Models of Birth Doula Access in Hospital Settings: Insights from the ACURE4Moms Study in North Carolina

Continuous doula support during labor and delivery in the hospital setting is associated with improved maternal and newborn outcomes, such as reduced labor duration and higher infant Apgar scores. ACURE4Moms, a 4-arm cluster randomized controlled trial of 39 prenatal clinic groups across North Carolina, is evaluating whether community-based doula support can reduce low birthweight. This short report outlines hospital doula policy insights gleaned from implementation of the doula support intervention.

Identify the most common models for doula support in the hospital setting and discuss their potential impact on patient access to doula support.

We worked with study clinics and their health systems to obtain their hospital doula policies so that we could prepare study doulas to support patients at the participating hospitals. We conducted thematic analysis to categorize the policies by their various approaches.

Four commonly observed approaches to hospital access policies for doulas were identified among study sites: (1) the Visitor Model, (2) the Credentialing Model, (3) the Vendor Compliance Model, and (4) the Hospital Workforce Model. We noted that the wide variability in policies and their enforcement and restrictiveness could create confusion and unnecessary barriers for doulas who support patients in labor.

There is a need for equitable, standardized, and clearly communicated hospital doula policies to ensure that more patients, especially those from underserved populations, can access the benefits of continuous doula support in hospital-based births.