbirth, adds another layer of complexity. While their role is primarily non-clinical, legal distinctions between midwives and doulas can be blurry, contributing to challenges in attributing outcomes strictly as non-clinical. The lack of standardized regulations and the varying legal statuses in different states make it difficult to assess the impact of these birth support professionals consistently.

As the demand for more personalized and holistic maternity care grows, the need for clear and comprehensive legal frameworks that acknowledge the nuances of midwifery and doula care becomes increasingly evident.

4. The Ability to Select the Doula Can Lead to Improved Patient Satisfaction

The journey of labor, delivery, and birth is an inherently intimate and personal experience, marking a profound moment in the lives of expectant parents. Given the intricacies and vulnerabilities involved, individuals often seek a doula who not only possesses the necessary professional skills but also understands the intimate nuances of their unique birthing preferences and experiences.

The sharing of Personal Health Information (PHI) becomes a delicate aspect in this context, as the chosen doula becomes a trusted confidant in the birthing process. Recent data suggests a common misconception that doulas can be assigned at random, emphasizing the need for a more thoughtful and personalized approach.

Recognizing the intimate nature of childbirth and the intricacies of individual preferences, it becomes imperative to challenge this misconception. Opting for a doula who intimately understands the expectant parent’s desires and values ensures a more supportive and tailored birthing experience, fostering a stronger bond between the doula and the birthing individual.

5. Make Sure they Are Paid Fairly. Birth work is Tough Stuff

Doulas often invest significant time and resources in obtaining professional certifications and staying current with best practices. Yet, the current reimbursement structure fails to recognize these qualifications adequately. If you consider that pregnancy, birth and postpartum care can essentially take a year ( at most), a $500 payment for services means the doula is only being paid $41.66 a month. If the reimbursement is $1500 the doula is providing optimal care for $125.00 monthly.

If the doula is required to be on call 24/7 from week 38 onward, spend hours massaging and educating patients and acting as a liaison during labor and delivery, the payment should also be adequate to cover their physical and emotional output. Further, given the significant cost savings and cost effectiveness for Doula care for plans and payers when reimbursement is less than $884, there should be continued conversation about benefits packages or other perks that should be afforded to the doulas in exchange for their physical and emotional contributions to the role.

6. In Doula Care, Sometimes, Race Matters

The role of race in the selection of healthcare providers, including doulas, OBGYNs, and nurses, is a critical aspect of patient-centered care. Studies reveal significant racial disparities in maternal health outcomes, emphasizing the importance of culturally competent care. When patients choose a doula, OBGYN, or nurse, considerations related to race and cultural sensitivity come to the forefront. According to a report by the American College of Obstetricians and Gynecologists, Black women are three to four times more likely to die from pregnancy-related complications than white women.

Therefore, it is essential to recognize the impact of systemic biases on healthcare experiences. When hiring doulas for a diverse patient population, it is crucial to prioritize cultural competence, acknowledging and respecting the unique needs and backgrounds of individuals. Doulas should be trained to navigate conversations about racial disparities in maternal health, fostering an environment of trust and understanding. This includes recognizing and challenging implicit biases and actively working towards dismantling systemic barriers that contribute to healthcare disparities. Moreover, diversifying the doula workforce to better reflect the communities they serve can enhance communication, foster a sense of cultural understanding, and contribute to more positive birth experiences for individuals of all racial and ethnic backgrounds.

7. Doulas Are Called, Not Created. And the Phrase “Doula Play” Can be Offensive to Us

There’s a myth floating around that Doula workforces can easily be created. I’m addressing this in this article so practical expectations can be discussed amongst investors. Although someone can easily google a Doula class and get a certificate, success in the field is often dictated by a preceptor or social sign off from peers. Additionally, due to the intimate, and sometimes spiritual or religious nature of our work; there’s usually a very profound reason someone becomes a doula.

For some it’s because they felt unsupported in the own birth, for others its because they also have an interest in activism and women’s reproductive health. But across the board, many of us will say we felt uniquely called.

Many people know I started Wingwomen out of my lived experience with Preeclampsia, but what was not obvious, is the journey of healing, sisterhood, therapy and self-re-education that took place in the years that followed. It was in the process of the interpersonal work that I became clear about where I wanted to be. In addition to being a founder, I’m also a doula and midwife in residence. I wasn’t lead into the space because someone said I’d make a lot of money, or get a lot of likes. It was because I knew how much women could be impacted due to their birth story, and I wanted to walk the path next to other people so long as they would allow me to.

At our core, many birthworkers are just people who deeply care about the welfare of others.

What some investors or people may see about the designation is the attractive ability to scale, or the sparkly reimbursement rates in places where there are few competitors. But please also consider that our efficacious value, and our unique holistic approach to pain management has been built over long periods of time, and sometimes only after great losses endured by ourselves or others. For this reason the terminology “play” could be perceived as a play on the pain women have endured as the result of childbirth, miscarriage or infant loss.

For doulas reading this article, the notion of a “play” in investment strategy refers to the tactical maneuvers and calculated decisions made by investors to capitalize on market opportunities. It is common to hear this terminology in conversations amongst venture capitalists.

This is a niche space where people will expect the service or technology you are investing in to stick around for a while. Because for as much of a positive impact that is created when the service or technological solution becomes available for us to serve our patients, larger holes within our communities are created when they are quickly removed.

--

--

Adonica Shaw

Adonica Shaw is the founder of Wingwomen, a doula and a midwife in residence.