Labor, birth, and postpartum doulas often find themselves doing
assessments for depression and anxiety as a normal part of their practices. If clients have responses indicating that they need more resources or support, most doulas are instructed to help their clients to find those resources and to refer on to medical or mental health professionals for further screening and referrals. Symptoms of birth trauma may show up on the Edinburgh Depression Scale or on the Perinatal Anxiety Screening Scale (PASS). The symptoms of a stress disorder – avoidance,
intrusive thoughts, negative mood and cognition - are enough to make people feel anxious or depressed. However, the root cause is the birth experience itself, not another mental health condition.
The City Birth Trauma Scale, developed by researchers at the City University of
London, is a 29 item scale that is valid for assessing birth trauma in a person who gave birth or in their intimate partner who witnessed the birth. It’s possible for the partner to have an acute or post trauma stress disorder related to the birth while the person who birthed the baby has no symptoms.
The page containing pdf links for both scales and the screening information is here: https://blogs.city.ac.uk/citybirthtraumascale/
The article explaining more generally about birth related trauma disorders and the validation of the scale is here: https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00409/full
Doulas are often on the front line watching births unfold and feeling
helpless to influence the type of medical care their clients receive. It is not uncommon for a birthing person or mother to develop an acute trauma disorder or post traumatic stress disorder related to their birth experience. Their articles estimate birth trauma in the United States at 14% for birthing people and around ten percent for partners who witness the birth.
Using the City Birth Trauma Scale In Your Doula Practice
Empowerment of the client is one of the doula’s primary purposes, however the client is the person who defines what makes them feel empowered. Like all things, how we foster that feeling of belief and confidence
in one’s self will vary from client to client and family to family. Because of this, I strongly prefer the client to decide that they want to be screened; that the doula has explained ahead of time what the screening process looks like; and what will happen afterwards.
Language choice is very important. So is connecting what you are suggesting with what you have observed in their behavior. In facilitating the screening experience, I want to squash any self-blame or responsibility for having a trauma response.
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