"It takes a village and we are the village": A qualitative community-engaged study of doulas serving migrants and refugees in Georgia.

BACKGROUND There is growing evidence that doulas may buffer poor birth outcomes for marginalized groups by providing social support, health education and advocacy between patients and their medical team.

OBJECTIVE This study aims to examine the current environment and scope of work for doulas serving immigrants and refugees.

DESIGN This study is an extension of the on-going mixed methods, community-engaged Georgia Doula Study. From June to November 2022, researchers conducted in-depth interviews with 22 doulas serving immigrants and refugees in and outside of Metropolitan Atlanta.

METHODS Semi-structured in-depth interviews were conducted. Interviews were recorded and transcribed. Two research assistants independently coded the interviews using Dedoose. Data were examined using thematic analysis.

RESULTS Four themes emerged for immigrant-serving doulas including: doulas fill the gap of care and societal navigation, doulas are asked to integrate themselves into their client's communities, the relationship between doulas and their clients is mutually empowering, and the landscape included both doula-centered and systems-centered frictions. Doulas reported a high level of desire for their services among immigrants, with positive experiences for both clients and them. However, doulas were frequently the only source of support for immigrant clients and were tasked with navigating the complexities of both new arrival experiences and the complex U.S. healthcare system.

CONCLUSION Doulas provide critical support in the navigation of immigrant experiences in the United States-including and beyond pregnancy. Their work with immigrant communities enriches the lives of their clients and improves maternal and child health outcomes. However, revised policies and programming for more holistic perinatal services are needed to facilitate their expansive scope of work.