Abstract overview:
Doulas provide emotional and informational support that is distinct from clinical care. Their involvement enhances patient autonomy, facilitates informed decision-making, and contributes to improved birth outcomes and breastfeeding success. Support for vulnerable groups—such as immigrant women, teenagers, or those experiencing socioeconomic disadvantage—should be particularly emphasised. However, challenges persist, including varied attitudes from midwives and unclear definitions of the doula’s role within healthcare institutions. Inconsistent and unregulated training contributes to a lack of institutional recognition and limited access to some hospital settings. In Estonia, women may engage a professional doula for support throughout pregnancy, childbirth, and early motherhood. While collaboration with private midwives has been established, doula training remains unregulated and lacks practical components. Consequently, some hospitals restrict doulas from attending births.

Aims and objectives:
To explore Estonian doulas’ experiences in providing services and collaborating with midwives.

Methods:
A qualitative approach was adopted. Semi-structured, in-depth individual interviews were conducted with Estonian doulas during August and September 2022. Inclusion criteria required prior experience as a doula. The interview framework consisted of six thematic categories, each comprising five questions. Data were transcribed verbatim and thematically analyzed.

Results:
Estonian doulas primarily offer psychological and emotional support, with some specializing solely in labor and childbirth assistance. They conceptualize their roles differently—some act as intermediaries, guiding women and encouraging informed decision-making. Although doulas do not provide medical advice, clients often consult them after midwife appointments to clarify or process information. Midwives’ attitudes vary—some question the doula’s necessity, while others embrace their support. Hospital regulations frequently limit doulas’ participation, at times relegating them to unofficial support roles. Doulas advocate for policy development and clear regulation of professional competencies.

Conclusion:
Doulas face regulatory barriers in providing services, primarily due to unclear recognition within healthcare institutions. Collaboration with midwives is generally positive, particularly with private practitioners. Doulas express willingness to engage in cooperative dialogue with midwives. Further research is required to understand why women seek medical guidance from doulas following clinical appointments.