The Blurred Boundaries of Care: A Qualitative Analysis of Nurse-Doula Role Conflict.

Abstract

Introduction: Conflict between nurses and doulas can contribute to miscommunication, delays in treatment, and decreased patient satisfaction, especially among marginalized populations. Nurses and doulas both play essential roles in supporting birthing individuals, yet their interactions are often strained by unclear role boundaries, differing philosophies of care, and institutional policies that fail to integrate doulas into clinical teams. The purpose of this study is to examine the underlying sources of tension between nurses and doulas and identify facilitators that support more effective collaboration within maternity care teams.

Methods: We conducted semi-structured interviews with 20 participants (9 nurses and 11 doulas) recruited from both clinical and community settings in South Carolina. Interviews were analyzed using thematic analysis to identify barriers and facilitators to nurse-doula collaboration in maternity care.

Results: Three key themes emerged: (1) lack of institutional recognition and role legitimacy (structural conditions), (2) territorialism and perceived competition in shared care spaces (interpersonal dynamics), and (3) blurred boundaries between advocacy and scope of practice (role-level influences). Participants also identified strategies to enhance collaboration, including clearer role definitions, institutional support, and mutual respect.

Discussion: Findings underscore structural, interpersonal, and role-level barriers to nurse-doula collaboration. Integrating doulas into maternity care teams through inclusive hospital policies, joint training, and explicit role clarification may improve teamwork and advance equitable, patient-centered care.

Health equity implications: Strengthening nurse-doula collaboration is a critical step toward addressing the U.S. maternal health crisis, particularly for marginalized communities. Integrating doulas more fully into maternity care teams can promote equitable, patient-centered care and reduce avoidable disparities.