Association between doula care and postpartum post-traumatic stress disorder: A mixed-methods study

The benefits of doula care during childbirth are well-documented, yet its impact on postpartum post-traumatic stress disorder (PTSD) has not been explored.

This study aimed to examine the association between doula care and postpartum PTSD, with a specific focus on the psychological experiences of women with postpartum PTSD.

A mixed-methods sequential explanatory design study was performed at a tertiary teaching hospital in China between November 2022 and October 2023. Women over 18 years who had a singleton live vaginal birth were invited to participate. Demographic and clinical data were collected through questionnaires at 3 days postpartum, and postpartum PTSD was screened using the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) at 42 days postpartum. Women identified with postpartum PTSD were purposively selected for semi-structured interviews. Quantitative data were analyzed using multiple logistic regression and qualitative data were analyzed using Colaizzi's seven-step method.

A total of 437 eligible women were analyzed, including 207 women with doula care and 230 women without, resulting in a postpartum PTSD incidence rate of 7.3 % (32/437). In the quantitative analysis, women who received doula care had a lower risk of postpartum PTSD compared to those who did not (OR 0.15, 95 % CI 0.05-0.42), after adjusting for potential confounders. The qualitative analysis identified four main themes contributing to postpartum PTSD: negative childbirth experience, lack of family support, additional stress, and perceived parenting stress.

This mixed-methods study suggests that doula care may reduce the risk of postpartum PTSD, potentially by improving the psychological impact of childbirth experience.