An Examination of the Knowledge, Attitudes and Perceptions Regarding Perinatal Mood Disorders Among Birth and Postpartum Doulas

Abstract

Introduction: Perinatal Mood Disorders (PMD), including depression, anxiety, obsessive-compulsive disorder and stress disorders, disrupt the mental health of mothers during one of the most vulnerable, challenging periods of their lives, with low-SES women experiencing a greater number of stressors and factors associated with the development of PMD. Doulas are lay health workers who build their entire practice around serving the mother’s practical and emotional support needs. Previous research revealed that women who utilize either birth or postpartum doula services have demonstrated positive birth experiences, earlier lactation onset and better breastfeeding experiences, and greater confidence in their abilities as a mother. The presence of a doula providing emotional support, such as listening reflectively to a distressed or frustrated new mother, and practical support, such as ensuring the mother and baby can get into a good sleep routine, might offer one solution for early detection of PMD. To what degree, if any, are doulas trained to recognize symptoms of PMD in their clients, and how would their own knowledge, attitudes and perceptions regarding PMD impact their relationship with a client whom they suspect may be suffering? Methods: Twelve doulas from the Seattle area were interviewed regarding their level of experience, insights on the preparation and training requirements for new doulas, and experiences with clients suffering from PMD. Results: All of the doulas had been practicing for over one year. Nine of the twelve (75%) felt the training they received in doula certification programs regarding PMD was inadequate for the situations they had experience with clients, and many doulas relied on continuing education courses to learn more about PMD. All twelve doulas reported assisting clients perceived to be suffering from PMD. Discussion: Each of the participants emphasized the supportive role of the doula throughout the perinatal period, particularly in providing emotional support to the mother. The collective attitudes toward PMD were to take action and help clients develop a solution – more sleep for the mother, more time spent outdoors, a referral to a support group, or an appointment with a medical provider or therapist; however, many emphasized that doulas cannot diagnose or treat mental health issues, only empower the client to seek help. Each of the participants identified gaps in the training they received regarding PMD and expressed what they felt was a critical need for more in-depth training, including instruction on the many forms of PMD, any knowledge of recent research on PMD, and how to address PMD with clients and families. The participants in this study spoke confidently about their role in nurturing, guiding, and validating mothers and parents during an extremely vulnerable time – a crucial continuity of emotional support for mothers, especially high-risk mothers.