Doula Perspectives on Supporting Survivors of Sexual Victimization

Background: Female survivors of sexual assault face unique challenges during the perinatal period extending beyond typical risks associated with this timeframe. Doulas provide empirically validated interventions for high-risk pregnant populations. However, researcher examining the experience of doulas in supporting survivors is extremely limited. This exploratory phenomenological qualitative study interviewed doulas to answer the following research questions: (1) What was their experience of providing support to survivors of sexual assault?; and (2) Did doulas observe differences in the pregnancy, labor, and delivery experiences of survivors of sexual assault compared to clients who did not identify as survivors?

Methods: Methods were informed by a hermeneutic, phenomenological perspective. We recruited until we reached data saturation through private Facebook groups and snowball sampling. We conducted in-depth individual interviews using a semi-structured guide developed by the authors addressing participants' perceptions of the differences in the perinatal period for survivors of sexual assault, doula support provided to survivors, and perceived gaps in current doula training. Interviews were conducted by a trained doula, audiotaped, transcribed verbatim, and reviewed for accuracy. We used a hybrid process of inductive and deductive thematic analysis to develop the codebook and analyze data. Data was managed in Excel. We used multiple coders and facilitated triangulation through qualitative workgroups, member checking, collecting multiple sources of data, negative case analysis, and receiving expert feedback. Open axial coding was initially conducted, followed by focused coding as thematic categories emerged. Coding discrepancies were resolved through mutual consensus.

Findings: Seventeen participants reported practicing between 4 and 15 years (M= 7.5, SD= 4.03). Participants received training from Doula Organization of North America (71.43%), Childbirth International (14.29%), and MamaToto Village (14.29%). The majority completed additional trauma focused training (85.71%). Participants noted differences in childbirth patterns for survivors of sexual assault including the presence of flashbacks and increased levels of fear and tightening in the pelvic floor, negative reactions to cervical checks, and feelings of loss of control. Participants discussed lack of training in the certification process related to the impact of sexual assault on pregnancy and the birthing process. Participants described assuming a buffering role between survivors and perinatal care providers. While participants perceived midwives as trauma-informed, they reported less sensitivity and understanding among obstetricians and nurses.

Conclusions/Implications:

This study identified perceived benefits of doula support for survivors during the perinatal period, the need for trauma-focused training in doula certification, and adoption of universal trauma-informed practice among perinatal care providers. This research takes an important step toward understanding the gaps doulas fill in the perinatal care of survivors. Given the high rates of sexual assault in women prior to and during childbearing years and its documented impact on perinatal health, this study supports the call for screening all women during the perinatal period for a history of sexual assault. Additionally, this study identifies opportunities for improved collaboration between doulas, survivors, and perinatal care providers - including social workers – and the need for trauma-informed care training for doulas and other medical professionals providing perinatal care.