Holding Space for Birth with Open Arms: A Qualitative Study Exploring the Experiences of Community-Based Doulas Providing Perinatal Services in Washington State

Abstract

SIGNIFICANCE: Persistent racial and ethnic disparities in pregnancy-related morbidity and mortality rates in the United States continue to widen. While not the lone solution to our current maternal health crisis, community-based doulas play an integral role in reducing racial disparities in maternal and neonatal health outcomes. PURPOSE: This qualitative study explored the motivations and experiences of nine community-based doulas (maternal support professionals) working for Open Arms Perinatal Services, a non-profit organization dedicated to strong community-based support for women through pregnancy, birth, and early childhood. POPULATION: All study participants were currently practicing community-based doulas employed by Open Arms Perinatal Services providing services to laboring individuals in King, Pierce, and Snohomish counties. METHODS: Utilizing face-to-face, semi-structured interviews, doulas discussed their experiences providing health care services and support to low-income and/or women of color in Washington State. ANALYSIS: Interviews were transcribed and analyzed utilizing content analysis through a deductive and inductive process. RESULTS: Eighteen themes across eight domains were identified: motivations for engaging in birth work, providing equitable care, experiences of community-based doulas, the importance of the doula profession, barriers to care, facilitators driving success, the sustainability of birth work, and the future of the birth workforce. CONCLUSION: Community-based doulas play an essential role in confronting racism, buffering bias, and interrupting harm to improve birth outcomes. Further research is needed to continue to examine: (1) the barriers and challenges faced by community-based doulas, especially from the perspective of women of color, (2) the experiences of community-based doulas serving queer laboring individuals, and (3) the experiences of community-based doulas serving immigrants in today’s political and healthcare climate.