Scarce perinatal social support for women with OUD: Opportunities for doula services
Reading Between the Lines
October 2025
In this month’s Reading Between the Lines, we reviewed “Scarce perinatal social support for women with OUD: Opportunities for doula services” by Gannon et al. Utilizing a mixed-methods study, authors found that perinatal support networks decreased from the prenatal to postpartum period, and that doulas and peer recovery support specialists may fulfill the needed support role throughout the perinatal period for persons with opioid use disorder. Both our Epidemiologist and EMPOWER moms shared their insights on the strengths, limitations, and implications of this study.
What was the study design?
This mixed-methods study included 34 participants to explore perceived social support throughout the perinatal period for pregnant and parenting individuals with OUD. Both survey instruments and semi-structured interviews were utilized, as well as social network mapping. Qualitative and quantitative data were collected simultaneously and analyzed using a variety of statistical and inductive qualitative analysis.
What do you think about the findings?
Epidemiologist’s View
The study utilized a mixed-methods design, using both qualitative and quantitative data collection to describe the perinatal social support networks and perception of doulas of persons with opioid use disorder. Though the study included a small sample of participants, the study design was appropriate and findings have broad applicability.
EMPOWER Moms’ View
The EMPOWER Moms overall appreciated the article’s focus on doulas and their potential to support women with OUD in the perinatal period. While they acknowledged the article as generally informative and valuable, concerns were raised about the study’s limitations—including its small sample size and lack of diversity—which made it harder for some to fully trust the conclusions. They emphasized the importance of clearly defining the roles and boundaries of peer supporters and doulas. The group also highlighted the need for clearer explanations of the study’s implications, underscoring that people “need the why” to connect with research meaningfully.
Who does this study represent?
Epidemiologist’s View
This study recruited a small sample (N=34) from a single clinic to participate in this study. While a small sample is common for qualitative research, the small number of participants in this study may make the findings less generalizable to other clinics across the US. The recruitment was done via convenience sampling, which also may have biased the sample towards those who wanted to participate rather than being truly representative of the population the study is trying to represent. However, the participants that did participate all completed the study, and therefore there were no participants who were lost to follow-up.
EMPOWER Moms’ View
While the study offers valuable insights, the group of participants was small and drawn from a single urban clinic and that can limit how much we can generalize these findings. It’s also important to note who might be missing from this conversation; Indigenous, rural, or culturally diverse families who face different barriers and supports. Expanding beyond one clinic or geographic area could strengthen future studies and ensure that more lived experiences are represented.
Was the measurement of the exposure and outcome appropriate?
Epidemiologist’s View
Social support was the primary outcome in this study and it was measured both by the Medical Outcomes Study (MOS) Social Support Survey Instrument, as well as through in-depth questions in the interview. The secondary outcome of the study, interest and perception of doula and peer support, was also measured using survey questions as well as interview questions.
One of the exposures was measured by the adverse childhood experiences (ACE) tool which has limitations, but has been validated and utilized across a wide range of studies. Furthermore, previous studies have shown that this population has a higher ACE burden, and so including this measurement was appropriate.
EMPOWER Moms’ View
The EMPOWER moms appreciated that the researchers went beyond standard tools, expanding the ACEs measure to better capture real-life experiences. They saw the mixed-methods design as a major strength; it offered a fuller, more nuanced picture than numbers or interviews alone could provide. Despite limitations like a modest sample and potential recall bias, the integrated design and careful attention to social support enhanced the study’s overall credibility and depth.
A balanced view: recognizing both strengths and limitations
Strengths:
Mixed methods gives a much more in-depth answer to a research question – much more comprehensive than purely qualitative or purely quantitative
All participants who were approached about the study consented to participate – important for nonresponse or participation bias
Appropriate measures for outcome and exposure variables
Multiple measurements of social support
Limitations:
Small number (n=34) of participants in a primarily urban area from a single opioid treatment program – may not be generalizable or representative of everyone
Could be some recall bias, but questions and study design were appropriate
How could this study affect families?
Epidemiologist’s View
The study findings highlight the potential utility of doulas, especially peer support doulas in support roles for persons with OUD. It also emphasizes that more work is needed to improve awareness around the role of a doula, especially in the postpartum period, and important differences exist between participants interested in doula support and those who were not interested. Participants who were not interested in doula support relied primarily on nurses and parenting experts for information, whereas participants who expressed interest in doula support reported seeking health information from a wide variety of sources. Additionally, this study’s findings emphasize that support is more available during pregnancy compared to after the child is born. These findings speak to the importance of providing additional support after the birth of a child and the untapped potential in the role of a doula for this population.
EMPOWER Moms’ View
This study shows how support often drops off after birth and how doulas and peers could help fill that gap. For many, the word “doula” can sound a little out of reach or like something meant for someone else, not for people juggling treatment or recovery. When doulas, especially those with lived experience, are accessible and understood, they can make a real difference. They help families navigate postpartum stress, advocate within systems like CPS, and stay connected in recovery. The takeaway is simple: postpartum peer support isn’t a luxury—it’s a lifeline.
Does it reflect lived/living experience?
EMPOWER Moms’ View
Yes. The study’s descriptions of doula roles felt on point, especially the way trust, education, and advocacy were framed. Still, there’s a disconnect in how doulas are often perceived. Many people in treatment settings have never met a doula or assume it’s something “woo-woo.” The reality is that peer doulas, people who have lived experience and training, can make this support practical, relatable, and grounded.
What should researchers do next?
Epidemiologist’s View
Future research should examine the effectiveness of doulas, especially peer support doulas, as support persons during the perinatal period, particularly in the postpartum period.
EMPOWER Moms’ View
Future studies should examine how peer doulas can be woven into care as actual team members, not side support. Doulas who’ve been through recovery themselves can build the kind of trust that changes outcomes. We must also determine how to pay for and sustain these roles through real billing and reimbursement options. Since fears around mandated reporting and CPS often shape whether parents feel safe accepting help, those issues must be part of the conversation. The bottom line is that lived experience shouldn’t be an afterthought; it should be at the center of how doula programs are built.
Final thoughts
Overall, this study is a well conducted mixed-methods study that identifies a lack of support, particularly in the postpartum period, for persons with OUD. The article does a good job illustrating the value of a doula. However, almost a third of the participants of this study had never heard the term “doula”, and this highlights a significant gap in awareness around the role of a doula and their potential support role throughout the perinatal period. Persons with OUD are uniquely positioned to benefit from additional support throughout the perinatal period, and doulas, particularly peer support doulas, may be an avenue to provide that support.
