Perspectives of Doulas of Color on their Role in Alleviating Racial Disparities in Birth Outcomes: A Qualitative Study

Abstract

Introduction The purpose of this study was to explore how doulas of color conceptualize both their work and how their racial and ethnic identities influence their work within the context of racial disparities in birth outcomes in the United States. Methods We conducted semistructured qualitative interviews with doulas of color who had attended at least 3 births as doulas. Participants were recruited from across the United States. The interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to derive themes from the transcribed interviews. Results Interviews were conducted with 8 doulas of color, ranging in age from 21 to 47 from across the United States. All participants were either current college students or had earned a college degree. Although many of the doulas identified as being of more than one racial or ethnic group, nearly all participants identified closely with being Black or African American first, and their other racial groups second. Four major themes emerged: relationship with the medical system, role of identity in the doulas' work, role of class, and divisions within the natural birth movement. Discussion The majority of doulas who participated in this study stated that their racial identity strongly influenced their work, particularly when working with women of the same race or ethnicity due to their shared identities. Several participants initially became doulas because of a desire to alleviate disparities in birth outcomes for women of color. This suggests a commitment on the part of the study participants to serving their communities and to bridging the gap between women of color and the health care system. Several participants also noted that they feel alienated by both the health care system and the mainstream natural birth community.

Promoting Shared Decision-making in Maternal Health Care

“…The authors state that the trained doulas are the liaisons to the Black community, who will increase trust, build relationships, and increase open communication between patients and providers for shared decision-making. In a 2021 qualitative study by Kathawa and coauthors, the findings reinforced the hypothesis that doulas of color are uniquely well suited to support women of color and that tensions surrounding race discordance between women and providers can be alleviated by the presence of a doula from a similar background to the birthing person [21]. The perinatal doula training program described in the Standard article recognized the need to enhance traditional birth doula training with content that would create more culturally appropriate and concordant doula training.…”

Perspectives on cultural competency and race concordance from perinatal patients and community‐based doulas

“…A critical first step is recognizing doulas as essential and valuable providers and formally integrating them into the maternal care system through equitable reimbursement and payment 26,37 . The experiences and perspectives of both patients and providers of color should inform all doula training and education, which in the US, has generally centered on the experience of white, highly resourced patients 27 . Hospitals and health systems should invest directly in community programs, especially given that many aspiring birth workers of color have limited access to training and educational opportunities 27 .…”

“…In a study exploring doulas' views on pandemic‐induced changes, concordant doulas had an increased awareness of the unique impacts limited COVID‐19 testing access, disrespect, excessive medical intervention, and restrictions on support people in the labor room had on Black, Indigenous, and People of Color communities 26 . Another study assessing perspectives of doulas of color found that participants felt doulas are able to support clients because they are able to notice instances of poor treatment and negative hospital encounters due to personal experience and are more likely to validate such challenges rather than dismiss them 27 . Moreover, Black doulas emphasized the role of intuition in the perinatal care experience, referencing the historical origins of Black midwifery 27 …”

“…Another study assessing perspectives of doulas of color found that participants felt doulas are able to support clients because they are able to notice instances of poor treatment and negative hospital encounters due to personal experience and are more likely to validate such challenges rather than dismiss them 27 . Moreover, Black doulas emphasized the role of intuition in the perinatal care experience, referencing the historical origins of Black midwifery 27 …”

The Ambivalence of Power in the Twenty-First Century Economy

“…In the United States, doula support is often a commercial enterprise, and doulas and their clients are predominantly white middle-class women (Hunter 2012, 318). Although there are grassroots doula organizations, such as black doulas helping black mothers achieve a positive birth experience in racist hospital environments (Lakhani 2019), the dominant US doula practice focuses on a white, middle-class clientele (Kathawa et al 2021;Lantz et al 2005).…”