Oregon’s new laws expanding access to doulas could save lives — and provide something a little closer to the level of support new mothers routinely get outside the U.S.
Anyone who spends time around modern American parents has probably heard that maternal health in the United States is lacking, and that “the village” is damn-near non-existent. I am an avid proponent of hiring villagers, like a doula, for the perinatal period.
Many still think of a doula as something that is a nice-to-have luxury, perhaps something for hippies or granola moms who want some extra “fluffy” support. Only 6% of mothers received doula care, according to a national survey. Much of this is due to the cost, low awareness and lack of integration into the medical system.
A birth worker who’s well versed in the processes of birthing, and becoming a parent, doulas may specialize in labor and delivery, the postpartum period, lactation, or even harm reduction and special underserved populations. Attitudes about them might be starting to change though, as new legislation in Oregon will make accessing culturally competent perinatal support much easier and more affordable — by mandating that insurers cover (or reimburse the cost of) doula and other postpartum care.
“Doula care is continuous, relational support during pregnancy, birth, and the postpartum period,” said Dr. Heather Buxton, a board-certified child, adolescent and reproductive psychiatrist and assistant professor at Oregon Health & Science University. “Unlike medical providers, doulas are not there to diagnose or treat — they are there to support.”
Buxton said doulas can help bridge the gap between a fast-paced, fragmented medical system and a deeply human experience that benefits from time, presence and continuity.
“That support can look like helping someone understand their options, advocating for their preferences, offering physical comfort during labor, and providing emotional grounding during a time that can feel overwhelming and unpredictable,” she said.
On Jan. 1, Senate Bill 692 took effect. The new state law requires commercial health benefit plans and Medicaid plans to cover perinatal services, including services provided by doulas, lactation counselors and lactation educators. The law also requires the Oregon Health Authority to create a “perinatal services access program” that increases access to culturally specific and culturally competent community-based services during the perinatal period, including by sending grants to those with a demonstrated ability to offer community-based services to pregnant or postpartum people.
And in March, lawmakers passed another bill refining the new law by adjusting coverage levels and defining roles like “lactation counselor.”
“Maternal health sits at the intersection of mental health, family systems, and public health — and it’s an area where we still have significant gaps in care,” Buxton said, noting that two of the leading causes of death in the postpartum period—the first year after birth—are suicide and accidental overdose.
“That should stop us in our tracks,” she said. “If we are serious about improving maternal outcomes, we have to invest in comprehensive, continuous postpartum support — not just short-term check-ins.”
Hiring a doula is one way to reduce harm — and in my personal opinion, also increase peace and joy — throughout pregnancy and postpartum.
My doula experience
Before I gave birth to my first child in 2022, I had heard that a doula can be an invaluable addition to one’s birthing support system, particularly for expectant Black mothers like me who want to avoid becoming a statistic.
Black women are three times more likely to die from a pregnancy-related cause than white women, according to the Centers for Disease Control and Prevention, and twice as likely to develop preeclampsia than non-Black counterparts. Some families document and share traumas like these on social media, scaring the crap out of Black pregnant people. My doctor was already monitoring me for gestational hypertension, so I hoped having a doula would improve my chance of survival — and my baby’s. Thriving wasn’t even on my radar.
Still, I wasn’t sure we could afford a doula, and didn’t even know where to start in terms of searching for a reputable one, and then vetting her as a good fit. So when I got a call from someone with Black Parent Initiative’s Sacred Roots Doula program about receiving doula care free of charge, I was stoked they were following up on the inquiry form I submitted early in my pregnancy. However, I still had my reservations about hiring a doula — a relative stranger to me — to participate in one of the most sacred and vulnerable experiences of my life.
About a month before I would give birth, BPI paired me with a doula named Chinelo, a biracial Black woman who was around my age, and mom of three (now four) who was also an internationally board certified lactation consultant. A couple weeks before my scheduled induction, Chinelo came to my home to meet me and the rest of my birth team (my husband and my mom). The four of us sat around the dinner table and went over my birth plan and preferences, discussed fears and hopes, questions about the labor induction process, breastfeeding and more. As an experienced maternal health professional who had not only given birth herself three times, she had also attended dozens of labors and deliveries. While I only met with her once before my scheduled induction, she felt like a long-lost sister.
“I was completely shocked by how unsupported the postpartum experience was. Six weeks after giving birth, I was already back producing an event as an independent business owner, and I remember feeling like
Zoe Piliafas
I was drowning in exhaustion.”
Doula and founder, Attune Births
But it was in the months of postpartum that followed my first child’s birth that Chinelo and I really got to know one another. As I healed from a cesarean section, she made her first postpartum visit to my house. She offered helpful tips on bonding and caring for my newborn, helped facilitate skin-to-skin, photographed some tender moments of me and my daughter, and even brought self-care goodies and baby gifts.
And because one of the hardest parts about postpartum is the isolation, what I most enjoyed was having a knowing, sisterly mom friend to come over and visit with me. Sometimes she would schedule time specifically to do basic chores, or hold the baby while us new parents got some sleep.
Because she’s a lactation pro, I was able to lean on her knowledge, and text her anytime with questions about breastfeeding — from latch challenges to mastitis and milk blebs, as well as effective breast pump use, milk storage and sanitation practices, and suggestions for weaning, when I decided it was time.
Chinelo had a reverence for breastfeeding, and her attitude helped normalize lactation and nursing — a body process I was unfamiliar with and very nervous about. It also gave me an understanding of the myriad benefits of continuing to nurse past infancy. While my initial goal was to breastfeed for at least a year — the standard minimum recommendation in the U.S. — my daughter and I hit our stride and I ended up nursing her for more than two years.
I’m not sure I would have surpassed or even met my feeding goals if I hadn’t had my doula/lactation consultant in my corner. A couple years later, when I became pregnant with my second child, I tapped Chinelo again, to help prepare and support me through my second round of pregnancy, postpartum and matrescence.
When I was around seven months pregnant with my second child, I experienced intense shooting, radiating pain in my lower back and hips that was debilitating and depressing. I was shocked to learn that the intense nerve pain was actually was caused by shingles! Having shingles while in the third trimester of pregnancy and caring for a toddler is a 0/10 experience — I do not recommend it. Chinelo held space for me to emotionally fall apart, and, by encouraging me to get an earlier appointment, likely saved me several more days of severe pain and exhaustion.
On Memorial Day 2025, I gave birth to my son. Chinelo was there to support us, and took our before and after birth photos. During my births, my doula helped me feel confident in my choices. She advocated for me when I needed it, and at a very vulnerable time, her presence was calming. My pregnancies and births were far from easy, and neither of them went as expected. But having someone whose literal job it was to check on me, come to my home and support me in the first year of postpartum was so grounding. Having a doula really helped me and my babies thrive in postpartum — not just survive.
‘If we have the right support’
Doula care can help in all kinds of situations. Julie Bennette, a peer support specialist and doula, provides flexible, compassionate care at Project Nurture, a harm reduction program designed for pregnant people and parents who are experiencing substance abuse.
As a mother of four, and domestic violence survivor who is in recovery herself, Bennette is passionate about removing the social stigma around substance use during pregnancy.
“(I was) in a very horrible (domestic violence) situation, but I couldn’t even ask for help for that because I was so shameful about the fact that I was using drugs and that it was my fault,” she said. “And that since I wasn’t quitting, that I was a horrible person and I deserved everything that was happening to me.”
Bennette, now 51, lobbied for the new legislation and spoke at the Senate Committee on Early Childhood and Behavioral Health on Feb. 18.
“The stigma is the number one killer of people with addiction because they don’t get help,” she said. “And it’s internalized and it’s external — it’s a biofeedback loop that keeps people from getting the help that makes it so that they will recover. Because we do recover, if we have the right support.”
Zoe Piliafas, a doula and founder of specialty doula agency Attune Births, also lobbied for Senate Bill 692. Working in maternal health for a little over three years, Piliafas’ passion for this work began after the birth of her first child.
“I was completely shocked by how unsupported the postpartum experience was,” Piliafas said. “Six weeks after giving birth, I was already back producing an event as an independent business owner, and I remember feeling like I was drowning in exhaustion.”
“I also remember feeling angry that no one had prepared me for how hard it would be,” she added. “That experience fundamentally changed me. I decided to dedicate my work to changing this reality for my daughters, for women who are silently struggling, and because I believe mothers are the most important people in our society.”
Piliafas is on the steering committee for Black Futures for Perinatal Health Collective, founded and rooted in the research by Dr. Roberta Suzette Hunte, associate professor in Portland State University’s School of Social Work. The project began as a working group conducting a study to develop a five-year agenda around Black maternal health in Oregon. Today, it’s a “community-led collaboration to advance patient-centered care for the most vulnerable birthing communities through direct service, advocacy, research, power-building, and cultural transformation,” according to its website.
“(Hunte) brought together a small but powerful team to help craft legislation in collaboration with the Children’s Institute in partnership with Senator Reynolds,” Piliafas said.
Piliafas, whose professional background fuses communications, multimedia storytelling, perinatal health and reproductive justice, led media strategy and coordinated testimony.
“The stories we gathered came from people across different backgrounds, religions and political affiliations,” she said. “Birth happens around America — every community experiences it. And the overwhelming narrative was clear: Our system is failing mothers.”
For all the emphasis put on pregnancy and birth, and lots of focus put on the baby’s health and development, many moms feel unprepared and unsupported through the difficulties and demands of the postpartum period. Sure, your doctor will ask how you’re doing at your six-week postpartum appointment — an errand that’s mostly about how you’re healing physically and which birth control you’re choosing. Your pediatrician’s office will also routinely require you fill out the The Edinburgh Postnatal Depression Scale, the standard 10-question tool used to screen for postpartum depression.
But other than that? There’s not a ton of eyes on mom. This is particularly chilling when you look at maternal morbidity data. According to a data brief by The Common Wealth Fund published in 2020, 63% of pregnancy-related deaths in the U.S. happen during the first year of postpartum, and are often linked to behavioral health crises and substance use disorders.
“A lot of our focus is on what’s happening during labor or pregnancy time,” said Ellen Tilden, a certified nurse-midwife who holds a doctorate in women’s health. “That’s certainly important, but it’s that postpartum time that is the higher risk.”
Along with being a midwife, Tilden is an associate professor at Oregon Health & Science University, and a health systems researcher who studies perinatal mood disorders, length of labor, improving maternal health outcomes and more.
In 2011, Tilden served as a committee member for House Bill 3311, which said the Oregon Health Authority must report options for providing or utilizing doulas in the state medical assistance program to improve outcomes for women who are at disproportionately greater risk of poor birth outcomes. Now in 2026, many more expecting moms, birthing people and families can benefit from this kind of support.
“So many of the structures and systems around the world, either formally through the state or government in some way or through cultural traditions, have a method by which they are really caring for their people who’ve birthed recently in a much more extensive way than we do in the U.S.,” Tilden said. “The U.S. has been very much along the lines of, ‘Congratulations that you survived birth. You’re alive and your baby’s alive. Now, put a big pad in, stand up and turn on PowerPoint.’ Right? Like, this very truncated vision of what it means to go through that physical transition and what people need to come through that thriving.”
In 2023, Oregon became one of the few states to provide paid family, medical and safe leave. Not everyone is eligible.
The U.S. appears to be alone in that abrupt treatment. Last fall, Tilden worked in Switzerland. There, she discovered that every person who gives birth has in-home nursing or midwifery care for eight weeks — a level of extended care she said is quite normal in a lot of Europe and parts of Asia.
And when Tilden was based in Chicago before moving to Portland, she worked with families from Central America, who were mostly immigrant families.
“They had this tradition of the 40 days,” she said. “So after birth, there were 40 days in which this the person who just birthed, they’re not cooking, they’re not cleaning, there’s this kind of wrap-around protection for that individual. And all I had to say in the postpartum discharge visits with mom, boyfriend, auntie, neighbor in the room: ‘We are in the 40 days, right?’ And everyone’s like, ‘We’re in the 40 days.’ It was a very different frame of reference. So I think that those are some of the either institutional or cultural fit processes that actually protect people in ways that get them through that postpartum period in a safer way or help have eyes on them to identify when they need more help.”
Having 40 days of constant, present communal support, in which I didn’t have to cook, clean, or think about what’s for dinner, would have felt like such a relief, particularly with my second child. In a country with no universal paid leave — and in which freshly postpartum moms have to pack the baby up into the car and drive to all the frequent appointments required after a birth — having 40 days to focus entirely on rest, recovery, caring for and bonding with my baby sounds like a pipe dream. Having a midwife or doctor who does home visits during this period would have also been significantly helpful. Maybe it would have reduced some of my postpartum stress and anxiety.
Buxton, the OHSU professor, also offers something unique: matrescence coaching, a service she says she created to address a tension in her work as a physician between treating mental illness and preventative care. Buxton has trained and continues to train with the Matrescence New Zealand program. Coined in the 1970s by medical anthropologist Dana Raphael, the term refers to the transition into and within motherhood.
“For a long time, we’ve either minimized this transition or only paid attention when something goes wrong,” Buxton said. “But when we name it as a developmental stage, similar to adolescence, it helps normalize the disorientation, the growth, and the identity shifts that come with becoming a parent. We even have real data showing that the brain changes during this time. There are measurable shifts in parts of the brain related to empathy, emotional regulation, vigilance and attachment. So when people say, ‘I don’t feel like myself,’ they’re not wrong. Their brain is literally adapting in real ways.”
Because of Oregon’s new perinatal services legislation, families now have greater access to care that actually helps during that transition. A close friend of mine who recently became pregnant with her first had asked me to share my doula experience with her, and asked for my doula’s rates. Chinelo, currently expecting her fifth child and due around the same time as my friend, offered to help find and refer her to a doula. She passed along the good news: “Now that insurance in Oregon has to cover doula care, she can get a super bill from her doula to get reimbursed by insurance.”
This article appears in April 8, 2026.