Guiding Lights: Exploring the Ethical Compass of Contemporary Doula Practices in the United States

Abstract

Current research highlights the importance of a birth doula’s presence during childbirth for improving maternal outcomes. Given that the maternal mortality rate in the United States remains significantly higher than in other developed nations, a closer examination of current maternal care practices is warranted. Integrating doula care into routine maternal healthcare offers considerable potential for improving maternal experiences and outcomes. This dissertation explores the question: What ethical values or systems underlie contemporary doula practices in the United States? Using a qualitative approach, this study examines doula training materials, ethical literature, current research, and narrative accounts to address this question. To understand the ethical values guiding doulas and the ethical encounters they face, the study first provides the historical and cultural context of childbirth in the U.S., followed by an evaluation of doula training programs and influential figures within maternal healthcare.

Findings reveal that doulas frequently encounter situations requiring professional ethics, particularly as many operate independent businesses. Using a feminist ethics framework, the study finds that doula practice is grounded in relational autonomy, virtue ethics, and care ethics. However, formalized ethical training for doulas is currently lacking, with ethical values emerging organically through experience and mentorship. As doula care becomes more prevalent and Medicaid reimbursement expands, structured ethical education will be increasingly important. This research aims to encourage dialogue around maternal healthcare in the U.S., advocating for a more holistic and person-centered approach amid a technologically advanced medical landscape. Ultimately, this work highlights the vital role of doulas as birth advocates and as human beings committed to enhancing one of life’s most profound and defining experiences: childbirth.

Disciplines

American Studies | Applied Ethics | Women's Studies

Subject Area

Ethics; Womens studies; Obstetrics; Health care management; American studies

Department

Humanities (HUM)

First Advisor

Cowdin, Daniel

Second Advisor

Demy, Timothy

Third Advisor

Lanza, Catriona

Date of Award

2025

Document Type

Dissertation

Degree Name

Ph.D.

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