Introduction: The imperative to diversify the health care workforce is evident: increased diversity contributes to the overall health of the nation. Given persistent racial and ethnic disparities in birth outcomes, workforce diversity is particularly urgent in the context of clinical and supportive care during pregnancy and childbirth. The goal of this analysis was to characterize the intentions and motivations of racially and ethnically diverse women who chose to become doulas (maternal support professionals) and to describe their early doula careers, including the experiences that sustain their work. Methods: In 2014, 12 women of color in the Minneapolis, Minnesota, metropolitan area (eg, African American, Somali, Hmong, Latina, American Indian) applied and were selected (from a pool of 58) to receive doula training and certification. In January and February 2015, we conducted semistructured interviews (30 to 90 minutes) with the newly trained doulas. We used an inductive qualitative approach to analyze key themes related to motivation and satisfaction with doula work. Results: For many of the women of color we interviewed, the underlying motivation for becoming a doula was related directly to a desire to support women from the doula's own racial, ethnic, and cultural community. Other key themes related to both motivation and satisfaction included perceiving birth work as a calling, easing women's transitions to motherhood by “holding space,” honoring the ritual and ceremony of childbirth, and providing culturally competent support, often as the sole source of cultural knowledge during labor and birth. Discussion: Doulas of color have a strong commitment to supporting women from their communities. Given the evidence linking doula support to improved birth outcomes, successful recruitment and retention of women of color as doulas may support broader efforts to reduce long-standing disparities in birth outcomes.
Bibliographical noteFunding Information:
Research reported in this manuscript was supported by a Community Health Collaborative Grant from the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors gratefully acknowledge research assistance and input from Jennifer Almanza, RN; Carrie Vogelsang, MPH; and Shruthi Kamisetty. The authors also wish to acknowledge the collaboration and support of our partners at Everyday Miracles (Mary Williams, LPN, and Debby Prudhomme) and Hennepin County Medical Center (Rita O'Reilly, CNM, and Amanda Huber, CNM). Most importantly, the authors are grateful for the time, energy, and wisdom of the doulas who were trained through the Doula Access Project. This research would not have been possible without them.
- cultural diversity
- health care disparities
- social determinants of health
- underserved populations