(744) Can Doulas Help Improve Equity in the Operating Room?: Clinician Perspectives

We aimed to describe obstetric clinical care team members’ perspectives on doulas’ impact on equity for birthing persons in the operating room.

Study Design:

We used in-depth, semi-structured interviews with questions based on the Consolidated Framework for Implementation Research. Using criterion-I and stratified random sampling, OB/GYNs, labor and delivery nurses, and anesthesiologists were recruited via fliers and emails. Rapid Qualitative Analysis was used for data coding and analysis.  

Results:

Twenty-seven clinicians were interviewed: seven anesthesiologists, ten OB/GYNs, and ten labor and delivery nurses. Of these, three quarters expressed a positive view on the impact of doulas on equity, describing benefit from an additional voice advocating for the patient and their goals. Many saw particular benefit for non-English speaking patients, for whom a language-concordant doula may significantly improve communication and trust. Participants also often mentioned benefits for their patients of color, who they noted sometimes have distrust in the medical system or may not see themselves reflected in their care team. Participants also observed that doulas improved equity by “translating” across levels of health literacy to help patients understand and accept recommendations, such as the need for cesarean delivery. Clinicians who were uncertain about doulas’ effect on equity cited concerns about possible inequities in the implementation of doula support (cost of doula care, variation in doula experience), while the two clinicians who endorsed a negative view expressed doubt that doulas improve equity, one of whom specifically expressed skepticism about the benefit of a race-concordant doula. 

Conclusion:

Most clinicians view doulas as beneficial in improving equity for patients undergoing cesarean delivery. These benefits mirror those of prior qualitative work exploring general benefits of doulas for equity, specifically aligning with themes of patient agency, knowledge, connectedness, and respect. Further work should examine impact of doulas on equitable experiences and outcomes in cesarean deliveries.