ACOG Releases New Guidance on Partnering With Doulas

ACOG Releases New Guidance on Partnering With Doulas

The American College of Obstetricians and Gynecologists has released new guidance encouraging ob-gyns and other maternity-care professionals to build stronger, more effective partnerships with doulas.

The guidance, titled “Partnering With Doulas in Clinical Settings,” recognizes doulas as valuable members of the maternity-care team and provides practical direction on how clinicians and doulas can work together while maintaining clear professional roles.

This is an important development for the doula profession and for families seeking more supportive, respectful, and patient-centered maternity care.

Doulas and Clinicians Have Different but Complementary Roles

One of the most important messages in the ACOG guidance is that doulas and clinicians do not perform the same job.

Ob-gyns, midwives, nurses, and other licensed health professionals are responsible for medical assessment, diagnosis, treatment recommendations, clinical monitoring, informed consent, and emergency care.

Doulas provide continuous, nonmedical support. Depending on their training and area of practice, this may include:

• Emotional reassurance
• Physical comfort measures
• Labor positioning and movement support
• Breathing and relaxation techniques
• General education and preparation
• Help identifying questions for the care team
• Support communicating preferences
• Assistance processing unexpected changes
• Encouragement for partners and family members

These roles are different, but they can work together.

A doula does not replace a doctor, nurse, or midwife. At the same time, medical care does not always provide the continuous emotional and practical support that many families need before, during, and after birth.

When both roles are clearly understood, collaboration becomes easier and the patient can benefit from a more coordinated care experience.

Why Collaboration Matters

Pregnancy and birth can involve complex medical decisions, strong emotions, and rapidly changing circumstances. Families may enter labor with clear preferences, only to face an induction, pain-management decision, assisted birth, or unplanned cesarean.

In these moments, clinicians focus on medical safety and treatment, while doulas can help clients remain calm, understand what questions to ask, and feel supported as plans change.

For example, if a clinician recommends an intervention, a doula may help the client ask:

• What is the reason for this recommendation?
• What are the expected benefits?
• What are the possible risks?
• Are there alternatives?
• Is there time to consider the options?
• What may happen if we wait?

The doula should not tell the client which medical decision to make. Instead, the doula supports the client in having a direct and informed conversation with the clinical team.

This distinction is essential to respectful, patient-centered care.

Keeping the Patient’s Voice at the Center

The strongest clinician-doula partnerships are built around the patient’s needs, values, preferences, autonomy, and safety.

Doulas often spend extended periods of time with clients and may have a deep understanding of their concerns, communication style, cultural background, prior experiences, and support needs.

Clinicians bring medical expertise and responsibility for evaluating risk and recommending care.

When these perspectives work together, the maternity-care team may be better able to support the whole person—not only the clinical situation.

A doula can help a client feel heard and prepared, but should never speak over the client or replace the client’s voice. Clinicians should communicate directly with the patient while recognizing that the doula may be a valuable source of emotional and practical support.

Clear Scope of Practice Is Essential

ACOG’s guidance reinforces the importance of clear professional boundaries.

A doula may:

• Provide physical and emotional comfort
• Share general educational information
• Help a client prepare questions
• Encourage direct communication with clinicians
• Support the client in expressing preferences
• Help the client process information
• Offer reassurance during procedures
• Identify situations that require referral to a licensed professional

A doula should not:

• Diagnose medical conditions
• Interpret fetal monitoring or test results
• Recommend or prescribe treatment
• Perform medical procedures
• Make decisions for the client
• Speak as though they are the medical provider
• Prevent clinicians from communicating directly with the patient
• Promise a specific birth outcome

Clear boundaries protect clients, support professional credibility, and reduce conflict within clinical settings.

Communication Can Prevent Conflict

Many tensions between doulas and clinicians begin with misunderstandings, assumptions, or poor communication.

Clinicians may worry that doulas will challenge medical recommendations or interfere with care. Doulas may worry that the client’s questions, fears, or preferences will be dismissed.

Respectful communication can prevent these concerns from escalating.

Doulas can support collaboration by introducing themselves, clearly explaining their role, communicating calmly, and directing medical questions to the appropriate clinician.

Instead of saying:

“You do not have to let them do that,”

a doula might say:

“You can ask the clinician to explain the benefits, risks, alternatives, and whether there is time to consider the decision.”

Clinicians can support collaboration by acknowledging the doula’s role, explaining changes in the care plan, allowing time for questions when medically appropriate, and avoiding assumptions that doula involvement means opposition to medical care.

Both parties should remain focused on the patient rather than on defending their own role.

Birth Preferences Should Support Communication

Birth plans can be useful tools when they are treated as flexible communication documents rather than guarantees.

Doulas can help families identify preferences related to:

• Labor movement and positioning
• Comfort measures
• Pain-management options
• Communication style
• Support people
• Cultural or religious practices
• Newborn contact
• Infant-feeding preferences
• Cesarean birth
• Prior trauma or sensitive care needs

However, labor and birth can be unpredictable. Medical recommendations may change based on the health of the patient or baby.

Doulas can help clients prepare for flexibility while still advocating for respectful communication and informed decision-making.

Supporting Families When Plans Change

Doula support can be especially meaningful when birth does not go as expected.

A client may feel disappointed, frightened, overwhelmed, or out of control when facing an intervention or cesarean birth.

In these situations, a doula may:

• Remain calm and emotionally present
• Help the client identify questions
• Support coping during procedures
• Help the partner remain involved
• Preserve meaningful preferences when possible
• Offer reassurance without minimizing emotions
• Support early bonding and feeding, when appropriate
• Help the client process the experience afterward
• Refer the client for additional support when needed

An unexpected medical intervention does not mean the doula’s role is no longer valuable. It often means the client needs emotional support even more.

The Role of Cultural and Community-Based Doulas

Doulas may also bring important cultural, linguistic, and community knowledge into the care setting.

Community-based doulas may understand the client’s lived experience, local resources, cultural traditions, language, and barriers to care.

This may be particularly valuable for families facing:

• Language barriers
• Racism or discrimination
• Limited transportation
• Financial instability
• Previous traumatic health care experiences
• Immigration-related concerns
• Lack of family support
• Difficulty navigating health systems

Culturally responsive doula care can help patients feel understood and more confident communicating with clinicians.

Health systems should recognize this value while ensuring doulas are respected as professionals and not treated solely as translators or informal navigators.

What This Means for Practicing Doulas

ACOG’s new guidance is an important recognition of the profession, but it also reinforces the responsibility doulas have to practice ethically and professionally.

Doulas should be prepared to:

• Explain their role clearly
• Practice within scope
• Communicate respectfully with clinicians
• Support client autonomy
• Avoid giving medical advice
• Remain calm during urgent situations
• Support clients whose choices differ from their own
• Adapt when birth plans change
• Maintain confidentiality
• Recognize when referral is necessary
• Continue their professional education

A doula’s credibility depends not only on knowledge of comfort techniques, but also on communication skills, emotional maturity, ethical practice, and respect for clinical boundaries.

What This Means for Doula Training Programs

Doula education should prepare students to work confidently within real maternity-care environments.

Training should include more than labor positions and comfort measures. It should also address:

• Scope of practice
• Ethics and confidentiality
• Informed consent and refusal
• Patient autonomy
• Communication with clinicians
• Conflict de-escalation
• Trauma-informed support
• Cultural humility
• Cesarean support
• Emergency awareness
• Referral practices
• Supporting changing birth plans
• Professional documentation
• Interprofessional collaboration

Role-play, case studies, mentoring, and hands-on practice can help doulas learn how to respond professionally in challenging situations.

What Families Should Look for in a Doula

Families considering doula support may want to ask:

• How do you describe your role?
• How do you work with doctors, nurses, and midwives?
• What do you do when a birth plan changes?
• How do you support informed decision-making?
• What is outside your scope?
• How do you handle disagreements with clinical staff?
• When do you refer clients to medical professionals?
• What training, certification, and mentorship have you completed?

A well-trained doula should be able to explain how they support the client’s voice while respecting the responsibilities of the clinical team.

A Positive Step for Maternity Care

ACOG’s new guidance reflects growing recognition that quality maternity care involves more than clinical treatment alone.

Emotional reassurance, physical comfort, continuous support, respectful communication, cultural understanding, and patient autonomy all contribute to the care experience.

Doulas and clinicians have different responsibilities, but they can share the same goal: helping families receive safe, informed, respectful, and compassionate care.

The future of maternity care should not be framed as clinicians versus doulas.

It should be clinicians, doulas, patients, and families working together with clear roles, mutual respect, and a shared commitment to better care.

Source

American College of Obstetricians and Gynecologists. “ACOG Releases New Guidance for Ob-Gyns on Partnering with Doulas.” Published July 16, 2026.

https://www.acog.org/news/news-releases/2026/07/new-guidance-for-ob-gyns-on-partnering-with-doulas

This article is intended for general educational purposes and does not provide medical or legal advice. Doulas should follow applicable laws, facility policies, professional standards, and their defined scope of practice.

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