Hospital “Doula Agreements” and You
There’s a growing trend across the USA, that has real implications for patient rights: hospitals are drawing up “doula agreements” and insisting that a doula sign before she can join her client.
We get it—the doula role is not always clear or transparent and hospitals are introducing these agreements in response to that.
We also observe that even highly responsible doulas are frequently scapegoated for the informed decisions of their clients. It is hard not to read these agreements through the lens of that reality.
These agreements often include statements that are in conflict with the contract a doula has signed with her client. They also often reflect a poor understanding of the doula’s role as a patient advocate.
Here are some 2025 examples of lines from real agreements presented by hospitals to doulas who shared them with us—followed by some questions they raise for us.
- “I will support the care being provided by the clinical team.
- “I will support the medical interventions and explanations given by the clinical team.”
How is “support” to be interpreted? What if the client (whom the doula is contracted to “support”) does not want the intervention, or does not agree with the explanation?
- “I will not make derogatory or judgmental comments regarding members of the clinical team or their recommendations for treatment plans.”
Will it be considered “judgmental of a medical recommendation” if a doula proposes an alternative to AROM? Will it be considered “derogatory” if the doula informs the client that induction for suspected macrosomia alone is not evidence-based?
- “I will ask the clinical team if it is acceptable to get the patient up to the bathroom prior to doing so.”
What if the patient wants to get up to go to the bathroom of her own accord? Is it assumed the doula is “getting her up?”
Is the doula being asked to alert the clinical team of her client’s autonomous actions?
- “Under this agreement a doula will not interfere with the medical care provided by Hospital.”
What if a doula sees that a client’s right to informed consent is being violated? A doctor has withheld information about the risks of a procedure… a nurse is starting a Pitocin drip without consent… if the doula raises the issue, is she “interfering with medical care?”
- “Hospital will respect the role of Doula providing the services to Patient; provided, Hospital shall have ultimate authority for all patient care decisions.”
We’ve never met a doula who didn’t believe that the patient holds the ultimate authority for all patient care decisions. The law would agree.
For anyone who has worked on either side of the clinical fence, it should be clear that these statements potentially undermine a patient’s access to to informed consent/refusal, or to the presence of an advocate and support person.
When a doula enters a hospital at her client’s side, in good faith and ready to work collaboratively, and she meets a piece of paper like this she immediately feels ostracized, watched, threatened, judged, mistrusted.
The truth is, many doctors and nurses have felt the same thing from doulas.
It’s a poor starting point for a team—a team intentionally chosen by a family seeking care and loving support.
We call for doulas to seek better training in transparent patient advocacy. We call for better training for healthcare providers (and all parties) in patient rights and the laws relating to informed consent.
We call for everyone to humanize each other for the ultimate benefit of the families we serve.
Read about how to become a certified Perinatal Patient Advocate.