NC program trains doulas as maternity care deserts grow

As most people in medical fields will tell you, the work is personal. 

2026-09-03

Rose Lewis of Nash County shared that her journey to become a doula started long before she even knew what doula meant. At the time, she was simply being a mother and supporting her daughter.

“My daughter was high-risk,” Lewis shared. “There was a moment where she had to be airlifted to Greenville. It was scary.”

Lewis remembers being there to offer emotional support, help her daughter navigate what was happening, and advocate for her throughout the experience. 

“I was there as a mom, being an advocate for her,” Lewis said. “What if she did not have that support? The outcome may have been different. It gave me time to think about that.”

Years later, Lewis shared that her daughter and granddaughter are doing well. 

“My granddaughter was born premature, but she is two years old, and she is talking and saying her ABCs and 123s,” Lewis shared.

Lewis started volunteering at North Carolina Central University’s Rural Health Hub in Enfield, NC. She then became part of the inaugural community-based doula program cohort in 2023.

A doula is a trained, non-medical professional who offers support to birthing individuals and their families before, during, and after childbirth. 

“We’re not medical professionals, but we do provide emotional, physical, and informational support,” Lewis said. “It doesn’t have to be just a single mom; it can be a married couple.”

The program provides intensive training and continued support as participants work toward certification through DONA International. NCCU says the first cohort included 12 doulas, with scholarships covering training, certification and materials. Participants must attend three qualifying births to complete certification requirements. 

The program comes as access to maternity care remains a challenge in rural communities across North Carolina.

North Carolina has more than 3.5 million people living in rural areas, the second-largest rural population in the country. The latest March of Dimes data shows significant gaps in access to obstetric care across the state.

A maternity care desert is a county with no birthing facility and no obstetric clinician. Nationally, roughly one in three counties meets that definition, according to the March of Dimes 2026 Maternity Care Deserts Report.

Rural counties are disproportionately affected. The report shows 18 North Carolina counties have no obstetric clinician, while another 12 have just one.

“Access,” said Dr. Undi Hoffler, lead of the NCCU Doula Program, when asked about the biggest barriers facing pregnant women in rural communities. 

“When we say the term maternity care desert, do we really understand what that means?” Hoffler said. “That means there aren't any providers there and there aren't any hospitals that have labor and delivery.” 

For some families, she said, that can mean traveling 45 minutes to more than an hour for care.

Lewis sees the same barriers firsthand.

“Some of the biggest health challenges I see is transportation, for one,” she said. “You’ve got to have transportation to receive prenatal care.”

The loss of hospital-based maternity services has added to that challenge.

Since 2013, at least 10 hospitals in mostly rural North Carolina counties have eliminated labor and delivery services, including facilities in Avery, Bladen, Caldwell, Cherokee, Davidson, Macon, Martin, Mitchell, Transylvania and Harnett counties.

Martin General Hospital has since closed entirely.

Hoffler said the program was purposefully launched in Enfield due to its geographical location and surrounding counties with health challenges. 

“We focused in that area because we’re focused on improving health outcomes in rural North Carolina,” Hoffler said. “Surrounding Halifax County, you have several maternity care deserts. Halifax County itself is a low maternity care access county.”

Hoffler said doulas cannot replace obstetricians, gynecologists, or nurses. However, she said they can serve as a trusted presence and provide an added layer of care. 

“The American College of Obstetrics and Gynecology has shown that when doulas are involved in pregnancy, labor, delivery, and postpartum, we're seeing improved birthing experiences overall,” Hoffler said. “We see decreased rates of cesarean delivery. We're seeing decreased use of medical interventions throughout labor and delivery.”

Hoffler added that doula involvement has also been tied to reduced use of pain medication and higher Apgar scores in infants. 

The NCCU doula program is now preparing for its third cohort. Hoffler said interest is already higher than in the past two years, with a month remaining to apply. 

“The doulas become a family themselves,” Hoffler said, explaining that participants can eventually serve as backups and sources of support for one another in work that doesn't follow a nine-to-five schedule. “This is heart work, but it's also very demanding work.” 

Lewis said members of her cohort have remained in contact since their training.

“We built a community right there,” she said. “Everybody is so eager and still enthused about it.”

That sense of community also resonated with Nedra S. Maryland, a 58-year-old retired U.S. Army veteran who joined the program's December 2025 cohort.

Maryland said she was drawn to the work by the belief that women deserve to feel supported, respected and empowered during pregnancy and childbirth. As a mother and grandmother with a life rooted in service, she saw becoming a doula as another way to advocate for people during moments when they may feel vulnerable or overwhelmed.

“These cohorts build stronger connections among healthcare providers, doulas, community organizations, and families in eastern NC, ensuring that mothers do not have to navigate pregnancy and motherhood alone,” Maryland said.

That support is particularly significant in a state where maternal health outcomes remain unequal.

In North Carolina, Black women die from pregnancy-related causes at nearly twice the rate of white women. State maternal mortality reviewers nearly 80% of the pregnancy-related deaths they examined were preventable.

WRAL’s documentary unit spoke with North Carolina mothers and medical providers about the issues plaguing minority communities in Critical Term: Why are Black mothers and babies dying?

For Lewis, education has become one of the most important parts of the job.

It also means reminding women that they know their own bodies and should feel comfortable raising concerns.

“Oftentimes there are questions that you want to ask, but you're afraid to ask those questions,” Lewis said. “You know your body more than anybody else.”

If something does not feel right, she wants mothers to know they have a voice.

“Let's voice it,” Lewis said. “Ask questions.”