The word “doula” comes from ancient Greek, where it meant “woman servant” or “woman who serves.” Its journey from an ancient Greek term to a modern caregiving role is surprisingly recent, beginning with a single anthropologist’s decision in the 1970s to revive the word for an entirely new purpose.
The Ancient Greek Root
In ancient Greece, the word referred to a female servant or slave. It carried no specific connection to childbirth or caregiving in the way we understand it today. The term sat largely unused in English for centuries until an American anthropologist gave it new life.
How the Word Entered Modern English
Dana Raphael, an anthropologist and breastfeeding advocate, was the first person to use “doula” to describe a childbirth support companion. She introduced the term in her doctoral dissertation, which she completed in 1966 under the guidance of famed anthropologist Margaret Mead. The dissertation was later published as a book in 1973 titled The Tender Gift: Breastfeeding.
Raphael used “doula” specifically to identify a woman who served as a supportive companion to another woman during childbirth and the early postpartum period, particularly for breastfeeding support. She chose the Greek word deliberately: the core idea was someone dedicated to serving a new mother’s needs during one of the most physically and emotionally demanding transitions of her life. The natural birth movement of the 1970s picked up the term and helped spread it widely.
From Informal Role to Certified Profession
For about two decades after Raphael coined the term, “doula” remained informal. That changed in 1992, when pediatrician Marshall Klaus, his wife, and colleague John Kennell cofounded Doulas of North America, now known as DONA International. This was the first organization to offer structured doula education and certification, and it gave the role professional legitimacy.
The definition also expanded. Raphael originally used “doula” to describe women who helped with breastfeeding. Klaus and Kennell broadened it to include continuous physical, emotional, and informational support during labor and birth, not just the postpartum period. That broader definition is the one most people recognize today.
Official Medical Recognition
Major medical organizations now formally recognize doulas as beneficial to birth outcomes. In 2014, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine reviewed the research and concluded that continuous one-on-one support from a doula during labor was associated with higher patient satisfaction and a statistically significant reduction in cesarean deliveries. They recommended that all women receive continuous support during labor as a strategy for reducing unnecessary cesarean births.
The World Health Organization reached a similar conclusion in 2018, publishing guidelines that include having a companion of choice during labor and childbirth as part of respectful maternity care. These endorsements moved the doula from a countercultural figure in the natural birth movement to an evidence-backed part of standard obstetric care recommendations.
The Word Beyond Birth
More recently, “doula” has expanded beyond childbirth entirely. The first formal use of the word in an end-of-life context came in 2001, when New York University Medical Centre launched a volunteer program called “Doula to Accompany and Comfort.” The program focused on the social, psychological, and spiritual needs of people at risk of dying in isolation.
End-of-life doulas explicitly borrow from the birth doula model: they provide informed companionship and nonmedical support before, during, and after death. The parallel is intentional. Just as a birth doula helps someone through the transition of bringing life into the world, an end-of-life doula helps someone through the transition of leaving it. The Greek root, “a woman who serves,” turns out to be flexible enough to hold both meanings.
Today, the word “doula” appears in contexts Raphael likely never imagined: fertility doulas, abortion doulas, postpartum doulas, and end-of-life doulas all trace their terminology back to that single decision in the 1960s to dust off an ancient Greek word and give it a new purpose.