The role of doulas in childbirth is gaining recognition in Texas, particularly in the Austin area, where local advocates are pushing for improved access to doula services. In March 2025, during the birth of her second child, Josephine Adegbite experienced the benefits of having a doula, Alicia Rivera-Clemente, by her side. The supportive environment allowed Adegbite to labor comfortably in a tub at a midwife-led birthing center, bolstered by music that held personal significance.
Adegbite’s previous birthing experience, which involved an emergency cesarean section, left her feeling unheard and dissatisfied with the healthcare she received. This time, she sought the assistance of a doula to ensure she felt supported and empowered during the process. Research indicates that having a doula can lead to improved birth outcomes, including lower rates of preterm labor and fewer unnecessary cesarean sections—a crucial consideration for communities facing higher maternal mortality rates, particularly among Black women in Texas.
Community Efforts to Enhance Access
Despite the documented benefits, access to doula services remains a challenge. Traditionally, these services have not been covered by insurance, limiting them primarily to those who can afford to pay out of pocket. To combat this issue, a network of organizations, known as the Maternal Health Equity Collaborative, has emerged in the Austin area to provide free doula services, specifically targeting Black and brown families.
Rivera-Clemente connected with Adegbite through the Healing Hands Community Birthing Project, demonstrating the collaborative spirit among local doulas. “If one organization doesn’t have the capacity, we’re not just telling you no,” she explained. “We can refer you to somewhere else … we’re getting you in touch with somebody directly.”
The proactive approach of the Austin doula community is further supported by the Texas Doula Association (TDA). Vice President DeAnna Vonbartheld noted that the proximity to the Texas Capitol encourages local doulas to adopt an advocacy-focused approach. The TDA recently conducted a survey to better understand the doula workforce in Texas, highlighting the need for greater public awareness of their role and its significance.
Advocacy and Legislative Progress
The movement to increase Medicaid reimbursement for doula services is gaining traction, with approximately half of U.S. states now offering some level of reimbursement. However, legislative efforts in Texas to establish a Medicaid pilot program for doulas have faced setbacks. A recent law permits doulas to be reimbursed for specific case management tasks, such as assessing non-medical drivers of health, but does not address direct support during childbirth.
While some progress has been made, many doulas express frustration at the limited scope of reimbursement, which does not adequately reflect the essential services they provide. “The compensation, to me, doesn’t equate to the work that’s being done and the impact that’s being made,” Rivera-Clemente stated, emphasizing the importance of fair compensation for their vital role.
Looking ahead, the TDA aims to engage more doulas in advocacy efforts as they prepare for the next legislative session. Rivera-Clemente is eager to deepen her understanding of the advocacy landscape, recognizing the need for systemic change in the recognition and support of doula services.
As the Austin doula community continues to build momentum, individuals like Adegbite are inspired to contribute to the profession. After experiencing a positive birthing process with the support of a doula, she aspires to become a labor and delivery nurse, hoping to help other women navigate their childbirth experiences. “It felt like I could do it. I knew what I was doing, I had support, I felt heard, I felt seen—and that’s really what every woman deserves during labor,” she affirmed.
The efforts of doulas in the Austin area exemplify a growing movement aimed at transforming childbirth experiences and advocating for equitable access to care. As they strive to establish a more supportive environment for all families, the impact of their work is poised to resonate far beyond the local community.
