Table 2.

Needs assessment findings

Domain	Findings
Knowledge of doula care	• Many participants reported that there is a general lack of knowledge around what doula care is and how it benefits birthing people and their families. • Some medical providers knew about doulas only in the context of labor and birth but did not know what doulas did with clients outside of that setting.
Knowledge of community doula care	• Participants familiar with community doulas described them as being members of the community they serve. Participants said community doulas typically serve anyone who needs support, regardless of their ability to pay. • Multiple participants talked about racial and/or cultural concordance in their descriptions of community doulas. • Having a broader scope of work than a traditional doula 1, including providing connections to resources, was described as a hallmark of community doula care.
Value of research	• While many participants knew about research on doula care, most did not know of any research about community doula care, specifically. • Most participants felt that research on community doula care was important and useful. • A few participants clarified that research should not be needed to “justify” doula care, as they felt that this type of care should not need justification. • Participants said research on community doula care could be used to: 1) increase access to doula care by informing funding decisions and policy changes; 2) help doulas be more welcomed in medical settings; and 3) provide education for various audiences around what doula care is. • One participant expressed a fear that increased research and attention to doula care may lead to regulation of the profession, which may make it inaccessible to community doulas. • Participants reported research is useful when: 1) it provides rationale for funding and increased access to doula care; 2) it centers the voices of a diverse range of doulas and clients, particularly Black and other BIPOC communities; and 3) findings are disseminated widely. • Participants reported research is not useful when: 1) it perpetuates negative racial stereotypes, narratives, and dangerous biases; 2) it does not center the voices of BIPOC doulas and clients; and 3) researchers are not inclusive and transparent.
Gaps in research	• Several participants were interested in payment and compensation models for doula care, including Medi-Cal coverage of doula services. • Various participants thought there should be more research on interactions between doulas and care teams in hospital settings and how to best integrate doulas into these care teams. • A few participants wanted to see more studies about doula support for non-birthing partners. • Generally, participants reported there weren’t enough studies that examined racism in hospital settings and racism in the doula profession. • Participants’ perspectives on the availability of research on birth outcomes were mixed; some felt that there was enough of this research available, while others felt birth outcomes could be studied further.
Concerns about how research is conducted	Participants’ reported their concerns about how research is typically conducted: • Research being exploitative or extractive • Biases affecting studies and results • Whether findings are adequately disseminated to communities • Research being conducted with a Western, white supremacist framework • Research on Black communities not being led by Black people
How research should be conducted	Participants’ reported their suggestions for how future research studies should be conducted: • Utilize focus groups, which give clients opportunities to share their experiences and allow for community healing • Incorporate more community members into research from the start • Create opportunities for Black people to be involved in research in a leadership capacity • Create funding opportunities for Black people to conduct their own research • Be transparent about who is conducting the research
Research participation	• Most participants expressed being open to participating in research about community doula care. Reasons for willingness to participate in research included: 1) making their voice heard and providing new perspectives; and 2) contributing to the knowledge base. • Some participants said they would want more information about the research before choosing to participate. • Several participants shared the belief that their peers would be open to participating in research. However, some participants described reasons why their peers might be hesitant: 1) concerns about research participants being compensated fairly for their time; 2) who is conducting the research; 3) who is included in the research; and 4) overall distrust in research as an institution.

¹ In this context, “traditional doula” refers to a private, fee-based doula