Program History and Structure
Swedish is one of about a dozen hospitals in the country where doulas are an integrated part of the care team.
Swedish Women’s Health identified establishing a doula program as a goal in its 2015 Strategic Plan. The initiative to create a doula program was based on the robust research showing that patients with doulas reported better experiences, had fewer Cesareans, and needed fewer interventions than patients without doulas. Swedish put out a Request for Proposals for an individual or business to build and run the program. A contract was awarded in October 2015 and the Swedish Doula Program launched in January 2016 with birth doula services. The bereavement doula program was created at the end of 2017. Postpartum doula services were added in 2019. The Black Birth Empowerment Initiative was started in 2020 within the doula program.
The Swedish Doula Program is a non-profit program within the larger non-profit hospital system. Twenty five percent of the every fee paid by self-pay doula clients is retained by the program; the other 75 percent goes to the doula providing care. The 25 percent is split between the costs to administer the program and funds to provide free doula care for low-income families. The independently contracted doulas who work within the Swedish Doula Program value the ability to make this contribution to families in the community who wouldn’t otherwise be able to afford doula care. The program is proud to be completely self-funded in order to provide sustainable support.
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The doula program has three inter-related goals and has seen strong success in each of these areas:
Goal 1: Enhance families’ birth experiences & outcomes by increasing the use of doula services
More than 40 percent of clients who hire a Swedish doula say they would likely not have hired a doula if the Swedish Doula Program did not exist. The program thus has expanded the pie of clients hiring doulas by nearly doubling the number of clients hiring doulas at Swedish hospital locations among Swedish doulas alone. In feedback surveys, the average client satisfaction rating with their doula care is 4.8 out of 5.
Goal 2: Integrate doulas more cohesively into the maternity care model
Doula program staff spend considerable time building relationships with providers and nurses and promoting collaboration with doulas. Since the beginning, the program has advocated for the same expansions of access for non-contracted doulas as for Swedish doulas. For example, expanded policies for doula attendance in the Operating Room is now codified into official hospital protocol and applies to both Swedish and non-Swedish doulas. The doulas receive rave reviews from the nurses, midwives and doctors who work with them: 98 percent say the doula had a positive impact on the patient and 98 percent say they would like to work with the doula again.
Goal 3: Elevate the doula profession through strong compensation and professional development
The program has remained committed to strong compensation of the doulas. In a survey of doulas on the team, 60 percent reported that their income increased by more than $500 or more per month after they joined the team. Certified doulas choose their own rates and rates have continually increased over time among the team members. Doulas also report that they value the community and opportunities for continuing education provided by the team.
Frequently Asked Questions
Birth doulas focus on providing support to patients during labor and delivery. They meet with the patient during pregnancy to get to know them. In spontaneous labors, birth doulas often begin their support at their clients’ homes in early labor, accompanying families to the hospital when labor shows a more active pattern. Birth doulas remain in contact with their clients up to one month after baby is born to provide emotional support and warning sign guidance.
Postpartum doulas support families in their home after their baby arrives. Their support includes guidance about feeding, soothing and sleep strategies; household tasks such as meal prep, laundry, and light housekeeping; care for the newborn during the day or night so parents can sleep; and emotional support and resources.
Bereavement doulas accompany families on the agonizing journey of delivering a baby who has died in utero or is expected to die shortly after birth. A bereavement doula meets with the family prior to the delivery, is there during the labor and delivery, helps them make memories in the all-too-short time with their child, and supports the family for a year after the birth/death of the baby.
Patients self-pay for doula services and choose the doula(s) they will hire. The doula program also provides free care for low-income patients from funds of the 25% retained from paying client fees, and donations. Patients are welcome to hire a Swedish doula or hire a doula who is not contracted with Swedish.
If nurses or providers have a patient admitted whom they think could use a birth doula and doesn’t have one, they can also request an on-call birth doula by filling out our online form. Patients must have Medicaid/Apple Health to qualify.
Patients are offered Bereavement Doula care by the Maternal and Fetal Specialty clinic if they find out their baby has died or has a lethal diagnosis. It is free of charge to families.
The doula program has built a diverse team of doulas to reflect the diverse population of birthing families at Swedish.
The doulas speak a total of 16 languages:
- American Sign Language
Coming from a number of different races and ethnicities, the doulas are often helpful in bridging racial, cultural or language differences that may be present. The program also houses the Black Birth Empowerment Initiative, which honors Black lives by centering and uplifting the Black birth experience with culturally congruent doula care. In addition, the doula program conducts ongoing trainings and discussion for our white doulas in cultural humility, white privilege and anti-racism.
A doula does not count as a visitor or extra support person. A patient may have three support people plus a doula. Doulas are allowed in the operating room for Cesareans with regional anesthesia, in addition to one support person such as a spouse or partner. Doulas are also allowed to remain in the room in addition to a support person during placement of an epidural and during recovery after a Cesarean. All of these policies apply to both doulas contracted with Swedish and those who are not.
All Swedish doulas are independent contractors, including the program leads. As a contracted service, the Swedish Doula Program maintains an important level of independence and ensures that the doulas are held to a code of conduct for doulas, rather than reporting through a medical chain of command. Doulas follow their certification organization’s scope of practice for supporting clients. This independence enables the doula to focus on essence of doula support and keep families’ emotional well-being as their central responsibility.
In order to apply to join the Swedish doula team, doulas must take an initial independent birth or postpartum doula training that prepares them to support clients. Locally, most of the contracted doulas received their primary training by attending workshops through Bastyr University’s Simkin Center for Allied Birth Vocations, Shafia Monroe Full Circle Doula Training, and others.
Some of the benefits of joining the Swedish doula team include:
- Steady referrals to clients
- Access to back-up partners
- Continuing education contact hours required for a doula’s periodic re-certification
Swedish-contracted independent doulas also receive a badge identifying them as independent contractors that allows them to utilize staff entrances and areas in the hospital. Hiring rounds are held 1-2 times per year. If you are interested in joining the Swedish doula team, please email us.