Doulas' Experiences Addressing Maternal Mental Health and Substance Use Challenges in the Rural Deep South: A Qualitative Study.

Abstract

Maternal mental health and substance use contribute significantly to the U.S. growing maternal health crisis (Trost et al., 2022; Policy Center for Maternal Health, 2023). This crisis is even greater in rural areas, where women residing in this region of the United States have a greater likelihood of experiencing maternal mental health and substance use-related challenges (Nidey et al., 2019). Doulas, perinatal support professionals, serve as an avenue to reduce the maternal mental health and substance use challenges that rural women experience. Using a qualitative research approach, the current study examined the experiences of nine actively practicing doulas in Alabama. Semistructured interviews were conducted, transcribed, and coded using established qualitative coding protocols through both deductive and inductive approaches. Through the analyses, three major themes were identified and expanded on the following: (a) doulas are currently helping their clients with mental health and/or substance use challenges, (b) the conceptual framework established by Kozhimannil et al. (2016) can be expanded to explain how doulas help clients with mental health or substance use challenges, and (c) rural residency adds substantial barriers to maternal physical health, mental health, and substance use care. This study establishes doulas as a strong resource for rural birthing persons in Alabama and shows that doulas can help combat the maternal mental health and substance use crisis, specifically in the rural United States.