Understanding doula integration through nurses’ eyes: The triadic relationship in hospital-based maternity care
- 1University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, CA USA
- 2Master’s Entry Program in Nursing, Student, University of California, Irvine, Sue & Bill Gross School of Nursing, Irvine, CA USA
- 3Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, CA USA
Abstract
Background: Hospital-based doula programs remain rare (7.4% of US birthing hospitals), yet evidence supports continuous labor support for improved maternal-neonatal outcomes. Implementation challenges persist nationally despite policy initiatives. Few studies systematically examine perinatal nurses’ perspectives, despite them being key stakeholders whose attitudes critically influence program success. The objective of this study was to conduct a pre-implementation needs assessment identifying specific barriers, facilitators and contextual factors influencing hospital-based doula integration from perinatal nurses’ perspectives.
Methods: Qualitative study with seven perinatal nurses at an urban academic medical center preparing to launch a doula program. Semi-structured interviews explored nurses’ experiences with and perceptions of doula integration. Inductive content analysis was conducted using Atlas.ti web version.
Results: Participants were predominantly bachelor’s-prepared (71.43%), White (57.1%), aged 23–41 (median 32.5), with labor and delivery experience ranging from < 5 to 20 years. Most participants (71.4%) rarely worked with doulas, with 28.6% sometimes working with them. Analysis revealed three themes: (1) The Triadic Nurse-Patient-Doula Relationship – nurses consistently conceptualized doula integration as an interconnected three-party system (nurse-patient-doula) rather than separate dyadic relationships, (2) Stabilizing Factors that Strengthen Triadic Collaboration – open communication and relationship-building strengthened collaboration; (3) Destabilizing Factors that Undermine Triadic Collaboration – role and scope confusion, advocacy rigidity, mistrust and a lack of institutional infrastructure undermined collaboration.
Conclusions: This needs assessment identified triadic relationship dynamics as the central factors affecting successful integration of doulas, representing a reframing of doula implementation as an organizational challenge inherent in implementation. Findings provide implementation recommendations including communication protocols, standardized training, role complementarity emphasis, and collaborative birth planning mechanisms. The triadic relationship offers practical guidance for healthcare leaders integrating doula support while addressing complex interpersonal dynamics influencing implementation outcomes. Future studies should include racially and ethnically diverse nursing perspectives related to implementation strategies.
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BibTeX
@article{burke2026understanding,
title = {{Understanding doula integration through nurses’ eyes: The triadic relationship in hospital-based maternity care}},
author = {Leanne T. Burke and Ah-Taisa Banks and Griffin Chanley and Madison Jang and Candice Taylor Lucas and Yuqing Guo},
journal = {BMC Pregnancy and Childbirth},
year = {2026},
month = jul,
doi = {10.1186/s12884-026-09629-6},
url = {https://doi.org/10.1186/s12884-026-09629-6},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Understanding doula integration through nurses’ eyes: The triadic relationship in hospital-based maternity care
AU - Leanne T. Burke
AU - Ah-Taisa Banks
AU - Griffin Chanley
AU - Madison Jang
AU - Candice Taylor Lucas
AU - Yuqing Guo
PY - 2026
DA - 2026/07/23
JO - BMC Pregnancy and Childbirth
DO - 10.1186/s12884-026-09629-6
UR - https://doi.org/10.1186/s12884-026-09629-6
AB - Background: Hospital-based doula programs remain rare (7.4% of US birthing hospitals), yet evidence supports continuous labor support for improved maternal-neonatal outcomes. Implementation challenges persist nationally despite policy initiatives. Few studies systematically examine perinatal nurses’ perspectives, despite them being key stakeholders whose attitudes critically influence program success. The objective of this study was to conduct a pre-implementation needs assessment identifying specific barriers, facilitators and contextual factors influencing hospital-based doula integration from perinatal nurses’ perspectives. Methods: Qualitative study with seven perinatal nurses at an urban academic medical center preparing to launch a doula program. Semi-structured interviews explored nurses’ experiences with and perceptions of doula integration. Inductive content analysis was conducted using Atlas.ti web version. Results: Participants were predominantly bachelor’s-prepared (71.43%), White (57.1%), aged 23–41 (median 32.5), with labor and delivery experience ranging from < 5 to 20 years. Most participants (71.4%) rarely worked with doulas, with 28.6% sometimes working with them. Analysis revealed three themes: (1) The Triadic Nurse-Patient-Doula Relationship – nurses consistently conceptualized doula integration as an interconnected three-party system (nurse-patient-doula) rather than separate dyadic relationships, (2) Stabilizing Factors that Strengthen Triadic Collaboration – open communication and relationship-building strengthened collaboration; (3) Destabilizing Factors that Undermine Triadic Collaboration – role and scope confusion, advocacy rigidity, mistrust and a lack of institutional infrastructure undermined collaboration. Conclusions: This needs assessment identified triadic relationship dynamics as the central factors affecting successful integration of doulas, representing a reframing of doula implementation as an organizational challenge inherent in implementation. Findings provide implementation recommendations including communication protocols, standardized training, role complementarity emphasis, and collaborative birth planning mechanisms. The triadic relationship offers practical guidance for healthcare leaders integrating doula support while addressing complex interpersonal dynamics influencing implementation outcomes. Future studies should include racially and ethnically diverse nursing perspectives related to implementation strategies.
SN - 1471-2393
ER -