Exploring innovative models of doula services in maternity care: A qualitative study on advancing equity and...

Maternal and infant health disparities remain a persistent public health issue in the United States, disproportionately affecting systematically marginalized communities. While doulas have been shown to improve birth outcomes and reduce inequities, their integration into maternity care systems remains limited.

This study aimed to explore the roles and challenges of different doula models, identify systemic barriers to their integration, and propose strategies for sustainable implementation.

A qualitative study using a phenomenological approach that adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.

Using purposive and snowball sampling, 20 stakeholders, including doulas, healthcare providers, Medicaid specialists, and public health professionals, were recruited from Omaha, Nebraska, and Nashville, Tennessee. Semi-structured interviews were conducted in person and via Zoom, lasting between 30 and 90 min. Thematic analysis, supported by Dedoose software, was used to identify key themes related to doula integration, systemic barriers, and policy recommendations. Data credibility was reinforced through member-checking and an audit trail documenting coding decisions.

Three primary themes emerged: (1) Doula Types and Their Impact, private practice doulas offer individualized care but face financial barriers; hospital-based doulas improve communication but encounter institutional constraints; community-based doulas provide culturally competent care but struggle with sustainability. (2) Strategies for Sustainable Integration, hybrid models enhance continuity of care, public health partnerships support funding and advocacy, and advisory boards foster interdisciplinary collaboration. (3) Policy Recommendations, expanding Medicaid coverage, increasing equitable reimbursement rates, and establishing standardized doula training and certification to improve accessibility and professional recognition.

Implementing policy reforms and fostering collaborative models can help optimize doula services and improve perinatal outcomes, particularly for systematically marginalized populations. Sustainable funding, standardized certification, and public health partnerships are essential for improving accessibility to doula care.