Community based doula support is an important tool in creating positive health and experience outcomes for women and babies, countering the health inequities that many women face. Internationally, the community volunteer doula support programs have been instrumental in improving experiences of care for women from diverse backgrounds, achieving a range of positive outcomes for socially disadvantaged women, including reduced rates of caesarean sections and instrumental births, and increased rates of shorter labours and positive reports of care experiences.
There is growing evidence to support the effectiveness and importance of these programs, yet there is limited understanding of how and why these volunteer programs lead to favourable outcomes for socioeconomically disadvantaged women in particular. In her PhD research, Kerryn O’Rourke explores this gap in the understanding of the mechanisms and contexts that lead to women’s health and experience during pregnancy and birth.
This important research develops and tests a range of evidence-based theories constructed through interviews and a review of existing literature. Employing a realist evaluation, her research focuses on what works, for whom, how, and in what circumstances programs work (or don’t), providing valuable knowledge for program design, implementation and monitoring. This paper is the first of four stages of realist evaluation: it reports on the first stage of theory development with focus on five program theories generated from the current workings of the Birth for Humankind doula program.
The research to date has identified seven theories – contexts, actions or occurrences that need to occur in order for a community based doula program to have a positive outcome. The theories will be further refined and the relative benefits and impacts of each of these will be investigated in more detail through further research.
- Attracting and activating the right doulas
- Good matching of clients and doulas
- Being by the client’s side
- Facilitating social connection
- Complementing or enhancing maternity care
- Doulas as a witness - demanding accountability in others
- Doulas as beneficiaries.
Subsequent stages of the evaluation will test and refine the theories – with focus on those that are deemed most critical.
This research contributes new evidence about the role of community based doula support in the Australian context, paving the way for a more thorough understanding of the methods to improve maternal health for women experiencing social disadvantage.
As the first external evaluation of Birth for Humankind’s doula support program, this research is critical for refining and targeting our programs to provide greater impact.
This independent PhD research is being conducted through the Judith Lumley Centre at La Trobe University and is funded by Birth for Humankind as part of our commitment to ensuring strong evaluation and evidence-based program development.