Objective: to describe women's experiences of having a doula present during childbirth.
Design and setting: a qualitative study with a phenomenological approach in two large Swedish cities. Data were collected via open-ended taped interviews 1-2 months after childbirth. The analysis of the text of transcripts included search for meaning units sorted into clusters for a final expression of the essential structure of the phenomenon.
Data: interviews from 10 women aged between 25 and 35 years, both primiparous and multiparous.
Findings: women's needs during childbirth were described in a metaphor, as a puzzle consisting of different pieces where the doula was the necessary missing piece. She was a mainstay functioning as an experienced adviser, an affirmative person, a mediator, a guarantor, a fixer and as an accessible presence.
Key conclusion: for these women, the doula fulfilled important needs. The roles of the midwife and the doula differ, yet some of the evolved doula supportive functions are also essential in the midwife's care. When a birthing woman has chosen a doula, the challenge for the midwife is to support her in collaboration with the doula and the partner if present. More research is needed in order to determine whether the presence of a doula for the midwife is an asset or a hindrance, and to find the essential prerequisites for midwife-doula collaboration to be possible.