Midwives’ and doulas’ perspectives of the role of the doula in Australia: A qualitative study Jeni Stevens, RN, BN (Hons) (Registered Nurse/Student Midwife) a , Hannah Dahlen, RN, RM, BN (Hons), M(CommN), PhD, FACM (Associate Professor of Midwifery) b,n , Kath Peters, RN, BN (Hons), PhD (Senior Lecturer) b , Debra Jackson, RN, PhD (Professor of Nursing) b a Antenatal Clinic, Blacktown Hospital, PO Box 6105, Blacktown, NSW 2148, Australia b Family and Community Health Research Group, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 1797, Australia article info Article history: Received 18 December 2009 Received in revised form 9 April 2010 Accepted 11 April 2010 Keywords: Doula Midwife Midwifery Continuity of care Normal birth abstract Objective: to explore midwives’ and doulas’ perspectives of the role of the doula in Australia. Background: doulas are relatively new in Australia; nevertheless, demand for them is increasing. Research has not previously explored the role of a doula in Australia. This research aimed to answer the question: What are midwives’ and doulas’ perspectives of the role of a doula in Australia? Design: qualitative study using focus groups that were digitally recorded, transcribed and the data analysed using thematic analysis. Setting: New South Wales, Australia. Participants: 11 midwives and six doulas. Findings: the key theme that emerged was that ‘the broken maternity system’ is failing women and midwives. The system is preventing midwives from providing woman- centred care. As a result, doulas are ‘filling the gap’ and midwives feel that doulas are ‘taking our role’. Doulas fill the gap by providing continuity of care, advocating for women, protecting normal birth and by providing breast-feeding advice and emotional support in the community. Midwives are concerned that doulas are taking the caring part of their role from them and want the ‘broken’ maternity system fixed. Midwives described that doulas take their role from them by changing the relationship between themselves and labouring women, by reducing their role to obstetric nurses, by overstepping the doula role boundaries, and by holding the power at births. Implications for practice: despite the conflict reported between midwives and doulas, both groups identified that they see the potential for future collaboration. Taking into account the continued employment of doulas, it is important to improve collaboration between midwives and doulas for the sake of childbearing women. & 2010 Elsevier Ltd. All rights reserved. Introduction ‘Doula’ is a Greek derived term for a woman helper who is experienced in providing continuous non-medical physical and emotional support before, during and after birth (Stein et al., 2004; Dundek, 2006; Campbell et al., 2007). The role of the doula is described as focusing on the mother’s comfort and wishes during labour (Papagni and Buckner, 2006), and providing one-to- one continuous support through encouragement, non-medical information and comfort (Hottenstein, 2005). Doulas are unique in that they are employed by women yet have no decision-making responsibilities. They only have one labouring woman that they devote themselves to and they remain with her throughout the whole labour and birth (Stein et al., 2004). Doulas provide tailored support specific to each woman’s needs by educating and encouraging them to write an informed birth plan, with the aim to facilitate normal births (Simkin and Way, 1998; Koumouitzes-Douvia and Carr, 2006). The World Health Organization (WHO) defines a normal birth as: a spontaneous birth that is low risk throughout the labour and birth; with the infant being born in the vertex position between 37 and 42 weeks of pregnancy; and mother and infant being in a good condition (Ahmed et al., 1997). The Lamaze Institute for Normal Birth adapted from WHO describes six evidence-based practices that promote normal birth. These practices are: labour begins on its own; the labouring mother has continuous labour support; there are no routine interventions; there will be spontaneous pushing in a gravity-neutral or upright position; Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.midw.2010.04.002 n Corresponding author. E-mail address: jenistevens@bigpond.com (J. Stevens). Midwifery 27 (2011) 509–516