Collaborative relationships between doulas and maternity care providers when supporting migrant women during labour and birth.

OBJECTIVE: To explore the perspectives and experiences of community-based doulas and maternity care providers working with each other in Australia; and to identify the facilitators and barriers to working relationships when supporting migrant women during labour and birth. DESIGN AND METHODS: A qualitative interpretive phenomenological study using in-depth semi-structured interviews. An inductive thematic approach and Capability, Opportunity, and Motivation (COM-B) framework were used in data analysis. SETTING AND PARTICIPANTS: 10 doulas from Birth for Humankind (a community-based doula service), and 13 maternity care providers from a tertiary maternity hospital in Melbourne, Australia were included. FINDINGS: We identified how collaborative working relationships between community-based doulas and maternity care providers may be enhanced by adopting facilitators across all three COM-B domains and by removing identified barriers. Factors facilitating collaborative working relationships included: knowledge and value of doula roles, establishment of rapport and trust between doulas and providers; doulas enhancing respectful care, communication and relationships between migrant women and providers; and community-based doulas differentiated from private practising doulas. Barriers included: limited understanding of doula roles and service; limiting behaviours impacting collaborative relationships; and limited opportunities for doulas and providers to establish rapport. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings are relevant to other models of doula care including private practice doulas and hospital-based doula services. Positive, collaborative doula-provider working relationships are integral for ensuring that the benefits of doula care continue to reach underserved populations such as migrant women and improve their maternity care experiences and outcomes within hospitals settings.

A qualitative study on community-based doulas' roles in providing culturally-responsive care to migrant women in Australia.

BACKGROUND: There is limited exploration into how culturally-responsive care may be provided to migrant women through community-based doulas. AIM: We aim to explore the roles of community-based doulas in providing culturally-responsive care to migrant women in Australian maternity settings, from the perspectives of maternity care providers and doulas. METHODS: We used an interpretive phenomenological qualitative approach with in-depth interviews with 30 maternity care providers and Birth for Humankind doulas, in Victoria, Australia. All interviews were conducted over video-call and inductive thematic analysis was performed using NVivo software. FINDINGS: Doulas were seen to support and enhance migrant women's maternity care experiences through numerous ways, strengthening cultural-responsive care provision. There were three domains which described the role of doulas in providing migrant women with culturally-responsive care: 1) enhanced care; 2) respectful care; and 3) supportive relationships with providers. The three domains included seven themes: 1) continuous individualised support; 2) social connectedness; 3) creating safe spaces; 4) cultural facilitator; 5) non-judgemental support; 6) enhancing communication and rapport with providers; and 7) making connections. DISCUSSION: Doulas appeared to counter negative factors that impact migrant women's maternity care experiences. Doulas with previous professional birth support qualifications and trauma-informed care training were equipped to create safe spaces and increase emotional safety for migrant women. Doulas may also have more responsibilities expected of them by providers when connecting migrant women with additional services in situations that may be missed through hospital care. CONCLUSION: Birth for Humankind doulas in Victoria play an important role in providing culturally-responsive care to migrant women. Employment models may be the next steps in acknowledging their valuable contribution as a complementary service to maternity settings.

Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis.

BACKGROUND: Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders' perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes. METHODS: We conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders' perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings. RESULTS: Twelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas' role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women's experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme. CONCLUSION: Community-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.

Sexual and reproductive health service utilisation of adolescents and young people from migrant and refugee backgrounds in high-income settings: a qualitative evidence synthesis (QES).

Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources.