Building birthing confidence in practice: Insights from community-based doula focus groups in New York State.

OBJECTIVE: This study aimed to understand the perspectives of community-based doulas in New York State regarding the opportunities and challenges facing the profession. Specifically, it explored their experiences, perceived barriers, and recommendations prior to the implementation of Medicaid reimbursement. METHODS: Five in-person focus groups were conducted with 22 community-based doulas in four regions of New York State between October and November 2023. Discussions explored participants' pathways into doula work, training experiences, professional practice, collaboration with healthcare providers, and perspectives on Medicaid reimbursement. Data were analyzed using reflexive thematic analysis. RESULTS: Five themes were identified: (1) pathways and motivation for doula work, (2) training and certification, (3) role recognition and hospital collaboration, (4) client outreach and recruitment, and (5) Medicaid reimbursement and implementation readiness. Across themes, participants described community-based doulas as providing community-rooted support while facing persistent structural barriers to professional recognition, financial sustainability, and integration within maternal healthcare systems. Participants emphasized the need for stronger professional support, greater public awareness, and more collaborative relationships with healthcare providers. CONCLUSION: Findings suggest that expanding Medicaid reimbursement alone may not be sufficient to support the community-based doula workforce. Sustainable integration of community-based doulas into maternal healthcare systems will also require investments in workforce development, improved public awareness and referral pathways, and stronger collaboration between doulas and healthcare providers.