“What our study showed is that [lower odds of a C-section] don’t come with wanting a doula; it’s having a doula that is actually associated with important and substantial risk reductions,” Kozhimannil said.
The cost of hiring a doula for people without private insurance is often prohibitive. And yet given the on-call time, unpredictable length of time away, skills used, cost of training, materials, childcare, administration etc. that goes into the work, doulas cannot give their services away as a rule and have a sustainable career. They cannot have full time jobs and do this “on the side”, given the demands upon availability. It takes a tremendous commitment of time, energy, and money to be a birth worker.
Theses statistics show that doulas are not just a luxury for those who can afford it, but a service that can actually bring healing to an overburdened healthcare system, as well as have a wide reaching positive impact upon the experience of birth. 
How are some ways doula work can become more accessible to all birthing women while respecting our needs for adequate remuneration? 
I am a Canadian doula and this article is American, but it is still relevant.
Awareness of the impact of birth upon new parenthood and beyond also needs to be increased. When people haven’t yet gone through birth, they may not know to prioritize the birth experience as something to invest in. How many mothers I speak to, years after birth, tear up and say, “I wish I had known about you when I was having my baby?”
Doulas are underutilized, and the general population of birthing folks who want doulas are under-served.