The Trauma-Informed Doula: An Evidence-Based Guide to Providing Trauma-Informed Doula Care

Doula care requires working with clients who possess a wide range of beliefs, attitudes and life experiences that shape their journey to childbirth. The perinatal period can be a vulnerable and frightening time for any woman, but especially for those whose backgrounds include trauma. Current or previous experiences of trauma have a profound impact on pregnancy, labor, birth and becoming a parent. As a doula, it is imperative to recognize the complex histories and backgrounds that clients bring to the childbirth experience and to provide care that avoids retraumatization and promotes safety and healing. This is what it means to be a Trauma-Informed Doula. Trauma results from experiences that overwhelm an individual’s ability to cope. A wide range of experiences can cause trauma, including assault, abuse, witnessing violence and many more. Because of its prevalence, this guidebook will focus primarily on intimate partner violence (IPV), one of the most common forms of trauma to which 1 in every 3 women in the United States fall victim. While IPV is most common among certain groups of women, anyone can be affected by this abuse of power and the negative coping mechanisms that develop in response. These experiences affect women in deep and lasting ways that influence how they experience childbirth. Doulas must recognize that every woman may have experienced some form of violence in order to provide care that is holistic and healing. Trauma-informed doula care helps ensure that every client feels safe, supported and understood during childbirth. Experiencing violence is often the first step in a chain of negative events that includes substance addiction and incarceration. Many trauma survivors, especially those of IPV, develop substance use disorders resulting from prolonged use of alcohol and drugs to cope with overwhelming feelings of fear, pain, helplessness and hopelessness. Substance use disorders (SUDs) often lead to incarceration, which itself is another traumatizing experience. Data confirms the interconnected nature of these events: 57% of incarcerated women report experiencing trauma or abuse, 84% have histories of drug addiction and 25% report a current mental health condition. The purpose of this guidebook is to help doulas better understand and serve clients with past or present experiences of violence, substance dependence and/or incarceration, and to examine the interrelated nature of these three occurrences. While this guidebook will have a general focus on women experiencing these conditions, providing trauma-informed doula care is best practice for all clients. Many survivors of trauma or violence avoid discussing their experiences because it is simply too painful. In order to effectively provide trauma-informed care, doulas must approach each client remembering that they do not know her full story, and that her past or present may include trauma that she has not disclosed. This text also provides background information and data related to IPV, SUDs and incarceration. This information is merely intended to provide context and preparedness for common circumstances encountered when working with vulnerable women and should never be used to shame or make assumptions about clients. Rates, risk factors and percentages can never encompass an individual’s story. It is important to note that doulas are not qualified to provide formal evaluations or diagnoses. While this guidebook can help doulas better understand and care for clients undergoing difficult circumstances, it should not be used to make medical or psychological diagnoses. Above all, this guidebook is meant to be used as a tool to help doulas approach every client with a mindset that promotes health, healing and safety.Master of Public Healt