Examining the Acceptability and Feasibility of a Doula Intervention Program for Veterans Receiving VA Maternity Care Benefits.

OBJECTIVE: We aimed to assess the feasibility and acceptability of a community-based doula care pilot program for pregnant veterans receiving Department of Veterans Affairs (VA)-purchased obstetric care. METHODS: This study was conducted at two VA medical centers (Durham, North Carolina, and New Orleans, Louisiana) in partnership with local community-based doula agencies. Certified doulas provided prenatal education as well as continuous labor support and postpartum follow-up. Telephone-based surveys were administered at baseline (∼20 weeks' gestation) and ∼4 weeks postpartum. Acceptability was assessed using the validated 4-item Acceptability of Intervention Measure (AIM; 5-point Likert scale) and participant-reported experiences. Maternal and infant health outcomes were assessed following childbirth. RESULTS: Of the 39 veterans referred, 74% (n = 29) enrolled, and 59% (n = 23) completed both assessments, comprising the final analytic sample. Participants were predominantly Black (74%) and multiparous (61%), with high rates of service-connected disability (91%), military sexual trauma (70%), and elevated prenatal depressive symptoms (44%). All veterans received prenatal doula support; 61% received intrapartum support and 57% received postpartum support. The overall cesarean birth rate was 17%, and 87% of participants rated their childbirth experience positively. The mean AIM score was 4.3 (SD = 1.2), indicating a high level of perceived acceptability and feasibility of the doula intervention. Most participants (70%) expressed interest in using doula services in future pregnancies. CONCLUSIONS: Community-based doula care was feasible and highly acceptable among perinatal veterans, particularly those with elevated psychosocial and obstetric risk. These findings support integrating doula services into VA maternity care to enhance culturally responsive, trauma-informed support for veterans of color.

Duke Scholars

Author Karen M. Goldstein Medicine, General Internal Medicine