Background: The US faces maternal and child health (MCH) crises with rising mortality rates and racial disparities. Doula services show improved outcomes but face integration obstacles into healthcare systems, an issue that remains challenging in Nashville and Omaha, where this study was conducted. This qualitative study aims to assess perceived challenges and facilitators in integrating doula services into perinatal care systems, as identified by public health professionals and doulas, and formulate recommendations for policy changes to improve MCH outcomes.

Methods: 15 interviews were conducted with participants involved in MCH organizations, including doulas and public health professionals. Interviews explored roles, experiences, and perspectives on integrating doula services. Thematic and framework analyses identified key themes.

Results: 5 themes emerged: 1) Doulas Matter, doulas provide vital advocacy, support, education, and improving outcomes; 2) Integration Needed, integration requires collaborative approaches recognizing doulas on healthcare teams and formal professional recognition; 3) Obstacles include institutional resistance, cost barriers, Medicaid reimbursement complexity, lack of supportive policies; 4) Enabling Factors involve education campaigns, insurance coverage policies, community engagement); 5) Policy Recommendations include formal state recognition via licensure/certification, mandating Medicaid/private insurance coverage, public awareness initiatives highlighting doulas benefits, establishing training standards, and funding for workforce development.

Conclusions: These findings underscore doulas’ vital role in enhancing MCH outcomes yet reveal systemic barriers impeding their integration into perinatal care systems. Enacting supportive policies is crucial to overcoming integration barriers, ensuring equitable access to doula support, and ultimately improving MCH and reducing persistent health disparities - a pressing public health priority.