Doula care meets each of the triple aims of the Affordable Care Act: improving health outcomes for all, improving the experience of care, and lowering costs by reducing non-beneficial and unwanted medical interventions. Cost is the greatest barrier to use of doula support. Reimbursement for doula services by private insurance, Medicaid, and Medicaid managed care organizations would significantly increase access to doulas. Widespread availability of doula care could significantly reduce cesarean rates, and increased access to community-based doula programs could reduce entrenched health disparities.

The author of this guest editorial calls for a higher level of transparency in maternity care. The public should have access to information about hospital and provider policies and practices so that women and their families can determine where and with whom to birth. Currently, many grassroots-level projects, includingThe Birth Survey, are addressing this need.