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. 2025 Apr 16:10.1007/s40615-025-02444-3.
doi: 10.1007/s40615-025-02444-3. Online ahead of print.

Implementation Barriers to Incorporating a Community-Based Doula Program to Improve Birth Outcomes for Black Patients in an Academic Medical Center

Katherine G Quinn  1 , Erica Marion  2 , Joni S Williams  3 , Dalvery Blackwell  4 , Jessica Olson  5 , Anna Palatnik  2
Affiliations

Implementation Barriers to Incorporating a Community-Based Doula Program to Improve Birth Outcomes for Black Patients in an Academic Medical Center

Katherine G Quinn et al. J Racial Ethn Health Disparities. .

Abstract

There are significant racial disparities in maternal health and birth outcomes in the USA that disproportionately affect Black individuals. Incorporating community-based doula programs into hospital settings may be an effective intervention to reduce these disparities. However, little research has examined potential barriers and identified strategies to optimize the implementation of a community-based doula program in an academic hospital setting. This study used in-depth interviews with clinicians and nurses (n = 19) and focus groups with doulas (n = 11) to identify multi-level barriers to implementing a doula program for Black pregnant patients in a single academic hospital setting in Milwaukee, WI. Data were analyzed using thematic analysis, and we developed four themes that highlight potential implementation barriers: (1) doulas' advocacy efforts were met with resistance from the healthcare team; (2) there was a lack of trust and established relationships between doulas, clinicians, and nurses; (3) there was a hierarchy of knowledge within medical settings that diminished the value of doulas' expertise; and (4) system-level barriers prevented sustained integration of doula programs. Despite the promise of community-based doula programs, significant investment and resources are needed to support implementation and ensure sustainability.

Keywords: Birth equity; Doulas; Medical mistrust; Qualitative research; Racial disparities.

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Conflict of interest statement

Declarations. Ethical Approval: All study protocols and procedures were reviewed and approved by the Institutional Review Board at the Medical College of Wisconsin. Consent to Participate: All participants completed informed consent prior to participating in any aspect of this study. Consent for Publication: The authors affirm that human subjects’ protection included consent to publish data collected for this study. Competing interests: The authors declare no competing interests.

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