Doulas can use validated perinatal mental health screening tools, including the Edinburgh Postnatal Depression Scale (EPDS), with clients any time during pregnancy or in the first year postpartum, and with partners as well. Screening is within doula scope because it means administering a questionnaire, not diagnosing or treating. It takes about two minutes per visit and can begin at the first prenatal appointment.

Key Takeaways

• Perinatal mental health disorders (PMHDs) affect more than 1 in 5 people who give birth and are the number one complication of childbirth, according to Postpartum Support International.
• The Edinburgh Postnatal Depression Scale (EPDS) is a free, 10-question screener validated for use during pregnancy, postpartum, and with partners. A score of 10 or above is generally considered a positive screen.
• A positive screen means a referral, not a diagnosis. The doula’s role is to acknowledge, connect the client to support, and follow up.
• Partners can be screened too. Approximately 1 in 10 partners experience a PMHD, and the EPDS is validated for partner use.
• Building a one-page referral resource before screening any client is the most important preparation step.

What are perinatal mental health disorders, and how common are they?

Most people associate perinatal mental health struggles with postpartum depression. That framing leaves out a lot. Perinatal mental health disorders (PMHDs) include perinatal depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), postpartum rage, and postpartum psychosis. They can begin during pregnancy, not only after birth. And they affect partners as well as the birthing person.

Postpartum Support International identifies PMHDs as the number one complication of childbirth. More than 1 in 5 people who give birth will experience a PMHD during pregnancy or in the first year postpartum. The rate among partners is roughly 1 in 10.

Most of those people will never be screened. Not because their providers do not care, but because prenatal and postpartum appointments are short, stigma runs deep, and being asked “how are you doing?” is not the same as having a structured way to answer.

Doulas have an advantage most clinical providers do not. We are with clients over weeks and months, in their homes, in conversations that happen outside the exam room. That sustained, trusting relationship is the most favorable environment there is for a client to tell the truth about how they are actually feeling, if someone gives them the right tool for it.

The Office on Women’s Health put together a short, practical video on doulas and postpartum depression worth watching and sharing with clients: Doulas and Postpartum Depression, U.S. Office on Women’s Health.

Which validated screening tools can doulas use in their practice?

Using a validated screening tool does not mean diagnosing, treating, prescribing, or providing clinical care. It means offering a client a short, structured questionnaire, noting the score, and knowing what to do if that score is above a threshold. That is entirely within the scope of non-clinical perinatal support providers, including doulas.

The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used tool in the perinatal period. It is 10 questions, free, and validated for use any time during pregnancy and up to one year postpartum. It was developed by Cox, Holden, and Sagovsky and published in the British Journal of Psychiatry in 1987, and has since been validated across dozens of countries and languages. The Patient Health Questionnaire (PHQ-9) is another common option, frequently used with partners. Both are appropriate for doulas because they are structured questionnaires, not clinical assessments requiring interpretation by a licensed provider.

If you want a trauma-informed, US English adaptation of the EPDS, look into the EPDS-US, developed by Moyer and Kinser at Virginia Commonwealth University School of Nursing. It keeps the same 10-item structure and scoring but replaces phrases that can read as confusing or judgmental in US populations, like “things have been getting on top of me,” with clearer, person-first language. You can request a copy at epds-us.vcu.edu.

I describe these, and other, screeners to my doula trainees the same way every time: they are the cosmo quizzes of depression. Short. Structured. Easy to hand to someone with a pen. The difference is that the score at the end tells you whether someone needs a referral, and sometimes it tells you something the person themselves was not ready to say out loud.

Introducing a screen does not have to feel clinical. I tell clients at the start of our work together that I use a brief check-in tool with all my clients, and that it takes about two minutes to fill out. That is the whole introduction. Most clients appreciate having a structured way to answer the question rather than being put on the spot.

You can screen at any prenatal visit, at the postpartum visit, or at multiple points across the relationship. Or the clients can screen on their own in private. PMHDs can emerge at any stage of the perinatal period, so a single screen at intake is not the full picture.

What does a doula do when a client screens positive?

A few months after one of my clients gave birth, I received a text message. It was a single number: 14.

I knew exactly what it meant. She had completed the Edinburgh Postnatal Depression Scale and sent me her score. A score of 14 is above the clinical threshold for a positive screen. I called her right away, and over the following weeks she got connected with the right support and into care.

When she reached out to thank me, she said she could not have said the words “I am depressed” out loud to anyone. Not a single word of that sentence was available to her. But she knew that if she sent me a number, I would come to her. The screening had given her a language for something stigma made nearly impossible to name directly.

That is what screening does. It does not diagnose. It does not treat. It gives clients a way in when every other door feels too heavy to open.

When a client scores above the threshold, your role is narrow, clear, and entirely within your existing skill set. But the number is not the whole story. A score of 10 or 11 on the EPDS means “possible, monitor closely and consider a referral.” A score of 20 or above on the PHQ-9 warrants urgent referral. And you are not just reading a number in isolation. You are the person who has been with this family for weeks or months. You know whether your client has support at home, whether something difficult happened at the birth, whether she has been quieter than usual. The score gives you information. Your relationship gives you context. Use both.

Acknowledge first

Before you do anything else, the person needs to know they are not in trouble and you are not alarmed. Something simple works: “I am glad you told me. This is something we can find support for.” Say it, mean it, and give them a moment before moving forward.

Connect them to the right resource

Your job is to point toward help, not to provide it yourself. Postpartum Support International (PSI) runs a peer support helpline at 1-800-944-4773, available in multiple languages, and maintains a provider directory searchable by location and specialty. Give the resource to your client in writing. When possible, offer to help them draft a message to their OB, midwife, or primary care provider. A client in the middle of a PMHD is not always in a position to navigate intake paperwork alone.

Follow up after the referral

Check in the next day. And the week after. Not to manage care, but to be the person who asked and kept asking. That follow-through matters more than most doulas realize.

When a self-harm item is endorsed

Item 10 on the EPDS and Item 9 on the PHQ-9 ask about thoughts of self-harm. Any answer above zero on either item requires same-day follow-up, not a scheduled callback. Stay with the client, help them contact their provider, or call or text 988 (the Suicide and Crisis Lifeline). Do not leave them alone with that result. This is a different level of response than a referral conversation, and it is worth knowing how you will handle it before you are in it.

How should a doula set up their practice before screening begins?

The preparation that matters most is building a one-page referral resource before screening any client. That document should include local perinatal mental health therapists, the PSI helpline (1-800-944-4773), your client’s OB or midwife contact, and a local crisis line. Thirty minutes of work before your first screen means you are ready when you need to be, not figuring it out in the moment.

Keep a brief note in your client file each time you administer a screen: the date, the tool used, and the score. This is not clinical recordkeeping. It is the same kind of note you might make after any significant visit. It creates a record of care that can be useful if a client later needs to describe the timeline of their symptoms to a provider.

Introduce screening at intake, not as a standalone event triggered by something you observed. When a client knows from the beginning that you use a brief check-in tool routinely, completing a screen feels like part of the relationship, not a response to a red flag.

If you want a structured walkthrough of how to bring perinatal mental health screening into your doula practice, I built a class specifically for this. It covers which validated tools to use, how to introduce screening to clients, what to say when someone screens positive, and how to set up your practice so you are ready before you need to be. It is $19 and available right now at doula.thrivecart.com/perinatal-mental-health-screening-doulas/.

Frequently Asked Questions

Does perinatal mental health screening require special certification for doulas?
No certification is required to administer the Edinburgh Postnatal Depression Scale or the PHQ-9. These are structured questionnaires, not clinical instruments that require licensure to use. A doula can introduce either tool at any prenatal or postpartum visit without additional credentials.

What score on the Edinburgh Postnatal Depression Scale indicates a positive screen?
A score of 10 or above on the EPDS is generally considered a positive screen warranting a referral conversation. A score of 13 or above indicates higher concern. Scores are the start of a conversation, not a diagnosis. The doula’s role is to acknowledge the result and connect the client with support, not to interpret it clinically.

Can doulas screen partners as well as the birthing person?
Yes. The EPDS has been validated for use with partners, and the PHQ-9 is also commonly used with partners. Approximately 1 in 10 partners experience a perinatal mental health disorder. Screening both people at the same prenatal or postpartum visit normalizes the conversation and broadens the support the doula can offer the family.

What if a client declines to complete a screening tool?
Screening should always be offered, never required. If a client declines, acknowledge it and keep the door open: “That’s completely fine. I’m always here to talk if anything comes up.” Declining is not confirmation that everything is fine. It is information that the topic may need to be approached differently over time.

Can doulas use screening tools at homebirths as well as hospital or birth center births?
Yes. Screening is not tied to a birth setting. It can be administered at any prenatal visit, the postpartum visit, or any point in the perinatal relationship, regardless of planned or completed birth location. The tool requires only paper and a pen, or a digital intake form.