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Alvarado G, Schultz D, Malika N, Reed N. United States Doula Programs and Their Outcomes: A Scoping Review to Inform State-Level Policies. Womens Health Issues 2024; 34:350-360. [PMID: 38724343 DOI: 10.1016/j.whi.2024.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The field of maternal health has advanced significantly over the past decades. However, the United States continues to have poor outcomes in comparison with other industrialized nations. With emerging evidence on the promise of doula care, states are including doula care under their Medicaid programs. METHODS We conducted a scoping review across four academic databases and gray literature published between January 1, 2012, and March 10, 2022, to describe the landscape of literature on U.S. doula programs and their outcomes in order to inform state policy makers considering laws or programs related to doula care. FINDINGS Of 740 records identified, 100 met inclusion criteria. Outcomes fell into four areas: birthing people's outcomes, infant outcomes, systems of care and implementation, and cross-cutting issues. Data on outcomes related to doula care in the literature were predominantly clinical, even though doulas are not clinical providers. Although some studies have found associations between doula care and improved clinical outcomes for birthing people and infants, the evidence is limited due to small sample sizes, study methodology, or conflicting conclusions. Doula outcomes are underexplored in the literature, with mainly qualitative data describing low levels of diversity and equity within the doula workforce and ineffective payment models. When cost-effectiveness estimates have been calculated, they largely rely on savings realized from averted cesarean births, preterm births, and neonatal intensive care unit admissions. CONCLUSIONS As state Medicaid programs expand to include doula care, policymakers should be aware of the limitations in the evidence as they plan for successful implementation, such as the narrow focus on certain clinical outcomes to quantify cost savings and conflicting conclusions on the impact of doula care. An important consideration is the impact of the reimbursement rate on the adoption of doula care, which is why it is important to engage doulas in compensation determinations, as well as the development of improved metrics to untangle the components that contribute to maternal health outcomes in the United States.
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Knight EK, Rich R. "We Are All There to Make Sure the Baby Comes Out Healthy":: A Qualitative Study of Doulas' and Licensed Providers' Views on Doula Care. Dela J Public Health 2024; 10:46-59. [PMID: 38572130 PMCID: PMC10987029 DOI: 10.32481/djph.2024.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Policymakers are exploring ways to expand access to doula care to address persistent inequities in maternal and infant health across the United States. Doulas are non-medical professionals who provide physical, emotional, and informational support to birthing people before, during and after childbirth. Growing evidence supports the role of doulas in improved birth outcomes. Delaware is among several states moving towards Medicaid reimbursement for doula care to serve those most at risk. Objective: To gain an in-depth understanding of key stakeholders' knowledge, attitudes, beliefs and experiences regarding doula training and certification, relationships among providers, and other potential needs related to infrastructure to identify areas of agreement and inform policy change in the state of Delaware. Methods: We conducted focus groups with 11 doulas and key-informant interviews with 12 licensed providers practicing in Delaware, including six nurses, four physicians and two certified nurse midwives. Qualitative data was collected via Zoom (video conferencing) between September 2022 and April 2023. Results: Analysis revealed themes related to training, credentials and competencies of doulas, including cultural competence; logistical, administrative, and financial considerations for policy and practice change; and the whole care team-relationships between doulas and medical partners, and opportunities for growth. Conclusions: Doulas and licensed providers agree on key elements of doula training, the value of certification, the need for financial support, and the importance of relationship-building across the care team. Policy implications: Areas of agreement among stakeholders provide a foundation for state leaders to move forward to ensure the delivery of the most accessible, high quality, and culturally competent doula care for birthing people in Delaware.
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Herriott AL, Etling S, Hans SL. Community-Based Doulas' Roles Within the Birth Support System: Young Black Mothers' Perspectives. J Midwifery Womens Health 2024; 69:33-40. [PMID: 37766383 DOI: 10.1111/jmwh.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/05/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Doulas have been found to be beneficial to pregnant adolescents during childbirth, but little is known about their role within the larger system of people providing birth support, including family and health care providers. The purpose of this study was to examine, from the perspectives of young mothers, the role of the doula within their broader birth support system. METHODS One hundred pregnant Black adolescents and young women (aged 13 to 21) who were provided perinatal community-based and racially concordant doula services at no cost to them were interviewed after the birth of their newborn, prior to hospital discharge. Interviews generated birth story narratives and responses to focused questions about their experiences of birth support. Thematic analysis was conducted to examine the role of the doula within the context of the broader system of birth support. RESULTS Doulas functioned in 2 primary ways within the birth support system by (1) providing tandem support alongside family and health care providers and (2) filling gaps in health care not provided by family and providers. Laboring adolescents sometimes described their family members and doulas working in tandem to provide multiple types of support such as comfort measures, coaching, and help with pushing. They also identified gaps in their care or support filled by the doula, in particular gaps due to family members' physical or emotional unavailability or health care providers' many responsibilities. DISCUSSION The findings highlight the ways in which doulas support pregnant adolescents during childbirth through their deft navigation of the existing support system. Well-being was enhanced by the inclusion of the doula in the birth support system. The findings align with existing research that underscores the valuable role doulas play in supporting individuals during childbirth, particularly for those most affected by processes of marginalization.
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Affiliation(s)
- Anna L Herriott
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
| | - Sophia Etling
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
| | - Sydney L Hans
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
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Erga-Johansen H, Bondas T. Multicultural doula care from the perspectives of immigrant women in Norway: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 35:100827. [PMID: 36822024 DOI: 10.1016/j.srhc.2023.100827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES The aim of the study was to illuminate immigrant women's experiences of multicultural doula care as part of the 'Vulnerable, pregnant and new in Norway - Safe during childbirth with a multicultural doula' project. METHODS The qualitative design was based on Braun & Clarke's thematic analysis. Semi-structured interviews were held, assisted by an interpreter, with seven immigrant women from three different countries. RESULTS The overarching theme illuminated a significant caring relationship between the immigrant women and their multicultural doula. The relationship was important for the women's positive childbirth experience. Furthermore, four themes emerged as follows: feeling alone and scared; needing to be looked after; not knowing the language; and giving birth in a new and unfamiliar culture. The results revealed that the women felt safeguarded by the multicultural doula. They felt cared for and understood when the doulas acted as guides, knowing the culture and language, in collaboration with the midwife in maternal care. CONCLUSIONS Multicultural doulas can contribute to optimizing the quality of care provided to immigrant women during pregnancy and childbirth, with focus on an equal quality of care for all women. The findings can raise awareness of cultural competence in midwifery practice. More research is needed to develop new models that incorporate multicultural doulas into healthcare policies.
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Affiliation(s)
- Henriette Erga-Johansen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway; University of Stavanger, Faculty of Health Sciences, Kjell Arholms gate 41, 4021 Stavanger, Norway.
| | - Terese Bondas
- University of Stavanger, Faculty of Health Sciences, Kjell Arholms gate 41, 4021 Stavanger, Norway.
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Turner D, Lindsey A, Shah P, Sayyad A, Mack A, Rice WS, Mosley EA. "Doulas shouldn't be considered visitors, we should be considered a part of [the] team": doula care in Georgia, USA during the COVID-19 pandemic. Sex Reprod Health Matters 2022; 30:2133351. [PMID: 36448944 PMCID: PMC9718548 DOI: 10.1080/26410397.2022.2133351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Doula support improves maternal-child health outcomes. However, during the COVID-19 pandemic, hospitals restricted the number of support people allowed during childbirth. An academic-community research team conducted 17 in-depth interviews and structured surveys with doulas in metro-Atlanta, Georgia, USA from November 2020 to January 2021. Surveys were analysed for descriptive statistics in Stata v. 14, and interviews were analysed in Dedoose using a codebook and memo-ing for thematic analysis. All 17 doulas reported COVID-19 changed their practices: most were unable to accompany clients to delivery (14), started using personal protective equipment (13), used virtual services (12), and had to limit the number of in-person prenatal/postpartum visits (11). Several attended more home births (6) because birthing people were afraid to have their babies in the hospital. Some stopped seeing clients altogether due to safety concerns (2). Many lost clientele who could no longer afford doula services, and some offered pro bono services. Most doulas pointed to restrictive hospital policies that excluded doulas and disallowed virtual support as they felt doulas should be considered a part of the team and clients should not be forced to decide between having their doula or their partner in the room. COVID-19 has severely impacted access to and provision of doula care, mostly due to economic hardship for clients and restrictive hospital policies. At the same time, doulas and their clients have been resourceful - using virtual technology, innovative payment models, and home births.
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Affiliation(s)
- Daria Turner
- Master of Public Health Student, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Alyssa Lindsey
- Master of Public Health Student and Graduate Research Assistant, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Priya Shah
- Master of Public Health Student, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ayeesha Sayyad
- Master of Public Health Student, Georgia State University School of Public Health, Atlanta, GA, USA,Graduate Research Assistant, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Amber Mack
- Research and Policy Analyst, Healthy Mothers, Healthy Babies Coalition of Georgia, Atlanta, GA, USA
| | - Whitney S. Rice
- Assistant Professor, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Elizabeth A. Mosley
- Affiliate Faculty Member, Center for Reproductive Health Research in the Southeast (RISE), Emory University Rollins School of Public Health, Atlanta, GA, USA,Assistant Professor, Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA.,Correspondence:,
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Kett PM, van Eijk MS, Guenther GA, Skillman SM. "This work that we're doing is bigger than ourselves": A qualitative study with community-based birth doulas in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:99-108. [PMID: 35797066 DOI: 10.1363/psrh.12203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Community-based birth doulas support pregnant women, transgender men, and gender non-binary individuals during the perinatal period and provide essential services and expertise that address health inequities, often taking on additional roles to fill systemic gaps in perinatal care in the United States (US). Despite the benefits that community-based birth doulas provide, there is little research exploring the work-related conditions and stressors community-based doulas experience. To address this gap, we examined the work experiences, related stressors, and stress management strategies of individual community-based birth doulas. METHODS In this qualitative, descriptive study we conducted 18 interviews in March through June 2021 with individuals who self-identified as community-based doulas working in underserved communities in the US. We analyzed the interviews for themes, which we defined and finalized through team consensus. RESULTS The doulas reported engaging in specific strategies in their work to address perinatal inequities. They also described facing several work-related stressors, including witnessing discrimination against clients, experiencing discrimination in medical environments, and struggling with financial instability. To mitigate these stressors and job-related challenges, interviewees reported they relied on doula peer support and reconnected with their motivations for the work. CONCLUSIONS Community-based doulas provide essential services and expertise which address inequities and systemic gaps in perinatal care. However, as they work to improve perinatal health, doulas themselves are providing equity work amidst an inequitable system and with insufficient political or financial support. Increased compensation and systemic support which acknowledges the breadth of services provided is needed to strengthen and sustain this critical part of the perinatal workforce.
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Affiliation(s)
- Paula M Kett
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Marieke S van Eijk
- Department of Anthropology, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Grace A Guenther
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Susan M Skillman
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
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Helena L, Amani E, Anna W, Nataliia T, Rhonda S, Erica S. Multi-tasking community-based bilingual doulas are bridging gaps-Despite standing on fragile ground. A qualitative study of doulas' experiences in Sweden. Midwifery 2021; 105:103231. [PMID: 34979361 DOI: 10.1016/j.midw.2021.103231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Community-based Bilingual Doulas (CBDs) are women from migrant communities trained to support and comfort migrant women during labour and birth, and to facilitate linguistic and cultural communication between women, their partners and staff. The aim of the study was to describe CBDs' experiences of supporting migrant women during labour and birth, working alongside caregivers, and to explore CBDs perceptions of their work situation in a Swedish setting. METHODS As part of an ongoing randomised trial of CBD support in XX, Sweden, semi-structured individual interviews were conducted with nine of the 35 participating CBDs. The interviews were conducted in each CBD's first language (Arabic, Somali, Tigrinya, Russian, Polish) or in Swedish, and were audio recorded, transcribed verbatim and translated into English. Thematic analysis of data identified, analysed, interpreted and reported patterns and themes across the data. RESULTS The overarching theme which emerged was "Multi-tasking bilingual doulas bridging gaps - despite standing on fragile ground". To reach out a helping hand and receive appreciation from the women when their needs were met, motivated the CBDs to continue despite the constraints related to roles, working conditions and boundaries. The CBDs felt proud of being acknowledged, although they did also feel a need for more supervision and education. CONCLUSIONS The CBDs experienced their doula tasks as meaningful and emotionally rewarding, which mostly outweighed the challenges of their work which they saw as insecure, exhausting and underpaid. If CBDs are implemented on a larger scale, the scope of their role (including boundaries), education, access to supervision and working conditions all need to be better addressed.
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Affiliation(s)
- Lindgren Helena
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
| | - Eltayb Amani
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden
| | - Wahlberg Anna
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden
| | - Tsekhmestruk Nataliia
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden
| | - Small Rhonda
- Judith Lumley Centre, La Trobe University, Melbourne Victoria 3086, Australia
| | - Schytt Erica
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden; Centre for Clinical Research Dalarna - Uppsala University, Nissers väg 3, 791 82 Falun, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Møllendalsveien 6, Postboks 7030, 5020 Bergen, Norway
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Suárez-Baquero DFM, Champion JD. Accompanying the Path of Maternity: The Life History of a Colombian Doula. J Perinat Educ 2021; 30:145-158. [DOI: 10.1891/j-pe-d-20-00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Doulas have fundamentally improved the health-care experience of pregnant women internationally. Women who recognize the importance of not being alone during pregnancy have embraced this role for centuries. However, less is known about doulas practicing in countries experiencing health inequities like Colombia. Miller's methodology and Atkinson's interview domain was used to answer the question “What life experiences led a Colombian woman to become a doula?” A central theme emerged, “A calling from within: Growing up to accompany the transition from woman to mother.” The path to becoming a doula evolved from life experiences involving health inequities, and a sense of femininity, maternity, and the women's role in rural Colombia.
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