PURPOSE: The purpose of this study was to gather information that can be used to help inform doula integration into the clinical care setting. STUDY DESIGN AND METHODS: We conducted a convergent (parallel) mixed-methods online survey study to understand maternity care team members' perceptions of doulas and their integration into the clinical setting. RESULTS: One hundred and ten maternity care team members responded to the survey with both open-ended questions. The majority (90.0%) of respondents were nurses, female (94.5%), and White (90.0%). Three quarters (75.5%) reported prior experience working with a doula. Four primary themes related to barriers and facilitators were identified through thematic content analysis: Doula Support and Its Benefits; Uncertainty about Doulas' Qualifications; Interference with the Maternity Care Team Member; and Integration into the Health Care System. Respondents discussed the benefits of doulas and the valuable support that doulas offered to patients, including: 1a) emotional, physical, and educational support and 1b) advocacy and communication. They expressed concerns about the potential interference with the maternity team, including: 3a) role confusion and influence on clinical decision-making and 3b) disrupting the patient-maternity care team member relationship. Recommendations for successful integration of doulas into the health care system included 4a) clear roles and boundaries, 4b) building relationships of trust and respect, 4c) collaborative communication, and 4d) education of maternity care team members. CLINICAL IMPLICATIONS: The study will be used to develop a doula integration tool kit. Doulas and maternity care team members should work together to create clear guidelines about the role of doulas within the hospital. Collaborative development of doula-supportive hospital policies and formalized hospital-doula partnership agreements can help reduce role ambiguity and create a more supportive hospital environment.
McElfish et al. (Thu,) studied this question.