Doulas as Professional and Institutional Allies: The Upsides of Doula Disruption

BACKGROUND: The U.S. government recently prioritized including doulas in the perinatal workforce to help improve outcomes. Despite federal support, reticence among institutional leaders and discord between clinical staff and doulas present barriers to collaboration and policy implementation. OBJECTIVE: The purpose of this study was to examine barriers and opportunities for doula integration by analyzing clinicians’ characterizations of doula-related “disruption.” We aimed to investigate the potential role of doulas in mitigating systemic pressures on clinicians and institutions to promote interprofessional understanding and allyship. METHODS: To achieve this, we triangulated ethnographic data with in-depth interviews and the existing literature. FINDINGS: Disruption of the maternity care status quo was a primary theme across our data, describing how doulas and clinicians can disrupt routinized practices—often to improve care. Undesirable forms of doula disruption included clinician displacement, unsettling of clinical workflow, out-of-scope care, and conflict arising when advocating for clients’ choices. In contrast, participants also described doulas disrupting routinized practices in ways that bridge and compensate for systemic gaps in care with positive implications for patients, clinicians, and institutions; these positive implications have been largely overlooked. CONCLUSIONS: Disruption of routinized care can be a productive practice through which doulas and clinicians work together to provide a viable solution to systemic challenges, ultimately improving care experiences and outcomes. Recognizing doulas’ potential to support conditions that relieve pressures faced by institutions and providers could encourage clinicians and hospital leadership to integrate doulas as allied perinatal care team members, thus contributing to improved clinical and psychosocial outcomes for birthing families and clinicians.