A Systematic Review of the Use of Doulas to Support Rural Perinatal People in the United States.

Introduction: Maternal health outcomes are frequently worse for individuals living in rural and remote communities due to the distance people must travel for healthcare, higher rates of poverty, and higher risk factors for related health conditions, such as mental illness and substance use. Doulas, non-medical childbirth companions, provide emotional, informational, physical, and advocacy support to people during pregnancy, birth, and postpartum. Research has documented doulas' positive impact on birth outcomes, including lower rates of induction and cesarean birth. The benefits of doulas may be especially important for marginalized and underserved populations who experience disparate health outcomes, including rural residents. This scoping review was conducted to describe and assess the landscape of doula-focused research that focuses on the unique contextual challenges faced by rural communities.

Methods: We conducted a scoping review of research exploring the use of doulas in rural contexts. Peer-reviewed articles presenting original research using both quantitative and qualitative methods were included. Target populations for the included studies were rural perinatal people receiving doula support or doulas in rural contexts. All definitions of rurality were included. Database index terms were searched as well as keyword search terms: "rural" AND "doula" OR "labor coach" OR "birthing coach" OR "childbirth coach" OR "birth attendant" AND "United States" OR "U.S.A."12 peer-reviewed journal databases and Google Scholar were searched May 2022- September 2023. Data was synthesized using tabular and narrative methods to capture (a) study design and type, b) study purpose, c) population, d) study location, e) analysis, d) definition of rurality, and e) reported results and gaps in the literature.

Results: 2,195 articles were identified. After removing duplicates and ineligible studies, 3 articles were included in the final results. These articles included quantitative (1), qualitative (1), and mixed methods (1) studies exploring access to and perceptions of doulas in rural areas.

Conclusion: Findings demonstrate limited scholarship on the use of doulas in rural settings. This area of research warrants further attention.