Exempt Doulas From Hospital Visitor Restrictions in Massachusetts

Exempt Doulas From Hospital Visitor Restrictions in Massachusetts

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Birthworker's Collective of Western Massachusetts started this petition to Governer Charlie Baker

We are asking Governor Charlie Baker to join Governor Cuomo of New York, the New Jersey Department of Health(1) and the California Department of Public Health in recognizing privately hired doulas* as essential members of the maternity care team, and therefore make an official directive that exempts doulas from hospital visitor policies.

In 2019 The Commonwealth of Massachusetts State Senate drafted Bill 1182 that would allow Medicaid funds to reimburse doula services, from prenatal through postpartum support(2). This Bill in motion implies that Massachusetts has recognized the need for essential birth support. We hope that Hospitals in the state of Massachusetts also recognize this need and follow suit in the way of exempting doulas from hospital visitor policies.

Access to doula support is a health equity issue. Professional birth workers, such as doulas and birth advocates, provide an essential service to those in their care. This is especially important for those who are most affected by disparities of healthcare access: families of color (particularly Black and Indigenous populations), LGBTQ+ families, trauma or assault survivors, pregnant minors, English language learners, immigrants, and others. Doulas serve to protect the well-being of these families at a vulnerable time. 

Doulas are statistically shown to improve outcomes in maternal and fetal populations by decreasing interventions in labor, decreasing surgical birth rates, decreasing perineal tearing, and improving breastfeeding rates, among many other qualitative assessments of parental and newborn well-being.

In support of those clients working with doulas during the pandemic, and in solidarity with care providers dedicated to the comprehensive wellbeing of babies and families, we recommend that labor and delivery staff consider and classify doulas as essential workers, beneficial to our shared goal of providing evidence-based continuity of care which supports laboring people’s physical and emotional health (3). Doulas assist health care providers as well - for example, a nurse may find their rotations to be more effective with the consistent reports of a client who has a doula assisting them in communicating quickly and effectively with medical staff and providing continuous emotional and physical support.

The following organizations advocate for the use of a doula to improve birth outcomes for families:

The National Academy for State Health Policy’s guide highlights these benefits and showcases examples of States who used Medicaid to reimburse doula services.  
Four-times less likely to have a low birth weight baby;
Two-times less likely to experience birth complications; and
Significantly more likely to initiate breastfeeding.

●  The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) recent 2020 statement urges that: “Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period. Most doulas have been contracted by patients weeks to months ahead of time and have established provider relationships. They are recognized by AWHONN and ACOG as essential personnel and part of the maternity care team” (4).

●  The March of Dimes recognizes that access to doula care improves birth outcomes and reduces disparities in maternal morbidity and mortality among women of color in the United States (5).

●  The American College of Obstetricians and Gynecologists (ACOG) recognizes that a doula is associated with improved outcomes for women in labor including reduced cesarean rates (6,7).

●  The World Health Organization recognizes that the support provided by doulas improves birth outcomes including decreased complications/cesarean and improved APGAR scores for infants (8).

●  A Cochrane systematic review of 26 trials and over 15,000 people found that with a doula present, a mother’s risk of cesarean decreased by 39% and improved infant outcomes (9).

The CDC currently encourages hospital facilities to permit support persons who are “essential to the patient’s emotional well-being and care” (10). Countless professional and research organizations recognize designated doula support as essential in this way. Even so, doulas are currently prohibited from entering hospitals all over the state of Massachusetts by facilities who are striving to follow their interpretation of executive orders. This small confusion has resulted in far too many families going without essential professional birth support at a crucial time.

Governor Baker, will you update current public health guidelines to recognize doulas as essential members of the maternity care team and therefore exempt from hospital visitor policies?

Thank you for supporting Massachusetts’s birthing families.


Birth Workers Collective of Western Massachusetts



*doulas are defined as designated labor support persons, birth advocates, patient advocates, or any member of the birthing person’s private care team that does NOT identify as the non-birthing parent/partner.


1. Governor Cuomo of New York’s executive order and The New Jersey Department of Health’s executive directive.

2. Bill H.1182, 2019

3. JOGNN 2018, Cochrane 2017

4. AWONN: Position Statement on Doulas

5. The March of Dimes Position Statement on Doulas and Birth Outcomes

6. ACOG: Approaches to Limit Intervention During Labor and Birth

7. ACOG: Preventing Preventable Cesareans

8. WHO: Companion of choice during labour and childbirth for improved quality of care.

9. Evidence Based Birth: Evidence on Doulas

10.  CDC: Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, February 2020


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