"I live in a doula desert": Doula Experiences in Rural Georgia Public

Abstract

Background: Rural maternal and child health outcomes in Georgia are dismal, and there are fewer rural hospitals and providers every year. Doula care (or non-clinical perinatal support) can improve birth experiences and outcomes and reduce infant and maternal morbidity.  

Methods: The community-engaged Georgia Doula Study, co-led by a university doula-researcher and a community-based doula organization, surveyed, and interviewed 22 doulas across the state. Descriptive analyses were conducted in Stata v. 14, and the interview transcripts were analyzed using coding, memo-ing, and diagramming in Dedoose.

Results: Of the 22 doulas interviewed,16 served rural populations. Five themes emerged: at baseline, 1) Rual childbirth education disparities, knowledge gaps, and opportunities, 2) Poor access to full spectrum of childbirth options in rural areas, 3) Insufficient perinatal support and social service gaps, 4) Far distances between doulas, rural clients, and healthcare settings, and 5) Rural poverty impedes doula access through long travel times and economic barriers. These findings emphasize the facilitators and barriers to doulas providing care to people in rural Georgia. The protective factors of education, knowledge, advocacy that doulas implement into their practice are essential to providing care.

Conclusion: Doulas face challenges in their work with rural communities, and their rural clients also face numerous barriers to doula and other holistic perinatal care. However, doulas carry numerous benefits and opportunities for rural communities including perinatal education, empowerment and advocacy, and connection to care. 

 

Table of Contents

Table of Contents

Title Page i

Table of Contents ii

Chapter I: Introduction and Statement of the Problem and Purpose 1

Research Question 4

Chapter II: Literature Review 6

Chapter III: Methodology 16

Chapter IV: Results 22

Rural Childbirth Education Differences, Knowledge Gaps, and Opportunities 23

Poor Access to Full Spectrum of Childbirth Options in Rural Areas 28

Insufficient Perinatal Support and Social Service Gaps 34

Far Distances Between Doulas, Rural Clients, and Healthcare Settings 36

Rural Poverty Impedes Doula Access 41

Chapter V: Conclusions, Implications, and Recommendations 46

References 54

Appendices 62

Appendix I: Interview Guide 62

Appendix II: Screener 66

Appendix III: Demographic Survey 67

  Appendix IV: Codebook 92

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	doula rural communities maternal health
Committee Chair / Thesis Advisor	Dr. Jessica Sales, Emory University
Committee Members	Dr. Elizabeth Mosley, Emory University

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