During my training as a birth and postpartum doula, I received little education on perinatal mental health. When mental health was addressed in the postpartum doula training, the acronym PMADs was thrown around as a catch-all phrase for Postpartum Mood and Anxiety Disorders. In a previous post titled Language Matters: Perinatal vs Postpartum, I articulate how problematic it is to only consider mental health in the period after birth as opposed to during pregnancy as well as other events along someone’s reproductive journey. After entering pregnancy with a bipolar diagnosis and struggling with severe symptoms without adequate support, I realized the need for a new role in the birth world. That is when I conceptualized what I call a mental health doula.
The Combination of Peer Work & Birth Work
I arrived at this conceptualization from having lived in two worlds — the birth world and the mental health peer support world. I found the birth world lacking in education and resources for birthing people with pre-existing mental health conditions. And I found the peer support world lacking resources, support, and education around the perinatal experience. Thus, I envisioned the role of the mental health doula to bridge these two worlds.
As I started doing research around this kind of role, I only found one doula organization that does this kind of work. PND Mummies in the UK has a service which they call “The Mental Health Doula,” a small team of PND Mummies doulas that provide full spectrum support from pregnancy to postpartum. Although their slogan is “supporting you through your perinatal depression,” their site also mentions supporting perinatal mental illness more broadly. There are doulas and peers who do not call themselves mental health doulas, but their focus and expertise is on clients who are at risk of perinatal mental illness due to a pre-existing mental health condition or other risk factors. I would also include experiences related to fertility treatments and miscarriages within the realm of perinatal.
As a peer, I know the power of being a mental health doula with lived experience. It has allowed me to combine my research with embodied knowledge and deep empathy for what my fellow peers are going through. There is a mutual recognition that relieves the person from having to educate me on their lived experience. It also reduces the fear of stigma, freeing the person of the need to perform wellness or censor their thoughts. With that said, I am sure a mental health doula without lived experience can provide incredible support. If they approach their clients with an open mind, an awareness of their biases, and the humility to learn, they can be helpful. While these are qualities required of all doulas, but I believe more work has to be done for doulas who are not peers or do not have experience care for a loved one with mental illness. Even as a peer, it is still important to do research and learn about other perinatal mental health challenges outside of one’s lived experience. It is also important to acknowledge that two people with the same diagnosis may have very different experiences due to their race, gender, class, language, education, immigration status, disabilities and various other life circumstances.
This specialization potentially entails mental health crisis prevention and intervention planning as well as expertise about how to work with clients in altered states and those at risk of suicide or self-harm. Mental health doulas might accompany clients to mental health appointments, help them navigate the mental health care system, and provide resources and referrals for mental health professionals, support groups, and social and legal services. This role requires cultivating a relationship with clients so both parties can become aware of the client’s triggers and coping tools. This would allow the doula to help clients navigate activation points and advocate for themselves when necessary. The role entails learning about their clients’ relational world. A mental health doula may also be able to help with conflict resolution and mediation, particularly if the client’s relationships are stressful and strained. Loved ones may have difficulty relating to the client because of their mental health challenges. The doula may serve as a buffer or a key facilitator for connection and understanding.
Beyond the Perinatal Period
While I primarily see the need for the role of mental health doula in the perinatal period, I recognize that the mental health doula is a powerful concept that extends beyond this timeframe. Peer workers are essentially mental health doulas who help people navigate a new diagnosis, hospitalization, relapse, or a major life transition. I can only imagine how different my healing journey would have been if I had a mental health doula when I was first diagnosed with bipolar disorder at 18. I actually didn’t get introduced to the peer world and find the universe of peer support groups until I had a major crisis during my pregnancy at age 25. There is also a distinction between peer work and doula work in that peer work has mostly been coopted and smothered by the medical system. While there are some doulas working for hospitals or birth centers, many doulas and doula organizations are independent and less constrained by these oppressive systems. This affords doulas the ability to infiltrate hostile birthing spaces, circumvent hospital policies, and maneuver within bureaucratic confinements. Overall, doulas have more freedom to subvert oppressive systems in service of their clients.
Working as a Mental Health Doula
Given the way I just described the mental health doula, it should come as no surprise that this is a fluid professional role because this is the source of its power. There are many routes to mental health doula work. Mine started with my trainings as a birth and postpartum doula and then holding space for myself, my first client, through the rollercoaster ride that was my psychotic-manic-depressive pregnancy and post-traumatic-stress-and-anxiety-ridden as well as cognitively impaired postpartum. Now as a full-time PhD student, most of my mental health doula work is in how I show up as a friend, an acquaintance, and as a researcher. Instead of provider-client relationships, I foster connection, and reciprocity with expectant and new parents in my community as well as with the people I interview for my research. By holding space for others to share their experiences with their mental health, I establish an open line of communication for deeper connection, support, and resources.
Soon my mental health doula work will take the form of Support Group Facilitator for Postpartum Support International (PSI). I have benefited greatly from attending the Perinatal/Postpartum Psychosis Support Group and next month I will begin training to facilitate a new Perinatal Bipolar Support Group. While I have trained as a facilitator and ran support groups in the past, this will be my first opportunity facilitating in a perinatal space, (I’m so excited!). PSI also has a mentorship program for people in recovery from their perinatal experience. Serving as a mentor or a recovery coach is also another way to do mental health doula work.
My hope is that after I finish with coursework and begin fieldwork in 2024 that I will start a more formal practice as a mental health doula. I have already started working on my perinatal mental health curriculum that I’ve taught in collaboration with Project LETS and Birth Advocacy Doula Trainings. As I hone in on my skills and philosophy as mental health doula, I hope to become an instructor teaching my own courses and guest teaching at doula organizations. Teaching and training others is also an important aspect of the work that will allow mental health doula work to keep going!
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