Virginia has taken a critical step to address its maternal health crisis with a new law guaranteeing a birthing person’s right to have both a doula and a partner (or other support person) present during labor and childbirth. This legislation is a direct response to the state’s alarming maternal mortality rates, which disproportionately affect Black mothers who are nearly three times more likely to die from pregnancy-related causes than their White counterparts. A doula is a trained, often community-based professional who provides physical, emotional, and informational guidance to an individual before, during, and after childbirth. Research indicates that continuous doula support improves birth outcomes, reduces the need for C-sections, and enhances patient satisfaction. For Black and other minority women, doulas serve as important advocates, familiar with their communities and bodies, and able to communicate their needs and birth preferences to doctors who may lack the same understanding. Previously, and especially during the COVID-19 pandemic, many hospitals limited patients to a single support person, forcing birthing individuals to choose between their visitors. The new law rectifies this by legally defining a doula as a member of the essential care team—a foundational step that grants legal protection to a patient’s right to their full support system. However, while this law codifies a crucial right, its promise is diluted by significant systemic barriers that prevent equitable access.
A major implementation gap exists between the law’s text and lived reality in Virginia hospitals. The legislation grants “discretion to the treating physician” to override the patient’s right to a doula. This clause is used to enforce restrictive institutional polices, most notably banning doulas from operating rooms during C-sections, even though the law explicitly includes cesarean births in its definition of “birth.” Many hospitals lack clear, updated protocols, creating a confusing and inconsistent environment where a birthing person’s rights depend on their location and provider. This institutional gatekeeping maintains the status quo, leaving families without vital support during vulnerable moments and undermining the law’s core intent.
For many Virginians, a primary obstacle to hiring a doula is financial. Private doulas can range from $800 to $2,500, placing this essential support out of reach for low and middle income families. While Virginia’s Medicaid program now covers doula services, its design creates a new set of challenges. The reimbursement rate of approximately $859 is significantly below market rate and fails to provide a living wage, especially considering the on-call nature of the work. Furthermore, doulas face a costly process to become certified and enrolled with multiple managed care organizations. These financial disincentives limit the number of participating doulas, particularly in rural maternity care deserts, where support is already scarce, perpetuating a two-tiered system of access.
Senate Bill 1384 is a legislative victory for maternal health in Virginia. Yet, a right on paper is not a right in practice. To truly realize the law’s life-saving potential, policymakers, hospitals, and state agencies must work to dismantle the deep-seated institutional and economic barriers that continue to deny so many families the support they deserve and are now legally guaranteed.