ACOG Is Now Recommending the Partnership We Began Building M

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By Dr. Mohammed Agha and Caridad Saenz

In July 2026, the American College of Obstetricians and Gynecologists released new clinical guidance titled Partnering With Doulas in Clinical Settings.

The statement encourages obstetrician–gynecologists to understand the doula’s role, build constructive professional relationships with doulas and recognize the value that doula support can bring to patient-centred maternity care. It moves the conversation beyond simply acknowledging the benefits of continuous labour support and towards something more intentional: genuine partnership.

For us, this guidance felt both important and deeply familiar.

More than two years ago, before there was a formal statement encouraging obstetricians to partner with doulas, we had already begun building that partnership here in Dubai.

We did not begin because a professional organization told us to.

We began because, through our respective work, we had both come to understand the same truth:

Women receive better care when medicine and continuous emotional support are not positioned against one another, but are brought together around the mother.

At first glance, an obstetrician and a doula may appear to occupy very different worlds.

The obstetrician carries responsibility for clinical assessment, diagnosis, medical decision-making, intervention and the safety of the mother and baby. The doctor must remain alert to complications, interpret changing clinical information and respond when birth moves outside the boundaries of physiology.

The doula holds a different responsibility.

She offers continuous emotional, physical and informational support. She helps the mother understand what is happening, remain connected to her body, communicate her questions and preferences and navigate the intensity and vulnerability of birth.

A doula does not diagnose, prescribe or make medical decisions. An obstetrician cannot always remain continuously beside one woman throughout every hour of her labour.

These roles are not interchangeable.

But they are deeply complementary.

The problem arises when maternity care assumes that only one type of knowledge matters.

Clinical knowledge matters.

Physiological knowledge matters.

The mother’s emotional experience matters.

Her sense of dignity, safety and participation matters.

The strongest maternity care does not require us to choose between these things.

It asks us to bring them together.

Our partnership did not begin as a formal project or institutional programme. It began through conversation, observation and a mutual willingness to listen.

Caridad had spent many years supporting women through pregnancy, labour, birth and postpartum. She had witnessed how profoundly a woman’s environment, emotional safety and relationship with her care team could affect her experience of birth.

Dr. Agha had spent more than two decades practising obstetrics. He understood that birth can change quickly and that medical knowledge, careful observation and timely intervention can be lifesaving. He also recognized that safe medical care should not require women to feel unseen, frightened or excluded from decisions about their own bodies.

We began talking about the places where maternity care often becomes disconnected.

We spoke about women who arrived at the hospital already afraid.

We spoke about birth preferences that were sometimes interpreted as demands rather than invitations to communicate.

We spoke about doctors who felt that doulas were interfering with clinical care and doulas who entered hospitals expecting conflict before a conversation had even begun.

We spoke about the distance that can form between medical teams and families when communication becomes hurried, defensive or unclear.

Most importantly, we spoke about what might become possible if that distance were reduced.

From those conversations, a partnership began to grow.

We supported shared patients. We discussed birth planning, waterbirth, vaginal birth after cesarean, induction, movement during labour and the emotional needs of women navigating unexpected changes.

We began creating educational conversations together. Through workshops, writing, public discussions and our Doula Doctor Dialogues, we explored what happens when an obstetrician and a doula stop defending their professions and begin listening to one another.

The purpose was never to prove that one of us was right.

The purpose was to understand how each of us could serve the mother more fully.

True collaboration does not mean that the doctor, doula and family will always agree.

Birth is complex. Clinical circumstances can change. The mother’s preferences may need to be revisited as new information becomes available. A doula may see that a woman is becoming overwhelmed or no longer understands what is being discussed. A doctor may identify a concern that is not visible to anyone outside the clinical team.

Partnership means that disagreement does not automatically become conflict.

It means questions can be asked without being interpreted as challenges to authority.

It means clinical recommendations can be explained rather than simply announced.

It means doulas remain within their nonclinical scope while still helping women find their voices.

It means doctors can respect a woman’s need for time, privacy, movement or reassurance while still fulfilling their clinical responsibilities.

It means that when intervention becomes necessary, the mother is not made to feel that she has failed.

The quality of maternity care is not measured only by whether a particular birth preference was achieved.

It is also reflected in whether the woman understood what was happening, whether she was treated with dignity and whether she remained a participant in her own care.

One of the most damaging assumptions in maternity care is that the doula is present to protect a woman from the medical team.

A professional doula should not enter the birth room anticipating a battle.

She is not there to speak over the mother, frighten the family, interpret clinical information beyond her scope or encourage the rejection of necessary medical care.

She is there to support the mother.

Sometimes that means helping her communicate a preference for more time, movement or privacy.

Sometimes it means helping her formulate questions before consenting to a procedure.

Sometimes it means supporting her as she accepts that the birth she imagined is changing.

Sometimes it means helping her feel safe enough to trust the clinical team.

A good doula does not weaken the relationship between the woman and her doctor.

She can help strengthen it.

There is also a damaging belief that medical involvement and physiological birth are natural opposites.

They are not.

An obstetrician can respect physiological birth while remaining prepared to intervene.

Supporting physiology does not mean ignoring risk. It means understanding when the body can be given time and when medical assistance is genuinely needed.

A doctor who supports physiological birth is not abandoning medicine. The doctor is applying medicine thoughtfully rather than automatically.

This may include encouraging movement and upright positions, protecting the birth environment, avoiding unnecessary disruption, allowing time when mother and baby are well, listening to the woman’s priorities and recognizing the value of continuous support.

Medical expertise should create safety.

It should not unnecessarily remove autonomy.

ACOG has previously recognized that continuous one-to-one support during labour, including support from a doula, is associated with improved outcomes. Its earlier guidance on limiting intervention during labour acknowledged the value of support that facilitates the physiological birth process.

The new statement represents an important evolution.

The question is no longer only whether doula support may be beneficial.

The question is how obstetricians, hospitals and doulas can work together responsibly in real clinical environments.

ACOG describes a need to address knowledge gaps about the doula’s role and explains why partnership between obstetric clinicians and doulas is important. It also encourages obstetrician–gynecologists to advocate for further research into doula partnerships and the role of doulas within obstetric and gynecologic care.

This matters because collaboration cannot depend entirely on individual personalities.

Hospitals need clear policies.

Clinical teams need education about the doula’s scope.

Doulas need professional standards, accountability and an understanding of hospital realities.

Families need consistent information about what doulas can and cannot do.

When expectations remain unclear, mistrust grows. When roles are understood, everyone can focus on the person at the centre of the room.

Through our partnership, we have each been challenged to see birth through a wider lens.

Working closely with a doula offers insight into the parts of birth that may not appear in a medical chart.

A mother’s fear does not always show on a monitor.

Her confusion may not be visible in her vital signs.

A technically successful birth may still be experienced as traumatic when communication, dignity or emotional safety are absent.

The doula may notice subtle changes in the mother’s emotional state because she has developed a relationship with her throughout pregnancy and has remained continuously beside her during labour.

This information does not replace clinical assessment.

It adds humanity and context to it.

Working closely with an obstetrician creates a deeper understanding of the responsibility carried by the medical team.

The doula may be focused on one mother. The doctor may be responsible for several patients, changing clinical situations and decisions with serious consequences.

Not every recommendation is an unnecessary intervention.

Not every change from the birth plan represents a failure to respect physiology.

Sometimes medicine is precisely what allows the mother and baby to emerge safely.

Collaboration requires the doula to remain curious, grounded and responsible—to ask rather than assume, and to support informed decision-making without practising outside her scope.

At the heart of our partnership is a simple idea: every woman deserves to be met.

She should be met medically, with skill and vigilance.

She should be met emotionally, with patience and compassion.

She should be met as an individual, not merely as a diagnosis, a room number or a set of risk factors.

She should be given evidence without being reduced to statistics.

She should be able to express fear without being dismissed as difficult.

She should be able to change her mind.

She should be able to ask questions.

She should be supported when birth unfolds physiologically and cared for compassionately when medical intervention becomes necessary.

Being met does not guarantee a particular birth outcome.

It changes how the woman experiences the journey towards that outcome.

The publication of ACOG’s guidance is encouraging, but a statement alone will not transform maternity care.

Transformation happens in the birth room.

It happens when a doctor pauses to explain.

It happens when a doula communicates respectfully.

It happens when a nurse recognizes the doula as part of the mother’s chosen support system.

It happens when hospital leadership creates policies that support collaboration rather than confusion.

It happens when everyone remembers that the mother is not an observer of her own birth.

More than two years ago, we chose to work together because we believed that medicine and doula care could meet without either losing its identity.

We still believe that.

The doctor does not become less medical by listening to a doula.

The doula does not become less protective of physiology by respecting medicine.

Both become more capable of seeing the whole woman.

We welcome ACOG’s guidance not as the beginning of this conversation, but as an important affirmation of what many collaborative doctors, midwives, nurses and doulas have already discovered:

Birth is better served when the people surrounding the mother stop standing on opposite sides of the room.

The future of maternity care is not doula versus doctor.

It is not physiology versus medicine.

It is skilled, respectful people bringing their different forms of knowledge together—and placing the mother at the centre of them all.

Dr. Mohammed Agha is a consultant obstetrician and gynecologist .

Caridad Saenz is a birth and postpartum doula, educator, author and Birth Guardian who works to bridge physiological birth, emotional care and respectful medical collaboration.