Evidence and Guidelines for Trauma-informed Doula Care

Objective: Trauma and trauma-related health conditions are common during pregnancy, but there is little evidence and guidance on how doulas (trained lay birth assistants) can provide trauma-informed care. The purpose of this narrative review is to critique and synthesize the existing evidence for trauma-informed doula care and to offer guidelines for practice.

Design: We conducted a narrative review of existing evidence in the peer-reviewed and gray literatures on trauma-informed care in maternity and perinatal settings including doula training curricula and community-based doula guidelines on trauma-informed doula care. Materials were analyzed for relevant data on trauma and pregnancy, evidence-based approaches for trauma-informed doula and perinatal care, and strengths/weaknesses of the evidence including research design, gaps in the evidence base, and populations included.

Setting: This narrative review focuses on trauma-informed doula care in the United States, although the evidence and guidelines provided are likely applicable in other settings.

Key Conclusions: To be trauma-informed, doulas must first realize the scope and impact of trauma on pregnancy including possible ways to recovery; then recognize signs and symptoms of trauma during pregnancy; be ready to respond by integrating evidence and sensitivity into all doula training and practices; and always resist re-traumatization. Trauma-informed doula care also centers on these 6 principles: safety; trustworthiness and transparency; peer support with other survivors; collaboration and mutuality; resilience, empowerment, voice, and choice; and social, cultural, and historical considerations. In practice, this includes universal trauma-informed doula care offered to all clients, trauma-targeted care that can be offered specifically to clients who are identified as trauma survivors, and connection to trauma specialist services.