Beyond the Breast: Culturally Competent Doulas as a Breastfeeding Intervention

Read – Beyond the Breast: Culturally Competent Doulas as a Breastfeeding Intervention


When anthropologist Dana Raphael first utilized the term “doula” in 1973 it was in the context of providing emotional support to a breastfeeding mother. It’s an ancient and enduring concept that someone be present to ‘mother the mother’ before, during, and after childbirth and it’s a role that has become more professionalized in recent years.

The number of doula training programs and certifying organizations have grown alongside a body of research that shows doula care can decrease medical costs, improve birth outcomes, and increase breastfeeding rates.

. . .

“Doula work is being recognized at a higher rate, at a more professional level,” said Jeretha McKinley, National Program Director of HealthConnect One, a nonprofit with origins in grassroots breastfeeding advocacy. “But community-based doulas are not necessarily receiving the same recognition.”

Doulas are typically private practitioners with a fee-for-service model which makes them inaccessible to low-income pregnant women. By contrast, community-based doulas are paid community health workers trained in labor support and breastfeeding peer counseling.

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“It may look natural and easy when you see a mother latching her six month old, but it’s something that you learn, it’s a skill like anything else. You need patience in the beginning and you need support from people around you,” said [Deziree] Lindsay [Open Arms Outreach Doula]. She saw how often her clients were isolated. Many of them indigenous and recent immigrants, they spent their days alone with their young children in a small apartment while their husbands worked two or three jobs. Lindsay’s clients weren’t sure how to navigate the health care or social services systems. They often didn’t know enough English to ask their questions. Sometimes Lindsay was the only other adult they spoke with all day.

“This is where the cultural competence comes in,” said Lindsay. “In my culture communities are not so individualistic. We don’t have these same labels. So yes, I have a role, I am a doula, and a home visitor, but I am also just a person helping another person from my community, you know?”

by Malka Main-Tracey, published in the Northwest Bulletin for the University of Washington School of Public Health – June 2017