What Research Says About Interprofessional Collaboration in Maternity Care

By Birth & Baby University · Last updated: October 2026 · 3 min read

Maternity care is delivered by teams: obstetricians, midwives, nurses, anesthesiologists and, increasingly, doulas and community health workers. People often say that better collaboration improves care, but the research is thinner than the slogan. This article reviews what has actually been tested, where doulas fit, and what practical lessons are defensible.

Key takeaways

• A 2017 Cochrane review of nine randomized trials of interprofessional collaboration interventions graded the evidence low to very low certainty and concluded there was not sufficient evidence for clear conclusions about their effects.
• A systematic review of simulation-based team training for obstetric emergencies found only eight evaluations, with improved knowledge, skills and team performance in seven and perinatal outcome data in one.
• A Dutch survey of 379 obstetric professionals found perceptions of collaboration were good overall but not aligned: obstetricians rated collaboration more positively than the groups working with them did.
• None of these studies tested the inclusion of doulas, so applying them to doulas is an inference.

What the research says

Does collaboration improve outcomes?

The Cochrane review of practice-based interprofessional collaboration interventions included nine studies with 6,540 participants. The interventions included externally facilitated activities, interprofessional rounds, meetings and checklists. The authors found low-certainty evidence that functional status in stroke patients, professionals’ adherence to recommended practices and use of healthcare resources may be slightly improved, and very low-certainty evidence for collaborative working. No included study reported patient mortality, morbidity or complication rates, and the settings were general health and social care, not specifically maternity care. The authors concluded that evidence was insufficient for clear conclusions and recommended longer follow-up and mixed-method research.

What has been tested in obstetrics

A 2010 systematic review of multidisciplinary simulation training for acute obstetric emergencies identified 97 articles, of which eight assessed the effect of teamwork training. Seven showed improved knowledge, practical skills, communication and team performance, and the only study that reported perinatal outcome showed improvement in 5-minute Apgar score and hypoxic-ischemic encephalopathy. Training in a simulation center did not further improve outcomes compared with training in a local hospital. The authors said studies on effectiveness and cost-effectiveness were needed before broad implementation. It is an older review focused on emergencies.

Perceptions and barriers

A survey of obstetricians (74), clinical midwives (42), nurses (154) and primary-care midwives (109) in the north-west Netherlands, with a response rate of 80.8%, found ratings of collaboration were good overall, but obstetricians rated their collaboration with the other groups more positively than those groups rated collaboration with obstetricians. The biggest discrepancies were in the subscale about isolation, which includes sharing opinions and respecting each other. A Quebec case study of midwives and a hospital found interactional barriers such as conflict about scope of practice, myths about midwives and weak communication, organizational barriers and systemic ones such as too few midwives. These studies are contextual and not generalizable.

Where doulas appear

A 2025 qualitative study using seven years of field notes from one community doula program and 11 interviews with clinicians produced recommendations to facilitate collaboration between institutions, clinicians and doulas, and noted that clinician and institutional opposition to doulas persists despite documented benefits. It is observational and from one setting in the Pacific Northwest.

What this means for doulas

• Do not expect proven playbooks. The strongest evidence concerns structured team training in emergencies, not doula integration.
• Perceptions may differ across roles. Your view of how a birth went may not match the nurse’s or the obstetrician’s, and the Dutch survey shows even clinicians’ views diverge.
• Scope conflicts are a recurring theme. Be specific about what you do and do not do, and ask others to define their roles too.
• Be a collaborator in structured settings. If a hospital offers huddles, tours or debriefs, take part.

Putting the evidence into practice

• Ask each unit what its standard communication structure is, such as huddles or rounds, and how a doula can fit into it.
• Learn the titles and responsibilities of those you meet in labor and delivery, and ask how they prefer to be addressed.
• Offer to join debriefs where clients consent, and be prepared to listen to feedback about your own conduct.
• Keep a log of collaboration lessons for your own reflection, with no identifying details.
• Remember that collaboration for the family means they hear consistent information, so avoid contradicting the team in front of them.

The bottom line

Interprofessional collaboration is a sensible goal, but the research on specific interventions is limited and does not mainly involve doulas. The defensible lessons for doulas are clarity about scope, respect across roles and willingness to take part in structured communication.

Related reading: How Doulas Can Build Productive Relationships With Obstetricians and Midwives; Building Strong Referral Networks With Hospitals, Midwives, Pediatricians, and Other Perinatal Professionals; The Future of the Perinatal Workforce: Training, Credentialing, and Collaborative Care.

This article is for professional education. It is not medical, legal, financial or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• Reeves S, et al. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017. Read the source
• Merién AER, et al. Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstetrics & Gynecology 2010. Read the source
• Romijn A, et al. Interprofessional collaboration among care professionals in obstetrical care: are perceptions aligned? BMJ Quality & Safety 2018. Read the source
• Behruzi R, et al. Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study. BMC Pregnancy and Childbirth 2017. Read the source
• Keenan VC, et al. Navigating the Perinatal Partnership: Recommendations to Facilitate Integration and Collaboration Between Institutions, Clinicians, and Doulas. Journal of Perinatal Education 2025. Read the source

Understanding how maternity teams work is part of doula preparation. Birth & Baby University’s training, mentorship and agency-building resources are described on the For Doulas page. Ask any program how it teaches teamwork and scope.

More for professionals: the Professionals Blog.