"We're not clinicians, but we see it": Doulas' roles in supporting clients with perinatal mood and anxiety disorders.

PROBLEM: Perinatal mood and anxiety disorders (PMADs) affect approximately one in five birthing individuals and are a significant public health concern. Despite being non-clinical providers, doulas' close and sustained relationships with clients uniquely position them to recognize early signs of emotional distress and facilitate timely support.

BACKGROUND

Current doula training in PMADs varies widely, and little is known about how doulas are prepared to identify and respond to mental health concerns within their professional scope. Understanding doulas' perspectives and training experiences can inform strategies to strengthen early detection and culturally responsive care.

AIM: This study explored how U.S.-based doulas are trained to address PMADs and how they perceive and respond to these conditions in their work.

METHOD: Using a qualitative design, we conducted in-depth interviews with 29 doulas from multiple states. Participants varied in professional experience and educational backgrounds, with many early-career doulas (1-5 years), a substantial portion of whom hold bachelor's degrees, and work independently (private practice). Interviews were analyzed using thematic analysis to identify patterns in training, practice approaches, and doulas' perceived roles in recognizing and supporting clients experiencing PMADs.

FINDINGS: Four themes emerged: (1) Enhancing PMAD training through real-life examples and practice; (2) More than screening tools-equipping doulas to "hold space" and build meaningful client relationships; (3) Extending learning post-training through apprenticeship and mentorship; and (4) Recognizing the role of partners in PMAD detection. Doulas emphasized that while they are not mental health professionals, they often serve as early witnesses to postpartum emotional distress and want to be better equipped to offer informed, compassionate support. Participants expressed mixed views on using screening tools, advocating instead for "holding space," active listening, and client-centered dialogue.

CONCLUSIONS

The study demonstrates the need to integrate mental health content into doula certification programs, support non-clinical relational skills, and develop culturally responsive care frameworks. Findings also point to the value of apprenticeship models and interdisciplinary collaboration in bridging training gaps. By enhancing doulas' mental health literacy and practice skills, they can better support early intervention for PMADs and reduce disparities in perinatal mental health outcomes.