Finding Our Way in a System Not Built for Us: Staying With the Trouble in a Community Doula Program

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Recent research indicates that community-based doula care can reduce health inequities, particularly when culturally and linguistically matched. Doulas also play a crucial role in improving the birthing experience, especially for marginalized communities. This presentation by Dr. Melissa Cheney examines findings from a multimodal ethnography of a Community Doula Program (CDP) in Oregon.

The research aims to center the voices of diverse doulas and understand their experiences within a system not originally designed to include them. The research involved participant-observation over a four-year period and analysis of interviews, artwork, and poetry created by doulas within the CDP.

Through consensus coding, cross-cutting themes were identified, revealing a trajectory for doula care and professional development shaped by interactions with the larger system, the program, other doulas, and the clients they serve. The presentation explores this trajectory through three emergent temporal and visual themes: "Finding the work," "Hitting the Brick Wall," and "Staying with the trouble." Doulas’ narratives and visual storytelling suggest potential pathways for the systems-level integration of community doulas as universally valued members of US maternity care teams.

In the webinar, it is discussed how despite decades of research demonstrating improved health outcomes associated with doula support, less than 10% of birthing people in the US ever have access to this service. Doula care is linked with lower rates of interventions, higher breastfeeding initiation, and a reduction in preterm birth and NICU admissions.

Dr. Melissa Cheyney

PhD., LDM

Melissa (Missy) Cheyney PhD., LDM, is a Professor of Clinical Medical Anthropology at Oregon State University (OSU) and a Community Midwife. She is Co-Director of Uplift—a research and reproductive equity laboratory at OSU (https://upliftlab.org), where she serves as the Primary Investigator on more than 20 maternal and infant health-related research projects, including the Community Doula Project (https://www.communitydoulaprogram.org/doulas/). She is the author of an ethnography entitled Born at Home (2010, Wadsworth Press) and co-editor of Birth in Eight Cultures (2019, Waveland Press). She has published extensively on the cultural beliefs and clinical outcomes associated with midwife-attended birth at home and in birth centers in the United States. Dr. Cheyney is the Editor-in-Chief of the journal Birth: Issues in Perinatal Care and the chair of the Human Research Protection Program’s Institutional Review Board at OSU.

In 2019, Dr. Cheyney served on the National Academies of Science, Engineering, and Medicine’s Birth Settings in America Study, and in 2020 was named Eminent Professor by OSUs Honors College. She also received Oregon State University’s prestigious Scholarship Impact Award for her work in the International Reproductive Health Laboratory and with the Midwives Alliance of North America (MANA) Statistics Project.