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

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.