Indigenous Doulas: A literature review exploring their role and practice in western maternity care

Abstract

Objective: The purpose of this article is to establish a body of literature exploring the emergent topic of Indigenous doulas, in relation to Indigenous communities in remote locations, where women are routinely evacuated and no longer supported to give birth. In doing so the article will synthesise and critique key concepts in the literature and identify gaps for prioritisation in future research.

Design: The methodology is influenced by Indigenous, decolonising and feminist theoretical standpoints. A combined methodological approach of an integrative and scoping literature review was undertaken. Only published research, grey literature and grey data written in English and created between the years 2000 and 2018 was included. The search engines used were CINAHL plus, MEDLINE full text, Informat, Cochrane, Google Scholar and Google Search.

Setting: Resources originating from only Canada and America identified and despite regional similarities, no literature from Australia or Greenland was sourced.

Participants: Of the entirety of identified resources two author's Indigenous identity was readily identifiable; and in the research articles there was a total of 191 research participants identified as Indigenous. Much of the grey literature and grey data included quotations from Indigenous women.

Interventions (if appropriate): N/A.

Measurements and findings: Key concepts about the role and practice of Indigenous doulas were identified: reclaiming and supporting cultural practices; sovereignty over lands and bodies; strengthening families, training, work models and defiance of evacuation policies on the pathway to returning birth. Critique of these concepts suggests that Indigenous doulas have a unique role and practice scope in Western maternity care, which is readily distinguished from standard doula practice. Research gaps worthy of future research prioritisation include: Indigenous women's perspectives as recipients of Indigenous doula care, Indigenous doulas as a pathway into midwifery, escort policy and impacts on Indigenous doula provision; evaluation and alternative research settings.

Key conclusions and implications for practice: The role and practice of Indigenous doulas offers a promising approach to redressing the colonisation of Indigenous childbirth while contributing to improving Indigenous maternal and infant outcomes. Indigenous doula practice shares many best-practice characteristics with Indigenous Healing Programs and as such is also likely to also promote inter-generational healing. Most of the resources located were descriptive, but this emergent topic is worthy of further applied research.

Keywords: Colonisation; Doulas; Indigenous; Midwifery; Pregnancy care; Remote.