Doula Perspectives on Lactation Education and Breastfeeding Support for Diverse, Low-income Women: A Field Report

ABSTRACT

Women living below the federal poverty level have low breastfeeding rates and historically have lacked access to doula care. This disparity is particularly evident among African American women. The objective of this pilot study was to assess doulas’ experiences delivering lactation education to racially/ethnically diverse, primarily Medicaid-eligible pregnant women and describe doulas’ perceptions of client barriers to breastfeeding. We also wanted to understand doulas’ views of infant feeding and lactation education during their participation in a quality improvement intervention that trained doulas to provide lactation education and breastfeeding support at 4 clinics serving low-income clients. Two focus groups were conducted with 7 doulas. Focus group data were transcribed, coded, and analyzed using qualitative thematic analysis. Doulas reported close relationships with their clients and provided consistent breastfeeding support and education to women in prenatal, birth, and postpartum phases of care. Doulas emphasized the need for more lactation education, especially to overcome clients’ perceived milk insufficiency and early termination due to breastfeeding barriers. Doula-led breastfeeding education and support may improve breastfeeding outcomes for diverse women from underserved areas.

KEYWORDS:

• Doula
• doula care
• breastfeeding disparities
• lactation education
• lactation support

Acknowledgments

The authors gratefully acknowledge the doulas who participated in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data available on request due to restrictions e.g. privacy or ethical. The data presented in this study are available on request from the corresponding author. The data are not publicly available.

Informed consent statement

Informed consent was obtained from all subjects involved in the study.

Institutional review board statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of University of Florida (protocol code XXX and date of approval).

Additional information

Funding

Funding for this study was provided by grants from the Institution Foundation, the Organization of Teratology Information Specialists. In addition, the lead author’s time was supported by the Foundation for Society for Maternal-Fetal Medicine and American Association of Obstetricians and Gynecologists Foundation.