A challenging little balance: How white doulas with mainstream training understand and engage with anti-oppressive practice.

Though the benefits of doula care in reducing birth inequities and mitigating obstetric violence are well established, little is known about how White doulas from mainstream training programs (most doulas in Canada) understand and implement anti-oppressive practice (AOP) in different sociocultural contexts. Guided by interpretative phenomenological analysis, we conducted life history and semi-structured interviews with five White doulas working in Western Canada. The doulas described varying levels of engagement, confidence, and effectiveness across three distinct levels of sociopolitical interaction: relationships with birthing families (micro level), supporting clients within biomedical institutions (meso level), and advocating for enhanced maternal care within the broader structural landscape (macro level). Differences in AOP across these three sociopolitical contexts and between doulas were connected to various factors, including mainstream doula training, healthcare politics, professional structures, local histories, and individual preferences and circumstances. Implications for mainstream doula education, interprofessional collaboration, and hospital birthing practices are discussed.