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An 2025 analysis by Providence CORE examines the state of Oregon's birth doula workforce and the factors that are helping or hindering efforts to grow and support it.

Oregon was an early leader in recognizing the positive impacts of doulas on birth outcomes. Thanks to a 2011 law, it was among the first states to cover birth doula services through Medicaid. And when a 2018 assessment flagged low Medicaid reimbursement rates and training gaps as barriers to growing the doula workforce, Oregon raised those rates several more times, expanded access to trainings, and developed paths for doulas to enter the state's Traditional Health Worker (THW) registry. 

In 2025, following years of advocacy and policy change, statewide partners and doula advocates sought to understand the impacts of these investments in the doula workforce. The Oregon Perinatal Collaborative and Oregon Doula Association engaged our team at CORE) to study the state of the workforce and what's helping or hindering Oregon's efforts.

Check out the full report at OPC's website, or read on for highlights.

Elevating the voices of working doulas

At the heart of this study were 13 in-depth interviews with working doulas and health system partners. CORE also reviewed data from Oregon's THW Registry.

In the interviews, doulas described their unique experiences and perspectives. Some have advocated for better maternal health policies for years and watched Oregon's system evolve. Others were newer to the field but deeply shaped by their own birthing experiences. All shared a sense of purpose around culturally appropriate care, helping birthing people through vulnerable moments, and advocating for a system where race and ethnicity no longer predict birth outcomes.

"It's not up to the doulas to fix a broken system. It's up to the broken system to get fixed… It's whether we have to pay, as a society, to fix the gaps in our services so that we don't have to live with the reality that your race or ethnicity predicts whether you survive childbirth or not. That's the problem we're trying to solve, and that is not up to doulas to solve. Doulas are a part of the solution, but they're only a part of the solution." – Birth Doula

Many also described themselves as connectors, building trust with families, translating information, and helping people feel seen and supported in healthcare settings. Health system partners echoed this, noting that doulas help strengthen communication and cohesion among care teams, benefiting both providers and patients.

Key takeaways from the Oregon Doula Workforce Analysis

Our analysis suggests that Oregon’s doula policy and integration efforts are headed in the right direction, but challenges remain. 

Growing the doula workforce: A positive sign from the analysis was an increase in THW-registered doulas each year from 2022 to 2025. This growth suggests that Oregon's investments have had an impact.

However, access to doulas remains limited outside of Portland and the I-5 corridor. Interviewees shared concerns about how this impacts clients in areas with large non-English-speaking populations. And while the number of registered doulas grew, additional data is needed to verify if that growth translated to more working doulas or doula-supported births.

Improving doula-health system integration: Doulas and health system reps both pointed to a need to better integrate doulas into care teams. For example, steps like including doulas in caregiver huddles and care coordination meetings can build trust and prevent confusion about doulas' roles. This can also help prevent frustration from communication and knowledge gaps between doulas and clinicians.

If doulas aren't looped in ahead of time, they are at risk of having to explain their role during critical moments in the delivery room. The bottom line: earlier engagement sets everyone up for success. 

Enhancing health system policy communication: Doulas shared that differences in hospital policies and communication across healthcare systems can create friction. Varied visitor rules, documentation processes, and access to birthing spaces can make it difficult to navigate patients and care team relationships.

We also heard that relatively small steps to engage with doulas can help. For example, linking doulas with a designated health system representative who can provide guidance and information.

Supporting the business side of doula work: Billing was a common frustration among all interviewees. Many doulas want more billing-related support. Others prefer to focus on client work and leave administrative duties to doula hubs or health systems.

These differing views underscore CORE's recommendation to offer optional training around billing and claims that doulas can use based on their needs and preferences.

Recognizing the benefits of doula hubs: These doula-led organizations help doulas work with Medicaid clients and handle Medicaid billing. However, their value goes beyond billing support, according to doula interviewees. Hubs provide connection, community, mentorship, and coverage that working doulas find quite valuable.

Conclusion: Positive signs, with more work ahead

CORE’s analysis suggests that Oregon is on the right path. However, much work remains to grow this workforce and integrate it into healthcare and Medicaid systems. Continued partnership among doulas, health systems, and policymakers is key to building a sustainable, culturally responsive doula workforce that supports healthy pregnancies, healthy families, and healthier communities.

“This work started with two simple questions following our review of Oregon’s maternal landscape: Are there more doulas working today, and have programs to support their integration into healthcare been successful? CORE and the Oregon Doula Association helped us refine our questions and determine what the available data could actually tell us – Laurel Durham, Director of Quality Improvement, Oregon Perinatal Collaborative

For more information and recommendations, read the full 2025 Oregon Doula Workforce Analysis at OPC’s website.