New Research Illuminates Doulas Positive Role in Perinatal Mental Health Support for Birthing People of Color

March 6, 2024 12:21 pm Published by

The study indicates that culturally congruent doula care is key to creating inclusive care pathways for underserved communities.


Media Contact: Elena M. Teare,

SEATTLE, WA (March 6, 2024) – New research from the University of Washington’s PERC Center in the Department of Psychiatry and Behavioral Sciences and Open Arms Perinatal Services (Open Arms) sheds light on the role birth doulas can play as key conduits for perinatal mental health and substance use disorder support. The study, which interviewed doulas and clients of Open Arms and local doula practices within western Washington, found that the synergy of culture, language, and shared experiences fosters positive doula-client relationships, creating the conditions needed to increase perinatal mental health support access.

Perinatal mental health conditions exist on a spectrum from depression and anxiety to post-traumatic stress disorder and psychosis, with gaps in screening and treatment for Black and Latina/e pregnant people. The ‘double stigma’ of racial discrimination and perceived social stigma results in underdiagnosis and undertreatment.

The study highlights that varying cultural attitudes towards mental health issues, as well as socio-economic challenges, are significant obstacles but underscores that doulas with shared cultural identities can break down these barriers, facilitating increased access to screening and treatment.

Joanne Quiray, the study’s lead author, said, “Centering community voices is crucial when working on solutions to expand inclusive perinatal care pathways. In simple terms, our study asks doulas and clients, “What are you currently doing? What do you need to thrive?” We appreciated our partnership with Open Arms at each step, from the conception of the research study and development of interview guides to the development of the manuscript.”

“Perinatal Support of Washington, who was also a collaborator in the study, was available to provide training in perinatal mental health and emotional support for doulas if needed, as discussing mental health and substance use can be triggering for both doulas and clients,” continued Quiray.

The study concludes that with adequate training, community-based doulas are poised to be instrumental in connecting at-risk birthing individuals of color with essential mental health and substance use disorder treatment. Dila Perera, Executive Director of Open Arms, comments, “This study demonstrates what we have known through our work, which is that trusted birth doulas have the capacity to help identify mental health concerns and form the trusting relationships necessary to help pregnant and parenting families reach out for life-changing support.”


Maternal mental illness is the leading cause of pregnancy-related deaths in the United States. It has the worst maternal and infant health outcomes of any high-income nation, with Black, Indigenous, and Latina/e birthing people experiencing additional risk, resulting in alarming health disparities. Recent research has cited perinatal mental health and substance use disorders among the most prevalent and deadly of complications, yet are often sidelined in efforts to improve maternal health outcomes.

The Washington State Maternal Mortality Review Panel’s report examining maternal deaths from 2017 to 2020 found that 80 percent of pregnancy-related deaths were preventable, with behavioral health conditions, including suicide and overdose, constituting the leading causes (32 percent). Contributing factors were a lack of screening for at-risk individuals and access to appropriate care and treatment. The report recommends the expansion of mental health and substance use disorder prevention, screening, and treatment for pregnant individuals, coupled with an increase in healthcare access through reimbursement enhancements.

In a positive stride toward expanding access to comprehensive perinatal care, the state legislature passed HB 1881 in 2023 to create a new professional credential for Birth Doulas within the Department of Health. The 2024 Washington State budget has earmarked the funds needed to create the infrastructure to begin reimbursement, a crucial step in aligning public policy with recommendations from researchers, clinicians, and birth workers.


Founded in 1997, Open Arms is the first independent, community-based program in Washington State to provide comprehensive perinatal services to over four thousand economically marginalized families. We are a predominantly BIPOC organization that provides free support during pregnancy, birth, and early childhood with birth and community-based outreach doula services, lactation counseling, and social service referrals to over 500 families annually throughout the Puget Sound region.