Challenges of sustaining a community-based doula program: Lessons learned from listening to doulas

Abstract: Community-based doulas are emerging as an innovative and effective addition to the maternity care team for mothers with complex needs. Community Doulas, recruited from the communities they serve, provide culturally appropriate pre-natal and childbirth education; active support during labor and delivery; and breastfeeding and parenting support during the post-partum period. They function as community health workers during the birth year and assist mothers in navigating the health care system.

We examine the growth of a community doula program that provides services free-of-charge to underserved mothers in Pittsburgh, including the challenges of securing funding through federal grants, local foundations, and a unique collaboration with a medical assistance Managed Care Organization. We describe the process of recruiting and training paid doulas, assess training requirements for supplementing DONA International doula training, discuss the community doula job structure that has emerged and the infrastructure that has developed to support doulas in this demanding work.

An interactive panel of program staff members, including community doulas, will analyze results from doula focus groups, describing their calling to doula work and their strategies for combating burnout, including the unforeseen high incidence of secondary trauma that doulas experience after some births. The panel will identify lessons learned about communication needs for a program staffed with part-time field workers, describe the logistics of on-call staffing, and the challenges in accurately documenting doula work to maximize service quality, as well as collect data for program management and evaluation; for accounting/billing; and for doula supervision and support.