The Doula Model in American Health Care in the 21st Century: A Narrative Literature Review

The doula model has been used in American health care for the past 50 years. The model dates back to biblical times-a woman who serves-the model that has passed the test of time. American women sought to improve the birthing experience in the mid-70s, and the doula model used in England was incorporated into American obstetrical care to respond to this need. With the turn of the 21st century, providing greater comfort to the dying became the focus. The birth doula model became the template. During the next 2 decades, other types of doulas-comfort doulas, delirium doulas, hospice doulas, end-of-life doulas, death doulas, and palliative care doulas-evolved. This model has provided companionship, comfort, support, advocacy, and education for many individuals and loved ones who are experiencing serious illnesses. Doulas have access to educational training and certification; however, standardization of registration, education, and/or certification has been sporadic and inconsistent. Many doulas are volunteers, and yet, many others are paid for their services. The variations in service, type, reimbursement, and roles make this model less attractive, and yet, the values of cost-effectiveness, care satisfaction, and guidance through the difficult medical experience justify further consideration in future research.