What I heard, what was missing, and what Arkansas must do next
By Angela “Annie” Hill, Arkansas Department of Health Certified Community-Based Doula #005 August 23, 2026
I have had two full days to process what I heard at the 2026 Arkansas Maternal Health Roundtable, held Thursday, August 20, at the William J. Clinton Presidential Library and Museum in Little Rock.
I did not want to rush directly from nearly five hours of presentations and conversations into a tidy event recap. There was too much information, too much progress, and too much still unfinished.
The Roundtable made one thing unmistakably clear: Arkansas is finally putting serious attention, funding, policy, and institutional effort behind its maternal health crisis.
It also made some of the gaps in that work painfully visible.
I left encouraged by the programs being built, the policies moving forward, and the people clearly committed to making them work. I also left with a question that has continued to bother me:
Who was not in the room?
I Was in the Room Where It Happened
To borrow briefly from Hamilton, I was in the room where it happened.
But I was not there because anyone had made a point of ensuring that an actual Arkansas Certified Community-Based Doula, certified by the Arkansas Department of Health, had a seat in that room.
I was there because I had been savvy enough to set up online alerts for legislative activity, maternal health policy, Medicaid developments, and other events affecting my profession. That is how I learned about the Roundtable. I registered myself and showed up.
That distinction matters.
I am Arkansas’s fifth ADH-certified Community-Based Doula. I am also a retired home birth midwife with decades of experience supporting families during pregnancy, birth, and postpartum recovery.
Because of that background, another absence was impossible for me to overlook.
Practicing home birth midwives were not represented at all.
Although much of the Roundtable centered on hospital-based care, Arkansas’s maternal health crisis does not begin and end at hospital doors.
If Arkansas is serious about improving maternal health outcomes, this work will require all hands on deck. That means intentionally including the doulas, home birth midwives, community health workers, lactation professionals, emergency medical providers, rural healthcare workers, and other professionals already working directly with families in their homes and communities.
The people expected to help carry these solutions into practice should not have to stumble across the conversations where those solutions are being shaped.
Policy Is Only the Beginning
One message surfaced repeatedly throughout the Roundtable: passing a law or creating a program is not the same as changing an outcome.
Implementation matters.
Enrollment matters.
Reimbursement matters.
Communication matters.
Families knowing that a service exists matters.
Providers knowing how to deliver and bill for that service matters.
Collaboration cannot be “one and done.” It has to continue after the legislation passes, after the press release is issued, and after everyone leaves the Roundtable.
That message could not have been more timely.
While maternal health leaders were gathering at the Clinton Presidential Library, Arkansas was also moving the Medicaid rules for doula care across the legislative finish line. Arkansas Medicaid coverage for certified doula services is scheduled to begin September 1.
That is an enormous step forward for Arkansas families.
It is also the beginning of implementation, not the end.
Coverage on paper does not help a pregnant person unless certified doulas can enroll as Medicaid providers, managed care organizations are prepared to work with us, billing systems function correctly, healthcare teams understand our role, and families can find doulas who are actually available to serve them.
The state has opened the door. Now we have to build the pathway through it.
I will be writing much more about what Arkansas Medicaid doula coverage means for families, how Certified Community-Based Doulas become eligible to provide covered services, and what still needs to happen before this new benefit works smoothly in real life.
Pregnancy Does Not End at Delivery
Another major theme was postpartum care.
Pregnancy does not end when the baby is delivered, and maternal health risks do not disappear when a family leaves the hospital.
I was encouraged to hear about efforts such as Arkansas’s Proactive Postpartum Call Center, which contacts participating patients after hospital discharge to discuss recovery, identify warning signs, and connect families with appropriate care and community resources.
That kind of proactive outreach matters.
It also demonstrates why continuity of care is so important. A postpartum patient may be exhausted, overwhelmed, frightened, unsure whether a symptom is normal, or unaware that something warrants immediate medical attention. They may not know whom to call, how urgently to call, or how to explain what is happening.
A doula does not replace a nurse, midwife, physician, mental health professional, or emergency medical provider.
We can, however, help a family recognize that something needs attention, organize the information they need to communicate, and reach the appropriate healthcare professional promptly.
A statewide call center can provide an important layer of support. So can a trusted person who already knows the family, understands their circumstances, and has been checking on them throughout pregnancy and postpartum recovery.
Arkansas needs both.
Rural Communities Need More Support, Not Less
Rural maternal healthcare was woven throughout the day’s discussions, and it must remain central to whatever Arkansas builds next.
According to the March of Dimes maternity care access data for Arkansas, 50.7 percent of Arkansas counties are considered maternity care deserts.
When a community loses its birthing hospital or has no local obstetric provider, pregnant families must travel farther for prenatal appointments, monitoring, birth, and postpartum care. Transportation, work schedules, childcare, fuel costs, weather, and simple geography become healthcare barriers.
The absence of a hospital does not make a doula less relevant.
It makes community-based doula support even more critical.
A doula cannot replace a hospital, physician, certified nurse-midwife, home birth midwife, ambulance, or emergency department. What a doula can do is help bridge the growing distance between a family and the healthcare system.
We can help families prepare for appointments, identify barriers before they become crises, understand when they need to contact their healthcare team, locate resources, and make realistic plans for reaching care.
Mobile clinics, telehealth, transportation programs, community health workers, and doulas can all help build maternal health infrastructure where traditional infrastructure has disappeared.
But those solutions will only work if the people delivering them are included in the planning.
Trusted Information Is Maternal Health Infrastructure
The Roundtable also addressed something every doula and healthcare professional is already encountering: families are receiving pregnancy information from TikTok, Facebook, Instagram, YouTube, and online parenting groups long before they walk into a medical office.
Some of that information is excellent.
Some of it is incomplete, misleading, or dangerous.
Dr. Fran’s presentation about social media, trust, and pregnancy misinformation has stayed with me, and it deserves far more than a paragraph inside this article. Paging Dr. Fran will become its own continuing series because the subject is too large and too important for a single post.
Families are going to seek information online whether professionals approve of it or not.
Ridiculing people for what they have heard or frightening them into silence will not build trust. It may only guarantee that they stop telling their healthcare providers what they are thinking, reading, or considering.
The answer is credible, understandable information paired with respectful conversation.
Doulas can help with that, too.
We have time to listen to the question behind the question. We can help clients identify reliable sources, prepare questions for their healthcare providers, and understand that informed decision-making requires both accurate information and meaningful conversation with the professionals responsible for their medical care.
Trust is not an optional extra in maternal healthcare.
Trust is part of the infrastructure.
ACOG Says Doulas Matter
The importance of including doulas in maternal healthcare is not merely something doulas say about ourselves.
In 2026, the American College of Obstetricians and Gynecologists published new guidance on partnering with doulas in clinical settings.
ACOG’s guidance recognizes that strong doula-clinician partnerships can improve communication, continuity, patient-centered care, and the experience and outcomes of the families being served. It calls on obstetric professionals to understand the doula’s scope and create respectful, collaborative teams.
Arkansas is already taking steps in that direction. The UAMS Institute for Community Health Innovation has developed the Advancing Doulas and Perinatal Teams Toolkit to help hospitals and doulas work together more effectively.
That collaboration is essential because doulas and clinicians do different jobs.
Doulas are nonmedical professionals. We do not diagnose conditions, prescribe treatment, perform clinical procedures, or replace healthcare providers. We do not make decisions for our clients.
Our work is relational and continuous.
We spend time with families. We learn what is normal for them. We provide education, practical preparation, emotional support, physical comfort, and help navigating systems that can be confusing even under the best circumstances.
We help clients prepare questions and communicate concerns clearly. We reinforce the importance of contacting their medical team when something does not feel right. We help them understand when an issue has moved beyond the doula’s scope and needs to be handled by the appropriate healthcare professional.
In other words, we help connect the family to the medical system before a concern becomes an emergency.
This Must Be an All-Hands-on-Deck Effort
I do not want the gaps I observed to erase the value of the Roundtable.
Important work is happening in Arkansas. People in state government, hospitals, universities, public health agencies, nonprofit organizations, and community programs are investing real time and effort into improving maternal health.
I left the Clinton Presidential Library with more hope than I carried into it.
But hope does not excuse us from examining who was missing.
Representation is not ceremonial. It directly affects which problems are recognized, which solutions are considered, and whether those solutions will work outside conference rooms, hospitals, and government offices.
Hospital administrators bring essential institutional knowledge.
Physicians, nurses, and midwives bring clinical expertise.
Public health officials bring data and statewide planning.
Community health workers bring local knowledge and resource navigation.
Home birth midwives bring experience caring for families beyond hospital walls.
Doulas bring continuity, trust, education, and direct knowledge of what families encounter between appointments.
Families themselves bring lived experience that no professional can substitute for.
Arkansas needs all of those perspectives.
We cannot wait for a frightened pregnant person or newly postpartum parent to become sick enough, loud enough, or desperate enough for the system to notice them.
How else are we supposed to catch concerns early, help families communicate and escalate them appropriately, and get the right healthcare professionals involved before those concerns become emergencies?
At Bright Blessings, we often say:
We do not catch babies. We catch problems before they become emergencies.
To do that work effectively, doulas need access, collaboration, sustainable reimbursement, and intentional inclusion in the systems Arkansas is building.
We need a seat at the table.
And doulas belong in the room.