Pre-implementation Assessment of Clinician and Nurse Perspectives on Hospital Integration of Doulas in Perinatal Care

Background: Doula support is associated with improved perinatal outcomes, including lower rates of cesarean delivery and preterm birth, as well as improved patient experiences and continuity of support during pregnancy, labor, and the postpartum period (Bohren et al., 2017; Falconi et al., 2024). Despite growing evidence supporting doula care and increasing policy momentum, including reimbursement pathways aimed at expanding access, hospital programs that partner with doulas remain uncommon, and challenges to effective interprofessional integration persist. For health systems seeking to integrate doulas in clinical care, understanding the perspectives of frontline clinicians and nurses is essential to anticipating barriers, identifying facilitators, and developing strategies that support sustainable team-based collaboration for equitable perinatal care. Objective: To explore (a) experiences and perspectives of frontline clinicians and nurses and (b) identify shared and role-specific barriers, facilitators, and dynamics influencing hospital-based doula integration. Methods: To support the interprofessional integration of doulas in perinatal care, we conducted a mixed-methods pre-implementation needs assessment engaging two hospital-based stakeholder groups, perinatal clinicians and nurses, at an academic medical center. Twenty-two clinicians across obstetrics and gynecology and family medicine completed a survey about knowledge and attitudes towards doulas. From this group, six clinicians participated in semi-structured interviews. Seven perinatal nurses participated in semi-structured interviews exploring experiences with doulas, perceptions of doula integration in a hospital setting, and factors influencing collaboration in perinatal care. All interview transcripts were managed in Atlas.ti, and were analyzed using qualitative descriptive methods and inductive thematic analysis. Findings were synthesized to identify shared and role-specific themes related to the needs and experiences of hospital-based clinicians and nurses. Results: Across both stakeholder groups, doulas were viewed as valuable contributors to patient advocacy, health education, emotional support, and patient-centered care. Among clinicians, only 18% reported adequate knowledge of doula training and scope, identifying a major implementation barrier. Although most clinicians endorsed doulas as beneficial, half remained neutral regarding effects on birth outcomes and communication effectiveness. Among nurses, 71.4% reported rarely working with doulas, suggesting limited baseline exposure to doula partnered clinical care. Three themes emerged across stakeholder groups: (1) trust and relational dynamics, (2) communication and role clarity, and (3) implementation infrastructure and workflow integration. Stabilizing influences included: collaborative working relationships, open communication, and recognition of doulas’ complementary contributions to care. Destabilizing influences included: role confusion, mistrust, inconsistent communication, tension around advocacy boundaries, and lack of formal institutional infrastructure. Nurses primarily described doula integration as a bedside relational process shaped by the triadic nurse-patient-doula relationship, whereas clinicians more often emphasized systems-level concerns including communication reliability, interdisciplinary respect, and role boundaries across care settings. Conclusion: Perinatal clinicians and nurses broadly support integrating doulas into hospital care. For this integration to be successful, clinicians, nurses, and doulas need more opportunities to engage and collaborate. Results highlight the need for improved communication, clear role delineation, and stronger interdisciplinary relationships. These findings provide practical guidance for OB hospitalist teams implementing doula programs and promoting patient-centered, equitable, and collaborative perinatal care.