Who plans to give birth with a doula? Demographic factors and perceptions of birth

Problem: Research has demonstrated the benefits of continuous care during childbirth, particularly with doula support. However, much less is known about the factors underlying pregnant women's plans to have doula support. Background: Doulas provide one-on-one continuous care, emotional support, and advocacy, in a culturally sensitive way. Aim and questions: We aimed to investigate the characteristics of pregnant women who consider doula support and whether it is related to their birth experiences, beliefs and concerns, including fear of childbirth and of the staff, beliefs about birth as a natural and as a medical process, and expectations of motherhood. Method: A cross-sectional study, in which pregnant women (N = 1593) recruited in prenatal clinics completed questionnaires regarding socio-demographics, obstetric history, beliefs and concerns about birth, maternal expectations, and their plans for mode and place of birth and for having doula care. Findings: Women who planned to have doula care were more likely to be nulliparous and to plan a more natural birth. A doula plan was more prevalent among recent immigrants, religious women, women who viewed birth as natural and not as medical, and were concerned about the staff's attitude and control during birth. Discussion: In a medicalised maternity care system, women who view birth as natural birth and who have concerns regarding the care they will receive, are more likely to plan doula care. Conclusion: Understanding the factors related to a doula plan may uncover unmet needs, particularly the need for culturally sensitive care and support for women's personal choices.