Finding Our Way in a System Not Built for Us: Staying With the Trouble in a Community Doula Program

Despite decades of research demonstrating improved health outcomes associated with doula support, less than 10% of birthing people in the US ever have access to this service.  Doula care is associated with lower rates of interventions, higher breastfeeding initiation, and a reduction in preterm birth and NICU admissions. More recent research has shown that community-based doula care reduces health inequities in underserved communities, especially when that care is culturally concordant and linguistically matched. Doulas also improve the experience of care, reducing reports of mistreatment and disrespectful care disproportionately experienced in Black, Indigenous, other communities of color and among gender expansive birthing people. In this presentation, I discuss findings from a multimodal ethnography designed to examine the points of friction within one such Community Doula Program (CDP) in Oregon. Specifically, our community research team aimed to center the voices of diverse doulas to better understand the experiences of providing care in a system not designed to include them. We engaged in participant-observation over a four-year period, and analyzed semi-structured, open-ended interviews, original artwork and poetry created by doulas working within the CDP, using consensus coding to identify cross-cutting themes. We identified a trajectory for doula care and professional development shaped by interactions with the larger system and in relationship to the program, other doulas, and the clients they serve. In this talk, I examine this trajectory through three, emergent temporal and visual themes: 1) “Finding the work”: personal transformation; 2) “Hitting the Brick Wall”: birth work realities; and 3) “Staying with the trouble”: building community. Doulas’ narratives and visual storytelling highlight potential pathways for systems-level integration of community doulas as universal and highly valued members of US maternity care teams.