The Future of the Perinatal Workforce: Training, Credentialing, and Collaborative Care

By Birth & Baby University · Last updated: October 2026 · 8 min read

No one can predict exactly how the perinatal workforce will look in ten years. But the direction of travel can be read from what professional bodies, states and researchers are doing now. Doulas are being written into Medicaid programs, state advisory committees are drafting competency lists, an obstetrics professional society has issued a statement on partnering with doulas, and doulas themselves are saying what training and support they need. This article reviews those signals under three headings, training, credentialing and collaborative care, and is careful to separate what is documented from what is speculation.

Key takeaways

Quick answer: the documented trends point toward more public payment for doula care, more explicit competency expectations, more attention to training in mental health and equity, and more formal collaboration between doulas and clinicians. What is not settled is whether credentialing will converge on common standards, how payment levels will develop, and what outcomes the expanded workforce will produce.

• The National Academy for State Health Policy reports that as of March 2026, 26 states and Washington, DC provide Medicaid reimbursement for doula services.
• The American College of Obstetricians and Gynecologists (ACOG) published Committee Statement No. 31, Partnering With Doulas in Clinical Settings, in August 2026, endorsed by DONA International, Doula Trainings International, the National Black Doulas Association and the National Health Law Program.
• HealthConnect One convened 22 organizations that train and certify community-based doulas and published core competencies and training recommendations in October 2025.
• A 2025 survey of 252 U.S. doulas found they overwhelmingly wanted more training in emotional support.

Where the workforce stands now

The federal Office of the Assistant Secretary for Planning and Evaluation (ASPE) noted in its December 2022 evidence review that there was a general lack of information on the size and characteristics of the doula workforce, in part because doulas are often not reimbursed through health insurance, and that many doulas are solo practitioners without the capacity to manage health plan contracting and billing. It also reported that the Health Resources and Services Administration provided over $5.9 million in 2022 to support doula care programs and expand the workforce through training and certification opportunities, with 44 doula projects funded across 25 states and territories. Since then, state coverage has expanded. NASHP’s state tracker reports 26 states plus Washington, DC providing Medicaid reimbursement as of March 2026, with coverage and visit limits varying by state.

Training: what the signals suggest

Competency-based expectations. The National Health Law Program’s best-practices guide (last updated September 2026) recommends that states consider allowing doulas to meet a set of core competencies not tied to a specific organization, typically covering childbirth education, anatomy of pregnancy and childbirth, labor support techniques including nonmedical comfort measures, lactation support and other topics. It points to HealthConnect One’s core competencies for community-based doula training, developed in 2024 and 2025 with 22 training and certifying organizations. A Tennessee advisory committee established in 2023 was tasked with developing core competencies, among other duties, according to the Network for Public Health Law’s 2024 issue brief.

Content gaps doulas name themselves. In a survey of 252 U.S. doulas (Hall and colleagues, 2025), respondents overwhelmingly wanted more training in emotional support and preferred in-person training in foundational workshops. A 2026 qualitative study of 29 doulas (Shklarski and colleagues, 2026) found that PMAD training varies widely, and recommended integrating mental health content into doula certification, with learning extended after training through apprenticeship and mentorship. A 2025 qualitative study (Semadeni and colleagues, 2025) named cost, time and access as barriers to training and recommended removing financial and logistical barriers.

Likely direction, with caution. These sources suggest more training emphasis on emotional support and referral within scope, equity and cultural responsiveness, and affordability. They are not predictions that any particular curriculum will become standard, and they come from a few advocacy and research sources rather than a consensus process.

Credentialing: converging or fragmenting?

A 2023 NHeLP summary found no mandatory licensure, certification or credentialing requirements for doulas to practice in the United States, with states that pay for doula care using their own approaches: approved-organization lists, core competencies, experience pathways, or managed care discretion. The Medicaid and CHIP Payment and Access Commission (MACPAC, 2023) described the same two approaches and noted that credentialing can be complex, sometimes requiring separate steps with each managed care plan.

The NHeLP guide recommends flexible training and experience pathways, and lists states that have adopted them, with others, such as Illinois and Washington, still requiring training hours. The Network for Public Health Law notes a trend toward state regulation, and that many states have advisory committees that shape certification and reimbursement, often with doula members. Whether this becomes a shared national standard, or remains a patchwork, is not determined. Arguments exist for both: standardization could aid portability and clinician trust, while flexible pathways may protect community-based and experienced doulas from barriers. Both are policy positions, not research findings, and doulas should expect to keep tracking state-level rules.

Collaborative care: the clearest documented shift

ACOG’s August 2026 Committee Statement, Partnering With Doulas in Clinical Settings, says that fostering positive and strong partnerships between clinicians and doulas is essential and can benefit patients, clinicians and the workplace, and that evidence suggests that when doulas are part of health care teams, they improve patients’ experiences and outcomes. It reports that doula-clinician partnerships have demonstrated improvements in communication and patient-centered care, accountability in the health care team and continuity of care, and that barriers can be addressed through training, policy and approaches that promote collaboration, communication and accountability. It offers recommendations to foster collaboration among hospital systems, clinicians and doulas and to increase clinicians’ knowledge of a doula’s role and scope. This was developed by ACOG’s Committee on Advancing Equity in Obstetric and Gynecologic Health Care and endorsed by several doula and policy organizations.

Doulas’ own accounts show why such statements matter. A qualitative study of seven doulas in hospital team-based care (Burke and colleagues, 2025) described barriers to including doulas in teams and facilitators for collaboration, and emphasized the need for mentorship and support for novices moving into hospital settings. The state-level picture agrees in places: in the Illinois Medicaid-Certified Doula guide (posted December 2024) doulas are described as guests in medical facilities who collaborate respectfully with the healthcare team, in a role that is explicitly non-medical.

What the evidence says about outcomes of an expanded workforce

An expanded workforce is only as valuable as what it delivers. A 2026 meta-analysis in Obstetrics & Gynecology (Viswanathan and colleagues, 2026) found moderate-certainty evidence that doula support is likely associated with lower rates of preterm birth and cesarean delivery, improved birth experiences and greater postpartum visit attendance, but also that most of the 30 included studies had high risk of bias and that the effects of type and intensity of doula support are unclear. A 2026 systematic review of trials in JAMA Network Open (Groves and colleagues, 2026) found the most consistent benefits for anxiety, postpartum follow-up and breastfeeding initiation, and called for rigorous designs, equitable representation and attention to implementation. In short, the policy momentum is ahead of the evidence in some respects, and the next generation of studies will matter.

What this means for doulas

• Keep learning on a schedule. Plan continuing education on emotional support, referral, equity and collaboration, topics where doulas and research ask for more.
• Track your state. Rules for training, credentialing and payment change. Check your state agency and trusted trackers regularly.
• Practice collaboration. Treat introductions to unit staff, role clarity and respectful communication as skills worth developing and refining.
• Join the evidence conversation. Where appropriate and with consent, participate in program evaluation and research, and keep records that support honest reporting.
• Stay honest about uncertainty. Describe your work as supported by encouraging but evolving evidence.
• Protect the workforce itself. Doulas told researchers that mentorship, collectives and emotional support would strengthen the workforce. Build those into your own practice.

Putting it into practice

1. Pick two topics from the gaps above for your next continuing education cycle.
2. Review your certifier’s and state’s current requirements once a year.
3. Read ACOG’s statement and think about what it asks of clinicians and what it implies for your own conduct on a care team.
4. Find or form a peer group and, if you are newer, a mentor.
5. Keep a short, accurate account of what the research says, and update it.

Limits and uncertainty

This is a review of documented signals, not a forecast. Policy in this area is changing quickly, and federal and state Medicaid decisions can alter the picture. Sources include advocacy organizations whose recommendations are policy positions. The research on doula outcomes has many limits, as described above, and the evidence on workforce models is largely descriptive.

The bottom line

The perinatal workforce of the near future is likely to include more paid doulas, clearer competency expectations, more mental health and equity content in training, and more formal partnership with clinicians. How standard, how funded and how effective that will be is still open. The doulas best placed for it are those who keep learning, keep to their scope, and work well with others.

Birth & Baby University’s For Doulas page sets out its birth and postpartum doula training, recertification and mentorship, so you can plan your own development. As with any program, confirm that it meets your certifier’s, employer’s or state’s requirements.

This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• American College of Obstetricians and Gynecologists. Partnering With Doulas in Clinical Settings, Committee Statement No. 31 (August 2026). Read the source
• National Academy for State Health Policy. State Medicaid Approaches to Doula Service Benefits (as of March 2026). Read the source
• National Health Law Program. Best Practices for Medicaid Coverage of Doula Care (last updated September 2026); Doula Medicaid Training and Certification Requirements (March 2023). Best practices · Training summary
• HealthConnect One. Core Competencies and Training Recommendations for Community-Based Doula Training (October 2025). Read the source
• Medicaid and CHIP Payment and Access Commission. Doulas in Medicaid: Case Study Findings (November 2023). Read the source
• Network for Public Health Law. The Positive Impact of Doula Care and State Regulation of Doulas and Doula Care (October 2024). Read the source
• ASPE. Doula Care and Maternal Health: An Evidence Review (December 2022). Read the source
• Hall EM, et al. Doula support for perinatal mental health needs: perspectives on training and practice. Midwifery (2025). Read the source
• Shklarski L, et al. “We’re not clinicians, but we see it.” Midwifery (2026). Read the source
• Semadeni C, et al. “We don’t just want doulas. We want good doulas.” Social Work in Mental Health (2025). Read the source
• Burke LT, et al. Racial minority doulas’ perceptions of hospital team-based care. MCN (2025). Read the source
• SIU School of Medicine. Illinois Medicaid-Certified Doula Guide (posted December 2024). Read the source
• Viswanathan M, et al. Doula support during pregnancy, childbirth, and postpartum. Obstetrics & Gynecology (2026). Read the source
• Groves P, et al. Doula care and health outcomes: a systematic review. JAMA Network Open (2026). Read the source

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