I have been a doula for 20+ years.

I say that not as a credential but as context for everything that follows. Twenty years of births,  at home, in hospital, in complicated circumstances and in straightforward ones. Twenty years of being present for the moment people become parents. Twenty years of watching a system that is supposed to protect families fail too many of them.

Here is my honest account of where we are.

What 20 years in birthwork looks like

I started as a doula because I understood what it meant for Black and Brown families to move through a maternity system that was not designed for them. I stayed because the need did not go away.

I became a trainer because the doulas those families needed were not being trained. The programmes that existed were not asking the right questions, were not teaching from a justice lens, and were not building the kind of practitioners that communities of colour needed.

I built Abuela Doulas to change that.

What has genuinely changed

There is more visibility now than there was 20 years ago. More Black doulas and doulas of colour. More people using the words “birth justice” and “cultural safety” in mainstream conversations. Grass root campaigns have put the data in front of decision-makers in ways that were not possible before.

Formal inquiries have created pressure on NHS trusts to examine their practices. There is more acknowledgment at institutional level that something is wrong.

That is real progress. It matters.

What has not changed

The data.

The language has changed. The awareness has increased. The figures have not moved in proportion.

Knowing the problem exists is not the same as fixing it. Saying the right words at conferences is not the same as changing what happens in the birth room, in the postnatal ward, in the moment when a Black woman says she is in pain and is not believed.

The gap between acknowledgment and action is where families are still being failed.

What doulas do about this

Doulas are not a solution to a systemic problem. That needs to be said clearly.

The systemic problem is a systemic problem. It requires systemic change, accountability, resourcing, and a fundamental rethinking of how the maternity system operates.

But doulas are something real and concrete in the meantime. A trained doula who understands the system, who can support a person to exercise their informed choices, who can advocate in the birth room and be present in the postnatal period — that is a meaningful intervention in a person’s experience of a system that may not otherwise have their interests at heart.

Black doulas and doulas of colour who serve their own communities have something additional: the understanding that comes from shared experience. The trust that develops differently when a person feels genuinely seen. The cultural knowledge that makes support land in a way it otherwise might not.

Every doula trained to support Black and Brown families through pregnancy and birth is a direct and concrete response to a mortality gap that should not exist.