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Background: Community-based doula support for women and gender-diverse birthing people has a range of benefits in improving maternal outcomes and experiences. However, there is limited research on how doula services operate in Australia. Birth for Humankind is an Australian community-based volunteer doula service, which provides free doula support for women and gender diverse birthing people experiencing social discrimination and financial disadvantage. The aim of this study was to understand facilitators and barriers to implementation and sustainability of a community-based doula service delivered to clients concurrently receiving care at a major maternity hospital in Melbourne, Australia. Methods: We conducted a qualitative study consisting of 30 in-depth interviews with doulas and managers of the community-based doula service Birth for Humankind, and midwives, doctors and social workers from a maternity hospital. Data were inductively thematically analysed, and themes were then deductively categorised using the Capability, Opportunity, and Motivation (COM-B) model and Theoretical Domains Framework (TDF) to understand behavioural influences and facilitators and barriers to implementing and sustaining the doula service within a hospital setting. Results: Facilitators to implementation of the doula service included: collaborative relationships; having sound knowledge of referral processes; and being a valued professional doula service with dedicated volunteers. Barriers to implementation included: limited knowledge of the doula service from hospital staff; difficulty in retaining volunteer doulas; being a small non-profit doula service; and limited capacity of hospitals to financially support the doula service. Advocacy for renumerating doulas may be one means to strengthen and sustain existing doula-provider service relationships. Conclusion: Consideration of establishing strategic partnerships between the doula service and hospitals may create financially-sustainable pathways to enable provision of high-quality, community-based doula support for women and gender diverse birthing people to continue.

Background Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders’ perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes.Methods We conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders’ perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings.Results Twelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas’ role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women’s experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme.Conclusion Community-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.