Thirty-four years ago, Jennifer Campbell (now the executive director of the DOULA CO-OP of Nevada) walked into a hospital she'd never seen, to deliver with a medical team she'd never met. Her husband was deployed. Labor stretched past 19 hours. When her daughter, Brianna, was finally born, a neonatologist told her the baby was the most critical of 29 infants in the NICU and likely wouldn't survive her first 72 hours. Jennifer was released after 24 hours and spent the next three days sleeping in hospital hallways, alone, waiting.
On day three, a nurse found her, brought her to shower, and walked her to the lactation room. A lactation consultant sat down, put a hand on her leg, and asked one question: "tell me your birth story." Jennifer started to cry. It was the first time in three days anyone had asked how she was doing.
"I realized how much better it could be if I had just had support. And a year later, I was in birth work."
Jennifer Campbell, Executive Director, DOULA CO-OP
Brianna survived, and she turned 34 this year. But the part Jennifer remembers most, being profoundly alone at the hardest moment of her life, became the reason she has spent three decades in birth work and the reason the DOULA CO-OP of Nevada exists. Today, CO-OP doulas work alongside Renown Health's Labor & Delivery team in Nevada's first hospital-based paid doula shift program. In its first 11 months, the program supported 217 mothers, more than half of them having their first baby. Ninety-four percent of those births included skin-to-skin contact within the first hour, and the cesarean rate was 21%, compared with 33% statewide.
Jennifer with her daughter, Brianna, in the NICU 34 years ago.
Roughly four years ago, that mission became a formal partnership with Renown Health: the Renown-DOULA CO-OP Doula Access Program, allowing doulas access to closets and nutrition rooms and including them as "nurse extensions" to serve their own clients, including in the OR when a C-section is necessary. Then, in November 2025, Renown and DCNV expanded their relationship and launched the first hospital-based paid doula shift model in Nevada. Trained birth doulas now work as members of Renown Health's Labor & Delivery care team, offering continuous, evidence-informed support that complements clinical care. This report walks through what that partnership has produced so far, told through the words of the two women who built it and the data the program has generated along the way.
About the Program
The Renown-DOULA CO-OP Shift Program is the first hospital-based paid doula shift model in Nevada. Designed through a partnership between Renown Health and the DOULA CO-OP of Nevada, the program integrates trained birth doulas into Renown Health's Labor & Delivery as members of the interdisciplinary care team to provide continuous, evidence-informed support for birthing families.
This report provides transparent reporting on program activity, patient care, and birth outcomes while measuring progress toward a shared goal of improving maternal and newborn health.
Together, the partners are creating a maternity care environment where every birthing family has access to compassionate, continuous labor support that complements clinical care, enhances the birth experience, and promotes healthy outcomes.
The Program Works To
- Improve birth experiences
- Increase access to continuous labor support
- Support positive maternal and newborn outcomes
- Strengthen collaboration between doulas and clinical care teams
Increasing Access to Doula Care
Doula support has traditionally gone to women who could pay for it out of pocket: typically $1,500 to $2,000 per birth, Jennifer says, covering prenatal visits, labor & delivery, and postpartum care. That leaves out most of the people having babies in Nevada. Jennifer Campbell puts it plainly: "55% of all pregnant women in Nevada have Medicaid. Over half of the women who are pregnant cannot afford to have a doula. They can't afford the support."
Closing that gap took more than good intentions. DOULA CO-OP founder Sue Foltz spent years building relationships inside Renown, and advocated alongside the CO-OP for a 2023 Nevada bill that raised Medicaid doula reimbursement from roughly $350 for an entire birth (often 60-plus hours of work) and 4 educational visits, to a living wage. Nevada had been among the lowest-reimbursing states in the country for doula care before that bill passed. Sue sums up the turnaround: "Four years ago, they didn't really like doulas at all. Now it's like, oh my gosh, the DOULA CO-OP is here!"
Planning Before Labor
Nearly half of patients arrived with a documented birth plan, and two in three had a birth plan reviewed or created with a doula. That matters because, as Jennifer puts it, informed consent means walking through decisions before labor, not during it: "If I talk about an epidural to 100 women, 30% are like, where can I sign up, and 30% will absolutely never want that done. The information isn't different. It's their decisions, their comfortability, their baby, their body, their family. Asking them to make that decision (any decision) in active labor is ridiculous."
Getting Support Earlier
One data point is worth watching rather than celebrating: early prenatal care in Washoe County has consistently trailed both the Nevada and national rates over the past decade, dipping as low as 59% in 2018 before a pandemic-era spike in 2020. Getting mothers connected to a doula earlier in pregnancy, not just at delivery, is one lever the CO-OP is actively working on, including a new bilingual (English and Spanish) doula training curriculum aimed at reaching Washoe County's largely Hispanic Medicaid population sooner.
Improving Birth Outcomes
Doulas are non-medical by design, and both Sue and Jennifer describe that as a strength rather than a limitation. Sue puts it plainly: doulas work "waist up." Jennifer tells a story about being in an operating room, unrecognized in her surgical outfit, when an anesthesiologist finally asked who she was. "I'm the doula," she said. "Oh, but you're so smart," he replied. Jennifer corrected him: non-medical doesn't mean uneducated.
"It's not that we're lacking what they have. That's a great thing that we aren't the same. We're constantly searching for what we can do to help things go right: how can we wait longer for an epidural, how can we do position changes that help avoid a C-section."
Jennifer Campbell, Executive Director, DOULA CO-OP
Jennifer makes a related point with a number attached: the U.S. national target (Healthy People 2030) sets the appropriate C-section rate at 23.6%, while the World Health Organization (WHO) recommends 10 to 15%, and nurse-midwife-attended births tend to run under 10%, while national and regional rates often land between 26% and 34%. Doulas, she argues, are one of the more direct tools available for closing that gap through movement, positioning, and continuous encouragement rather than intervention.
The program's cesarean figure is worth sitting with. Over the past decade, cesarean rates ran between about 33% and 34% in Nevada and about 32% nationally. Among DOULA CO-OP program births with a recorded delivery method, the rate was 21%, roughly 12 percentage points below Nevada's 2024 rate and just under the Healthy People 2030 target of 23.6%. DOULA CO-OP program births aren't a matched comparison group, so that gap shouldn't be read as an effect of doula support alone, but it's a promising early signal.
The First Hour
Skin-to-skin contact and breastfeeding are tightly linked to newborn health and bonding, and both are areas where a doula's continuous presence in the room, rather than a clinician's periodic check-in, tends to make the difference. Among mothers who planned an unmedicated birth, more than half achieved one, and about half of those who planned an epidural were able to wait until active labor.
The Statewide and National Backdrop
Across Nevada and the U.S., induction of labor climbed from roughly 21% (Nevada) and 25% (USA) in 2016 to about 32% (Nevada) and 34% (USA) by 2024, and anesthesia use during birth held between about 79% and 82% in Nevada while rising from about 74% to 78% nationally over the same years. Preterm birth measures for Washoe County, Nevada, and the U.S. stayed within a narrow band of roughly 9% to 11% across the decade, without a clear trend in either direction. None of those broader trends are specific to this program. They're included here as the backdrop the CO-OP's own numbers sit against.
Low Birth Weight and Maternal Health
The low-birth-weight trend line is countywide public health data, not a program-specific measure. The Renown-DOULA CO-OP partnership is only a few years old, while this trend runs back to 2016. It's included here as context: Washoe County's low-birth-weight rate started below both the Nevada and national rates in 2016 and has been gradually converging with them since, landing close to the national rate by 2022-2024 while staying below Nevada's. That's a trend worth watching over the coming years as the program matures, not a result to attribute to it yet.
Improving Impact on Community Health
The DOULA CO-OP's model was built to reach people who are often left out of maternal health support entirely. Jennifer Campbell is still the only doula in northern Nevada who serves incarcerated mothers giving birth: four to eight cases a year, always with two sheriff's deputies standing guard, and always, Jennifer says, without a single bad experience in that room.
"Resilience in less-than-ideal circumstances can make all of the difference. It is truly beautiful to watch these young women grow, overcome challenges, and become wonderful mothers."
Sue Foltz, Founder, DOULA CO-OP
That same commitment to underserved communities shapes where Sue and Jennifer want to take the program next: rural Nevada, where prenatal support and telehealth infrastructure are thin, and where Sue is looking to partner with UNR's School of Public Health and with maternal care organizations statewide to extend the Doula Access Program (DAP) model beyond Renown.
Birth rates across Washoe County, Nevada, and the U.S. have all declined steadily since 2015, from roughly 12.3 per 1,000 residents to somewhere between 9.5 and 10.7 by 2024. It's a broad demographic trend playing out nationally, and one this local partnership sits within rather than drives on its own.
Teen birth rates tell a more specific, local story worth flagging. They fell sharply and consistently across all three geographies from 2015 through 2022. But in 2023 and 2024, Washoe County's teen rate turned back upward while Nevada's and the nation's kept declining. It's one data point, and it doesn't establish a cause. (From 2021 onward, Washoe County's figure counts teen pregnancies rather than births, so the comparison isn't exact.) But it lines up closely with what Sue and Jennifer describe as their next frontier: reaching younger, rural, and underserved mothers earlier, before they ever reach a delivery room.
The Broader Maternal Health Picture
Two related public health measures are worth tracking alongside these. Severe maternal morbidity, a broader complication measure tracked at the county, state, and national level, rose across all three geographies over the past decade: from roughly 125 to 140 per 10,000 deliveries in 2016 to about 200 to 245 by 2023 and 2024 in Washoe County and Nevada, and from about 72 to 95 per 10,000 in the U.S. (national data currently runs only through 2022). Fetal death rates, by contrast, have shown no sustained upward or downward pattern: Nevada's has stayed between about 6.6 and 8.2 per 1,000, Washoe County's swings more from year to year (roughly 5 to 10), and the national rate has held just under 6. Neither measure is specific to this program, and both sit well outside what a hospital-based doula shift can influence on its own, but they're part of the broader maternal health picture this work sits within.
Why This Work Matters
None of this happened by accident. About four years ago, Sue Foltz took Emily Barney to lunch with a simple pitch: she wanted to start a nonprofit, and she wanted Emily to start it with her. Emily brought in Samantha D'Andrea, a longtime doula, and the three divided the work by strength. Sue took the business side, Samantha brought deep birth-work experience, and Emily, in Sue's words, had "the best gift of words." Over coffee, they brainstormed names on a napkin, crossing out options like the Doula Collective until they landed on the DOULA CO-OP of Reno. It soon became the DOULA CO-OP of Nevada.
Since then, the organization has grown from a small working board of doulas to 90+ certified members (up from 53 as recently as September 2025), governed by a volunteer board that includes three physicians, a DNV/MBA, and a Medicaid managed-care chief medical officer.
Jennifer's goal for what comes next isn't just more doulas. It's making sure the doulas already doing this work can sustain it: simplifying the path to becoming a Medicaid provider, building out the billing infrastructure behind it, and making sure doulas can build a full caseload doing the work they're passionate about instead of patching it together with a second job. Her message to the next generation of doulas is simple:
"Yes, you can be a doula. Yes, there is a way. Yes, you can get the support. People just need to never be afraid to ask a question and reach out."
Jennifer Campbell, Executive Director, DOULA CO-OP