As a doula, one of the most important things we do is help parents prepare for birth. A new study found a lack of confidence about birth is associated with perception of childbirth as traumatic. This seems to be more evidence that the role of a doula could reduce the likelihood of birth trauma.

How? Doulas help parents learn about birth, understand what to expect, prepare them to make informed decisions – all of which increase confidence, also known as self-efficacy. We also provide continuous labor support. This allows us to continue to build their confidence throughout the labor process.

Why This Study Is Important For Doulas and Birth Trauma

The study examined how a pregnant person’s self-efficacy (their confidence in their ability to birth) relates to their perception of childbirth as traumatic. The results showed a significant negative correlation: lower birth self-efficacy was associated with higher perceptions of childbirth as traumatic.

For doulas, these findings reinforce the importance of our role. Our role is not just physically or emotionally, but in building confidence around birth.

This study helps identify a way we can help reduce birth trauma. When we help families feel confident about birth, we help them have more positive birth experiences. Confidence, as well as support in making decisions around birth, could be key to reducing birth trauma.

What Did The Study Find?

• The study involved 603 pregnant women in Eastern Turkey.
• On average, participants scored 230.20 ± 40.56 on the Childbirth Self-Efficacy Inventory (CSEI) and 78.82 ± 26.40 on the Traumatic Childbirth Perception Scale (TCPS).
• About 35.5% of the participants had high perceptions of childbirth as traumatic.
• Sociodemographic and obstetric variables (education, income, employment status, perception of childbirth as difficult) significantly impacted self-efficacy and traumatic perception scores.
• The major take-away: As self-efficacy decreases, the perception of childbirth as traumatic increases.

What This Means for Supporting Parents as Their Doula

Building Self-Efficacy Is Important

Your support can make a difference in a birthing person’s confidence. To help build self-efficacy, be proactive in prenatal education and provide realistic expectations for the birth experience. Work on affirmations of strength and encourage them to practice. Teach them about self-advocacy (BRAIN acronym) and effective communication.

Those things can all help improve confidence around birth and be protective against traumatic perceptions of birth.

Watch for Risk Factors for Low Self-Efficacy

This study found several risk factors which increased the risk of low self-efficacy. Things such as lower education, lower income, employment status, perceiving birth as “difficult” were all associated with lower self-efficacy.

As a doula, consider using an intake questionnaire that allows families to share what they are comfortable with. Anxiety levels, personal beliefs about birth, prior experiences with birth (their own births or those of family and friends), and socio-economic stressors could impact self-efficacy.

Re-frame Birth as Experience, Not Just Outcome

When people perceive birth as likely to be traumatic—even ahead of time—self-efficacy can drop. Your work helps shift the narrative: “You are capable,” “You have support,” “This is your experience to shape.”

We can also proactively help parents see birth as an experience and not something they can fail at. It is important to help parents understand that medicated vs unmedicated, vaginal vs c-section, etc., is not better or worse. We can help them understand what makes a positive vs negative experience is often were they an active participant in decision making? Did they feel safe and supported? We can ensure them they will have support and can find ways to have an empowering experience regardless of specific outcomes.

Work with Partners and the Whole Birth Team to Reduce Birth Trauma

While the study speaks to individual perceptions, many of those perceptions are shaped by environment.

Communication with caregivers, address previous trauma, provide partner support, and help parents find a sense of control. As a doula you can facilitate inclusive conversations with partners and providers, helping the birthing person feel seen and empowered.

Post-Birth Debrief Matters

Even when birth goes “well,” a person may still perceive it as traumatic if they felt powerless, unsupported, or lost control.

Including postpartum debriefs as part of your doula offering can help shift perception and support confidence for future births. We should never discount their experience. However, we can help them articulate and process the experience. And if they are still struggling, refer them to therapists specializing in the reproductive years.

Suggested Doula Conversation Starters 

When working with parents before birth, it can be hard to balance realistic expectations and creating a positive approach to birth. These conversation starters are some examples of ways to start discussing birth.

• “When you imagine labor, what feels possible? What feels challenging?”
• “What are your strongest beliefs about birth? Are there things you’d like to shift or explore?”
• “Tell me about a time you felt very capable of something in your life. How can we bring that strength into your birth journey?”
• “After your birth, how will you know you felt respected, heard, and in control?”
• “If worries or fears come up about birth, how can I support you in rewinding or reframing them so you feel more confident?”

For doulas, this study offers powerful evidence: support that builds self-efficacy isn’t just “nice to have”—it’s core to reducing perceptions of traumatic birth. Your presence, your preparation, your affirmations can impact people’s perceptions of birth.

By centering confidence, dignity, and connection in your practice, you help transform birth from something feared into something owned, experienced, and remembered with strength.

Not already a birth doula? Register today and help more parents experience empowering births.

Author: Aliza Juliette Bancoff

Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and  the International Breastfeeding Institute which provides lactation training and certification.   She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report,  Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...