Implementation of a Community Doula-Hospital Partnership to Improve Access to Linguistically and Racially Concordant Doula Care for Black Birthing People

Abstract

Introduction

Racially and linguistically concordant doula care has reduced disparities in maternal morbidity and mortality rates for Black birthing people. This mixed-methods pilot implementation study assessed the feasibility of implementing and maintaining a novel partnership between a community doula organization led by 2 Black doulas and an urban academic tertiary care hospital.

Methods

The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to design and evaluate implementation. Black birthing people were recruited from the hospital's midwifery and general obstetrician-gynecology practices. Partnership members selected the implementation strategies. Implementation outcomes were assessed through periodic clinician surveys of midwives, labor and delivery nurses, and physicians and through doula monthly check-ins, postbirth debriefs, and patient visit logs. Descriptive and comparative quantitative analyses were conducted for surveys and doula logs. Rapid qualitative analyses were conducted for open-ended survey responses, doula check-ins, and debriefs.

Results

A total of 51 of 55 patients enrolled in the study received doula services. Midwives expressed higher levels of acceptability and appropriateness of doula care on clinician surveys compared with labor and delivery nurses and physicians. Feasibility was high, but some clinicians demonstrated a lack of understanding of the doulas’ role in labor and birth. Fidelity for prenatal and postnatal visits was high (98% and 96.1%, respectively). A doula was physically present at 41 births and virtually present at 6 (N = 51). Reasons for not being present during the remaining 4 births included communication issues, precipitous births, and births at a facility other than the study site.

Discussion

This study demonstrates that implementation of a formal community doula-academic hospital partnership was largely feasible. Interprofessional education has the potential to improve physicians’ and labor and delivery nurses’ lower ratings of the appropriateness and acceptability of doula care compared with midwives’ ratings.