In October 2024, there was a noticeable dip in the average level of respect reported by SisterWeb doulas from hospital nursing staff. One key factor was the presence of travel nurses who may have been unfamiliar with community doula models or came from regions where doulas are less integrated into the care team. These staff often arrived with preconceived notions or limited understanding of the doula’s role, leading to tension or a lack of collaboration. However, scores began to recover and were sustained through early 2025 due to intentional strategies by the SisterWeb team. These included reminding doulas to submit feedback through Asana after each birth and increasing informal hallway check-ins to clarify roles with nurses and build rapport in real time.

Hospital staff—particularly nurse managers, clinical educators, and consistent bedside nurses—are key partners in fostering a respectful work environment. Nurse champions who understand and value doula contributions play a major role in setting the tone for their units. Within SisterWeb, the Community Doula Initiative (CDI) team helps doulas navigate difficult interactions and supports advocacy efforts when issues arise. Continued collaboration with UCSF, Kaiser, and other partner hospitals that actively engage with SisterWeb has also helped normalize the presence of doulas and build mutual understanding.

Proactive communication has proven effective in improving relationships between doulas and nursing staff. For example, doulas often initiate hallway check-ins to introduce themselves and explain their role, which helps reduce friction and avoid misunderstandings. Including nurses in care conversations and offering support in small ways during labor (e.g., helping reposition the client or offering a break) also demonstrates collaboration. SisterWeb’s internal process of tracking respect-related feedback through Asana has improved responsiveness and helped identify patterns or concerns early. Additionally, when doulas share respectful and constructive feedback about hospital interactions, it can be used in staff trainings or collaborative planning with CDI sites.

To maintain and build on this positive trend, SisterWeb can continue encouraging doulas to document experiences—both positive and challenging—after each birth. This information should be used to guide dialogue with hospital partners and identify opportunities for joint staff development. Investing in relationship-building with nurse managers and clinical leaders can help establish expectations and promote consistency across shifts and sites. Where appropriate, SisterWeb can co-develop brief orientation or training materials for new nurses—especially travel staff—that outline the doula’s role and shared goals for patient care. These efforts can reinforce a culture of mutual respect and partnership moving forward.