Addressing perinatal mood and anxiety disorders (PMADs) through a doula intervention

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Perinatal mood and anxiety disorders (PMADs) have intergenerational negative impacts on the physical and mental health of women and their families and are the most frequently experienced childbirth complication. PMADs are particularly common in rural populations, who experience additional obstacles in accessing maternal and child health (MCH) and mental health services. Doulas, non-medically trained childbirth and postpartum companions, have been proposed as one way to address existing healthcare gaps, and as a way to improve mental health outcomes, along with additional MCH outcomes such as decreased substance use, increased prenatal and postpartum healthcare visit attendance, and improvements in overall maternal physical wellbeing. The aims of this research are: 1) Explore the use of doulas to improve self-efficacy and maternal mental health outcomes for rural populations; 2) Develop a doula intervention to improve self-efficacy and maternal mental health in rural populations; and 3) Pilot a doula-led intervention to improve self-efficacy and maternal mental health outcomes. Using the NIM....'s experimental therapeutics approach, I will explore the underlying mechanism impacting these outcomes by focusing on how doulas improve self-efficacy among their clients. Following Whitbeck's (2006) model for adaptation of interventions, and community-based participatory research (CBPR) best practices, I will use formative and exploratory research approaches to address knowledge gaps about the use of doulas to improve PMADs and secondary maternal and infant health outcomes. Through this project we will first collect primary qualitative data regarding the feasibility of using doulas to improve PMAD health outcomes and will identify the needs and barriers in accessing mental health care, as well as social and emotional support that could be addressed by doulas (N=40). The proposed research will then synthesize quantitative data on the use of doulas and peer-support models with qualitative data collected from semi-structured interviews to develop and test a doula-led intervention through adapting an existing doula-training. A mixed-methods approach will be used to analyze findings from study participants (N=75) and doulas and providers (N=20). This project will provide preliminary data for the cultural adaptation of the intervention for use with other marginalized groups and rural populations, including Indigenous communities, who experience heightened PMADs and other negative MCH outcomes.