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Doulas don't just help welcome new life. There's a growing field of end-of-life doulas. 

State of play: As discussion of death has gotten less taboo, public figures, including Nicole Kidman and "Hamnet" director Chloé Zhao, have spoken openly about training to become death doulas.

By the numbers: Membership in the National End-of-Life Doula Alliance grew from about 260 in 2019 to 2,040 as of June 2, NEDA tells Axios.

Zoom in: Colorado is roughly the 20th most populous state, but NEDA says it's eighth in the nation for NEDA-registered death doulas.

Go deeper: Here's how you can talk about death — in person or virtually — over donuts.

The rise of death doulas

Illustration of a collage of hands holding and a bouquet of flowers behind a curtain. 

Doulas don&#x27;t just help welcome new life. There&#x27;s a growing field of <a class="gtmContentClick" data-vars-link-text="end-of-life doulas" data-vars-click-url="https://www.axios.com/local/chicago/2024/04/21/death-doulas-chicago-collective" data-vars-content-id="1d42f6c1-f287-431d-af63-c5824293640a" data-vars-headline="The rise of death doulas" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/local/chicago/2024/04/21/death-doulas-chicago-collective" target="_self">end-of-life doulas</a>. State of play: As discussion of death has gotten less taboo, public figures, including <a class="gtmContentClick" data-vars-link-text="Nicole Kidman" data-vars-click-url="https://people.com/nicole-kidman-shares-more-insight-into-why-shes-becoming-death-doula-11953739" data-vars-content-id="1d42f6c1-f287-431d-af63-c5824293640a" data-vars-headline="The rise of death doulas" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://people.com/nicole-kidman-shares-more-insight-into-why-shes-becoming-death-doula-11953739" target="_blank">Nicole Kidman</a> and &quot;Hamnet&quot; director <a class="gtmContentClick" data-vars-link-text="Chloé Zhao" data-vars-click-url="https://www.nytimes.com/video/podcasts/100000010679161/why-the-director-of-hamnet-is-training-to-be-a-death-doula.html" data-vars-content-id="1d42f6c1-f287-431d-af63-c5824293640a" data-vars-headline="The rise of death doulas" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.nytimes.com/video/podcasts/100000010679161/why-the-director-of-hamnet-is-training-to-be-a-death-doula.html" target="_blank">Chloé Zhao</a>, have spoken openly about training to become death doulas.

Wellness Brief

Adapted from National Health Law Program; Map: Axios Visuals

More than half of U.S. states now reimburse for doula care under Medicaid — a dramatic shift from just a few years ago. 

By the numbers: 28 states and D.C. are actively reimbursing, according to the National Health Law Program. Before 2020, only Oregon and Minnesota did.

That's "a lot of progress" in a few years, says Amy Chen, senior attorney at the National Health Law Program. 

Zoom in: As of July 2024, Colorado's Medicaid program expanded to cover doula services.

A year later, the state began requiring large employer health plans to cover doulas, too.

Between the lines: "In process" states have a defined path toward coverage but aren't reimbursing yet. "Adjacent action" states have taken related steps without a concrete plan to cover doula services through Medicaid, Chen says.

Yes, but: Expanding coverage could create a catch-22.

The more doulas get folded into insurance systems, the more regulated they become. Their effectiveness, however, may stem precisely from being unregulated and fully answerable to patients, says Nicole Sessions, a doula and maternal mental health researcher in Atlanta.

"The insurance model isn't quite savvy enough to hold the nuances of the profession just yet," she says, citing limits insurers may place on billable postpartum hours.

Reimbursement maximums vary widely — from less than $800 to more than $3,000. Experienced doulas may not sign on if rates fall below their typical charges.

The big picture: Sessions worries that doula care is becoming a temporary fix — absorbing pressure that should be driving deeper changes to the obstetric system.

What we're watching: Whether "in process" states follow through or quietly stall, as Montana already has amid the Trump administration's cuts to Medicaid.

Where doulas are covered by Medicaid

More than half of U.S. states now reimburse for doula care under Medicaid.

A map shows state efforts to expand Medicaid coverage of doulas, as of June 1, 2026. 28 states and D.C. are actively reimbursing doula care. 13 states have taken adjacent actions. Six states have implementations in process and three have either failed to pass legislation or have not taken action.

More than half of U.S. states now reimburse for doula care under Medicaid — a dramatic shift from just a few years ago. By the numbers: 28 states and D.C. are actively reimbursing, according to the National Health Law Program. Before 2020, only Oregon and Minnesota did.

Doula care is moving into the mainstream as major insurers expand coverage and more patients incorporate it into pregnancy care. 

Why it matters: Research has linked doula support to lower cesarean rates and fewer preterm births.

And a new review of clinical trials published in JAMA Network Open found doula support was most consistently associated with lower maternal anxiety, higher breastfeeding initiation and better postpartum follow-up care.

The latest: UnitedHealthcare recently announced it would allow coverage of doula care in employer-sponsored plans nationwide — a significant move into the private insurance space.

Improving maternal and infant health outcomes also reduces the total cost of giving birth for the health care system, UHC tells Axios.

Between the lines: A doula isn't a midwife.

Midwives perform medical tasks like cervical checks and delivering babies.

Doulas offer continuous nonmedical support — affirmations, position changes, advocacy in the hospital — before, during and after birth, says Nicole Sessions, a doula and maternal mental health researcher in Atlanta.

What they're saying: As awareness of doulas has increased, "many people expect us to be in the room" for a delivery, Sessions tells Axios. "There's a lot more camaraderie" among hospital staff.

Zoom out: Doula care has become a key tool for addressing the disproportionately high rate of maternal death among Black women.

Sessions argues that "culturally competent," community-based doulas — those who share a patient's race, neighborhood or life experience — are often better able to build trust and advocate for patients. 

Doulas go mainstream

Research links doula support to lower cesarean rates and fewer preterm births.

Melina Laverde, left, performs cranial sacral therapy on Sanaai Lynae, two weeks old, during a postpartum checkup on Destyni McClain in Houston, Friday, July 25, 2025.

A practitioner performs craniosacral therapy on a 2-week-old infant during a postpartum checkup in Houston in 2025. Photo: Ashleigh Lucas/Houston Chronicle via Getty Images

Doula care is moving into the mainstream as major insurers expand coverage and more patients incorporate it into pregnancy care. Why it matters: <a class="gtmContentClick" data-vars-link-text="Research has linked" data-vars-click-url="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00261-9/fulltext" data-vars-content-id="2eed56a6-b721-4e8f-ab61-20309344d349" data-vars-headline="Doulas go mainstream" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00261-9/fulltext" target="_blank">Research has linked</a> doula support to lower cesarean rates and fewer preterm births.

Denver's top dog is a mild-mannered breed known for its playfulness and ease with children.

The big picture: Golden retrievers are the most popular dog breed in the Mile High City, according to a new U.S. News & World Report analysis.

Chihuahuas came in second, followed by the Labrador retriever.

Driving the news: Tuesday marks National Dog Day.

The fine print: The annual nationwide report relies on pet insurance data, so it doesn't account for all dogs in the country.

Last year, the chihuahua was No. 1 in the U.S., but analysts had separated "Labs" (then No. 2) and "black Labs" (then No. 10) into separate categories. This year, the Labrador category includes labs of all colors.

Zoom out: Statewide, Denver's top breeds also dominate, though Labradors were slightly more popular than Chihuahuas.

Between the lines: It's tricky to track mutt popularity.

The study counted "mixed breed," "pit bull" and labels like "German shepherd mix" as separate categories. The goldendoodle was the only mixed breed to crack the top 10.

Go deeper: Dog surrenders are soaring at Denver Animal Shelter

Denver's most popular dog breed

Smiling people pet a golden retriever wearing a purple bandana at a baseball stadium, a man nearby holds another large dog on a leash in the background.

A golden retriever during Bark in the Park night at Coors Field in 2018. Photo: Andy Cross/The Denver Post via Getty Images

<a class="gtmContentClick" data-vars-link-text="Denver&#x27;s top dog" data-vars-click-url="https://www.axios.com/2023/11/21/dog-research-mental-health-stress" data-vars-content-id="c41843db-2852-49d5-8a4e-e7b88082d323" data-vars-headline="Denver&#x27;s most popular dog breed" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/11/21/dog-research-mental-health-stress" target="_self">Denver&#x27;s top dog</a> is a mild-mannered breed known for its playfulness and ease with children.The big picture: Golden retrievers are the most popular dog breed in the Mile High City, according to a new <a class="gtmContentClick" data-vars-link-text="U.S. News &amp; World Report analysis" data-vars-click-url="https://www.usnews.com/insurance/pet-insurance/most-popular-dog-breeds-study" data-vars-content-id="c41843db-2852-49d5-8a4e-e7b88082d323" data-vars-headline="Denver&#x27;s most popular dog breed" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.usnews.com/insurance/pet-insurance/most-popular-dog-breeds-study" target="_blank">U.S. News &amp; World Report analysis</a>.

News

Culture

Dads who throw themselves into fatherhood may also be at risk for depression, says clinical psychologist and "Dad Brain" author Darby Saxbe.

Why it matters: New dads are often treated as the support system, not someone who might need support — yet when one parent struggles, so does the other.

By the numbers: About 1 in 10 dads experience anxiety or depression in their child's first year — and they're far less likely to be screened for it than moms.

What they're saying: The more dads take on, the more they're "kind of shouldering those same risks" mothers have long faced, Saxbe says — a "double-edged sword" where the involvement that deepens the bond also carries the cost.

The intrigue: Couples' stress hormones and moods tend to move in tandem, Saxbe's research finds. So when one parent is depressed, the other's risk climbs. "If we care about Mom's mental health, we actually need to care about Dad's, too."

Some risk factors overlap: disrupted sleep, an identity reckoning and a strained partnership.

The bottom line: Dads do best with hands-on time and a network around them. "We were not designed to parent in isolation," Saxbe says. 

New dads can experience depression, too

1 in 10 dads experience anxiety or depression in their child's first year.

Illustration of a man in black and white looking at his reflection in water

Dads who throw themselves into fatherhood may also be at risk for depression, says clinical psychologist and &quot;Dad Brain&quot; author Darby Saxbe.Why it matters: New dads are often treated as the support system, not someone who might need support — yet when one parent struggles, so does the other.

Dallas

A U.S. map shows state efforts to expand Medicaid coverage of doulas, as of March 2026. 28 states and D.C. are actively reimbursing doula care. 13 states have taken adjacent actions. Six states have implementations in process and three have either failed to pass legislation or have not taken action.

Carly Mallenbaum

Featured stories

Where doulas are covered by Medicaid

Where doulas are covered by Medicaid

Where doulas are covered by Medicaid

Doulas go mainstream

Doulas go mainstream