A qualitative study of hospitals and payers identified key factors needed to successfully implement community-based doula programs.
Background
Community-based doulas provide emotional, informational, and physical support throughout pregnancy, childbirth, and the postpartum period, while also offering culturally responsive care that reflects the linguistic, cultural, and lived experiences of the families they serve. As interest in community-based doula models grows as a strategy to address perinatal health disparities, questions remain about how to effectively integrate these services into health care systems. This case study examines barriers and facilitators to implementing community-based doula programs, with a particular focus on partnerships with hospitals and payers.
About this Resource
This case study offers lessons for hospitals and payers seeking to implement community-based doula programs. Through focus groups with representatives from four hospitals and two payers at different stages of implementation, the study identified key factors that influence adoption and sustainability. Participants emphasized the importance of using both research evidence and personal stories to build organizational support, recognizing the unique role and training of doulas, cultivating champions such as midwives and other clinicians, and fostering an organizational culture that prioritizes health equity. Challenges included the resource-intensive nature of implementation, the need for sustainable financing and livable wages for doulas, and securing the staffing and infrastructure necessary to support these programs. The findings suggest that reimbursement alone is insufficient without broader organizational investment and commitment.
Program/Policy Takeaways
Community-based doula programs may help advance maternal health equity, but successful implementation requires more than reimbursement for doula services. Health systems, payers, and policymakers should consider the organizational culture, workforce investments, implementation infrastructure, and clinical champions needed to sustain these programs and integrate them into routine care.
