When Spirit Cooper returned to the hospital, her placenta had already begun to detach, a complication that led to a stillbirth within hours.
Later, doctors learned that Cooper had been sent home before her lab results were ready — results that, once processed, showed signs of preeclampsia at 36 weeks pregnant.
Her doula, Nataki Hill, still replays that day in her mind.
She wasn’t there, because Cooper had chosen to work with midwives, practitioners who focus on the clinical side of labor and delivery.
Hill believed she could have spoken up and made a difference – asked the staff to wait for the labs, to extend the fetal monitoring, to notice what her client couldn’t, to be the advocate she needed.
It remains her deepest regret.
But Cooper’s story didn’t end there. She later became pregnant again, and this time Hill stood beside her through every stage of the journey.
Together, they welcomed a healthy baby girl.
Cooper always tells Hill, “That’s our baby.”
Doulas are often described as a steady hand and calming voice during one of life’s most vulnerable moments — childbirth.
With a warm smile and a calm, steady voice, Hill carries the quiet confidence of someone used to bringing comfort in tense moments.
Doulas don’t perform medical procedures like midwives, but they offer emotional and physical support that research shows can reduce fear, lower the risk of complications and improve birth outcomes.
But in many Virginia hospitals, doulas still face barriers to being by their clients’ sides.
“It has been constant,” said Hill, who has worked under Virginia’s Medicaid reimbursement program since 2022. “For three years, I’ve only been allowed into one C-section,” she said, referring to the cesarean section procedure where babies are delivered surgically.
A new state law now guarantees anyone giving birth the right to have both a partner and a doula present during labor.
Still, hospitals ultimately decide who’s permitted in the operating room — a point of frustration for doulas like Hill, who said that exclusion during surgical births leaves families without vital support.
Chesapeake Regional Medical Center adopted its first policy on doula participation in August to define their role and access in labor and delivery areas.
Certified doulas are no longer considered among the three visitors who can rotate in and out while someone is in labor or giving birth; they now sign in with the charge nurse, receive a badge and remain with the patient through birth.
Patients who have a C-section may choose one support person, like a doula, to accompany them in the operating room.
Sarah Gallagher, manager of labor & delivery at Chesapeake Regional Medical Center, said the limit is necessary to maintain safety and space within the sterile environment.
“We do welcome doulas to come to our hospital. It's definitely something that we feel is very important for the patients,” Gallagher said.
The role of a doula
Alysia Hanbrick lost her mother when she was 16. When she became pregnant, having Hill as her doula felt like gaining another maternal presence.
Hill taught the expectant mother about reproductive health and how to advocate for herself in medical settings.
“It provided me a lot of comfort, and it soothed my mind a lot,” Hanbrick said.
Hanbrick said most women are not in the right state to express what they need or want during labor, so having a doula who already understood her body and preferences meant she did not have to.
The process of hiring a doula can look a bit like dating. It usually begins with a consultation, where both the client and the doula assess whether they’re a good fit.
Hill encourages clients to meet with several doulas before choosing, since comfort and trust are essential during childbirth.
During the consultation, doulas learn about the client’s preferences, health history and any past traumas that might surface during labor. Once hired, they stay involved throughout pregnancy, birth and postpartum recovery.
Hill said Medicaid typically covers a 90-minute consultation, three prenatal visits, delivery support and up to six postpartum visits, but her and many others often provide extra support through calls and texts.
During Hanbrick’s labor, Hill communicated with the medical team and made sure her wishes were respected.
That allowed Hanbrick to let go of the worry and focus on what mattered most — welcoming her baby into the world.
Hanbrick said she feels that hospitals focus more on medical procedures than on emotional care.
“Everything is pretty much by the book. There’s not a lot of empathy in the process anymore, and having a doula provides that,” she said.
Training the next generation
The use of doula care is still limited in the U.S. but has been rising over the last decade.
As many as 10% of all pregnancies in the country are now attended by a doula, up from 6% in 2012.
Old Dominion University has been helping grow Virginia’s birth support workforce since 2018 through its doula training program.
Elizabeth Groeneveld, professor and department chair of women’s and gender studies at ODU, said the program recruits about 15 students each year who go on to become certified birth doulas or keep pursuing careers in nursing, obstetrics, public health or advocacy.
After a brief pause during the pandemic, the program resumed with funding from the Mellon Foundation.
In partnership with Urban Baby Beginnings — a statewide maternal care organization based in Hampton Roads — ODU is offering a 60- hour hands-on training focused on community doula works this year.
The training is part of the university’s doula program and is designed to expand local maternal health resources while allowing any ODU students who are interested in a doula career to learn about birth support and reproductive health advocacy.
Stephanie Spencer, the founder of Urban Baby Beginnings, said many hospitals are still unaware that the new law requires them to establish clear protocols for doula access.
“It's important to get doulas, moms and hospital systems together to figure out how the law can be implemented appropriately to ensure that mom gets the support that she really wants and needs,” Spencer said.
