Continuous Support, Stronger Beginnings
The Renown-DOULA CO-OP Shift Program, One Year In
Continuous doula support. Better birth experiences. Stronger outcomes.
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 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
Jennifer’s daughter turned 34 this year. That experience (an overwhelmingly positive outcome that still involved being profoundly alone at the hardest moment of her life) became the reason Jennifer has spent three decades in birth work, and the reason the DOULA CO-OP exists at all.
Roughly four years ago, that mission became a formal partnership with Renown Health: the Renown-DOULA CO-OP Shift Program, the first hospital-based paid doula shift model in Nevada. Trained birth doulas now work as members of the 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.
Outcome 1: 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, 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) 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!”
The numbers behind that reach, from the co-op's own program data, tell the story of who this work is reaching and how.
Program Reach and Access
Mothers helped
111
First-time mothers
49 (44%)
Doula services provided
Labor & Delivery 80%, Postpartum 9%, Operating Room 5%, Antepartum, Other, and Triage about 1% each
Documented birth plan at admission
Yes 46%, No 42%, N/A 10%
Birth plan reviewed or created with a doula
Yes 64%, No 36%
Source: DOULA CO-OP program utilization data, 2025-2026.
T
hat 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. Asking them to make that decision in active labor is ridiculous.”
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 56% 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.
Outcome 2: 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 scrubbing into an operating room, unrecognized in her surgical gown, 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: not medical doesn't mean not educated. As she describes the mindset: “It's not just 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 help go right: how can we wait longer for an epidural, how can we do position changes that help avoid a C-section.”
Jennifer makes a related point with a number attached: the American College of Obstetricians and Gynecologists puts the appropriate C-section rate around 19%, 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.
Program Outcomes at a Glance
Childbirth method (doula-supported births)
Vaginal 42%, Assisted vaginal 9%, Cesarean 8%
Immediate or first-hour skin-to-skin contact
96% (95.96%)
Breastfeeding initiated
86% (85.86%)
Source: DOULA CO-OP program utilization data, 2025-2026.
The outcomes above 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. The cesarean figure is worth sitting with: over the same stretch of years, cesarean rates across Nevada and the U.S. overall ran far higher, generally between 31% and 34% in Nevada and 31% to 32% nationally, more than three times the rate among the births this program supported. Induction of labor climbed too, from roughly 20% (Nevada) and 24% (USA) in 2016 to about 31% to 32% by 2024 in both, and anesthesia use during birth rose from around 78% to 81% in Nevada and 73% to 78% nationally over the same years. Preterm birth measures for Washoe County, Nevada, and the U.S. stayed within a narrow 9-to-11 band 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.
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 both by 2022-2024. That's a trend worth watching over the coming years as the program matures, not a result to attribute to it yet.
Outcome 3: 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.
Sue Foltz puts what drives that work simply:
“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 10.5 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 birth 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. 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.
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 120 to 140 per 10,000 in 2016 to 190 to 240 by 2023 and 2024 in Washoe County and Nevada, and from about 50 to 90 per 10,000 in the U.S. (national data currently runs only through 2022). Fetal death rates, by contrast, have stayed comparatively flat, generally in the 6-to-8-per-1,000 range across Nevada, Washoe County, and the U.S., without a sustained upward or downward pattern. 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 started the DOULA CO-OP on the back of a coffee-shop napkin with two co-founders. Since then, the organization has grown from a small working board of doulas to roughly 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 ones 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.”
Truckee Meadows Tomorrow is not a partner or funder in the Renown-DOULA CO-OP Shift Program. Our role here is the one we play across all ten Quality of Life Indicators: connecting the community to accurate, timely, and objective data, and helping a program like this one show its work.
References
Unless otherwise noted, program data is from the DOULA CO-OP Program (reference 1).
1. Doula CoOp. (2025-2026). Doula CoOp program utilization data [unpublished raw data].
2. Nevada Division of Public and Behavioral Health. (n.d.). Maternal and child health in Nevada [Dashboard]. Retrieved August 11, 2026, from https://app.powerbigov.us/view?r=eyJrIjoiYTRjMTJmOTQtYTM1Ny00Y2RiLWJjMTUtY2M4Y2RlMjYzZIiwidCI6ImU0YTM0MGU2LWI4OWUtNGU4OC04ZWFhLTE1NDRkMjcwMzk4MCJ9
3. Centers for Disease Control and Prevention. (n.d.). Natality, 2016-2024 expanded [Data set]. CDC WONDER. Retrieved August 11, 2026, from https://wonder.cdc.gov/controller/datarequest/D149;jsessionid=BCAC75B270A93A3A0072F3C4726E
4. Hamilton, B. E., Osterman, M. J. K., & Gregory, E. C. W. (2026, April). Births: Provisional data for 2025 (Vital Statistics Rapid Release No. 43). National Center for Health Statistics. https://www.cdc.gov/nchs/data/vsrr/vsrr043.pdf
5. National Center for Health Statistics. (n.d.). NCHS data query system: Birth and fertility rates [Dashboard]. CDC. Retrieved August 11, 2026, from https://nchsdata.cdc.gov/dqs/dashboard?topic=birth-and-fertility-rates&topic_id=111220&subtopic=birth-rate&group=total&subgroup=all-females&estimate=live-births-per-1000-total-population&range=2016-to-2024
6. Centers for Disease Control and Prevention. (2025, April 21). NCHS, Teen birth rates for age group 15-19 in the United States by county [Data set]. HealthData.gov. https://healthdata.gov/CDC/NCHS-Teen-Birth-Rates-for-Age-Group-15-19-in-the-U/v3q8-qefr/about_data
7. Agency for Healthcare Research and Quality. (n.d.). HCUP fast stats [Dashboard]. Retrieved August 11, 2026, from https://datatools.ahrq.gov/hcup-fast-stats/
8. Gregory, E. C. W., Valenzuela, C. P., & Hoyert, D. L. (2025, June 17). Fetal mortality: United States, 2023 (National Vital Statistics Reports, Vol. 74, No. 8). National Center for Health Statistics. https://www.ncbi.nlm.nih.gov/books/NBK621168/
Interview sources: Jennifer Campbell, Executive Director, DOULA CO-OP of Nevada (interview conducted August 2026). Sue Foltz, Founder, DOULA CO-OP of Nevada (interview conducted August 2026). Additional organizational background: doulacoop.org.