Supporting in solidarity: An examination of social support, advocacy, and barriers among birthing doulas

“We Are All There to Make Sure the Baby Comes Out Healthy”:

“…Previous research highlights areas of tension between doulas and licensed providers of maternal healthcare, as well as opportunities for promoting positive working relationships. 7 , 16 , 17 , 29 Our research elicited similar concerns and challenges 21 , 22 ; however, areas of agreement between these stakeholder groups highlighted in this paper provide a strong foundation for the state to move forward with policy and practice changes. Most notably, we heard both doulas and licensed providers share their commitment to doing what is best for their patients, and an interest in finding ways to ensure the delivery of quality care in a mutually supportive team environment.…”

“…Financial support for doula training and certification should be considered, particularly as the state aims to improve outcomes for its most vulnerable populations. 16 , 18…”

“…Financial support for doula training and certification should be considered, particularly as the state aims to improve outcomes for its most vulnerable populations. 16,18 In addition to financial concerns related to training and certification, consideration of other logistical challenges is warranted. Stakeholders identified concerns related to doulas' abilities to navigate the Medicaid reimbursement process.…”

“…Anecdotal evidence from Delaware suggests that current working relationships may be tenuous, and more systematic research in other areas finds that many licensed providers are unaware of the benefits of doulas and/or may resist the integration of doulas as part of the care team. 15 Further, doulas cite lack of respect from clinicians as a workplace challenge, 16 while licensed providers have reported difficult working relationships when they perceive doulas as interfering with clinical decision-making in ways that could be harmful to the patient. 17 Finally, evidence from other states that have expanded access to doula services demonstrates the need to identify and prepare for potential logistical challenges associated with implementation of policy and practice changes, such as Medicaid coverage.…”