Barriers and Bridges: Black Doulas' Experiences in Healthcare Setting

Black birthing people experience disproportionately high rates of adverse maternal and infant health outcomes. Doula support is associated with improved birth outcomes and can help reduce racial disparities, yet culturally congruent doulas face hurdles practicing in the healthcare setting. This quality improvement project aimed to understand the experiences of Black doulas in Nebraska to enhance integration into healthcare systems.

Three group-based interviews were conducted as part of a quality improvement project in August 2023 with six Black doulas practicing in Nebraska. Participants were recruited through community organizations and snowball sampling. Semi-structured interviews explored doula practices, barriers, motivations, and sources of support. Transcripts were analyzed using thematic analysis.

Three main themes emerged: (1) Barriers inhibiting Black doulas in the healthcare setting, (2) Facilitators of a doula-friendly clinical environment, and (3) Coping strategies. Doulas described facing resistance, stereotypes, and a lack of understanding about their role from some healthcare staff, contrasted with client advocacy. Self-care strategies and peer support networks were critical for sustainable practice.

Despite systemic barriers, Black doulas play a vital role in supporting Black families and addressing inequities. Recommendations include implementing doula-friendly policies, addressing bias, fostering an inclusive environment in healthcare facilities, and enhancing the integration of culturally concordant doula support to improve outcomes for Black birthing people.