The postpartum doula has been around longer than I have been at it (1991), yet there are still many people who don’t know what a doula is. There is often much confusion with a midwife, who is clinically trained.
Many doulas worked hard to get doula into the dictionary. Online Meriam Webster’s says: “a woman who is trained to assist another woman during childbirth and who may provide support to the family after the baby is born.”
Dana Raphael, an anthropologist who wrote a book in the 1970s, The Tender Gift: Breastfeeding, brought us the word doula. It took a while for this term and the doula movement to progress to where we are today. Yet, many people have no clue what it is that doulas do!
I would add that we provide non-medical support, because “trained to assist” is very broad.
Most of my career has been spent as a postpartum doula and a postpartum doula trainer. Regardless of the postpartum doula training or the trainer, and what you learn in your class or workshop, these are many roles a postpartum doula takes on. One, two, three, or all!!
Some of these roles are the same for birth doulas or they overlap.
Educator. The doula teaches the new mother and father (partner), or other caregivers how to take care of their infant and reassures the new parents that everything is okay.
Day-to-day care such as bathing, diapering and cord care can be intimidating to some new parents and caregiver who may be rusty. With a hands-on teacher, parents can learn more easily in the comfort of their own home.
Although hospitals teach parents before they are sent home with their baby, the amount of information is overwhelming immediately following childbirth.
Breastfeeding is also a skill that sometimes requires a little bit of teaching, showing the new mother positioning and proper latch-on technique.
There are many other topics a doula can educate new parents on such as: bonding and attachment, safety, physical changes after birth, and emotional adjustment.
The key is for the doula to learn all she can and know where to look for evidence-based information when she does not have an answer.
Mother Care. The most important thing a doula does is care for the new mother, with nutrition, rest, reassurance, encouragement, reminders to take care of any physical problems (hemorrhoids, episiotomies, sore nipples).
Or whatever else is needed to help Mom relax so she can breastfeed and take care of baby. If not breastfeeding, Mom still needs this support. Some new mothers need to be reminded to eat and to rest. While a new mother is busy learning to care for her newborn, she needs someone to nurture her.
From serving meals, to setting up a nursing corner, the postpartum doula can provide the new mother with the support necessary to assist with a positive breastfeeding relationship between the MotherBaby couple. This emotional support can make all the difference in the world to a new mother who is beginning her journey into motherhood.
Breastfeeding Support. This is a big part of the doula’s job. All doulas should have a basic knowledge of breastfeeding. Some doulas have a broader knowledge base than others, depending on experience. Doulas should be able to guide and assist the mother with positioning and latch-on to prevent sore nipples and engorgement.
As a doula gains more experience, she should be able to recognize signs and symptoms of possible problems such as engorgement, sore nipples, improper sucking, weak sucking and blocked milk ducts.
If problems go beyond the doula’s realm of knowledge, she should call in a consultant (IBCLC), a certified lactation counselor (CLC), La Leche League or, if necessary, a medical doctor. When in doubt, refer out!
Child Care. If there are older siblings in the home, the doula may be hired to entertain them while mother is nursing and tending to her newborn. Older siblings are adjusting to receiving less attention than they are accustomed to. Having someone to play with can help ease this adjustment.
On the other hand, it may be that the older sibling requires mother’s attention and the doula cares for the newborn directly while mother plays with her older child(ren). If a baby is high need (crying a lot and/or needing to be held), it can be very frustrating, and thoughts of harming the baby in this situation are very common.
Having someone else to hand the baby to, someone there to say, “it’s okay,” and being able to take a break or rest is a relief for a mother in this situation. The doula helps the mother to balance her time and energy among her children. This is often very difficult in the early weeks postpartum. Without help, the new family can become quite fatigued and overwhelmed.
Resource and Referral Source. This is perhaps the most important aspect of the doula’s job. When a situation she encounters is beyond her realm of knowledge and scope of practice, the doula needs to know what is available in her community. In order to refer the family to, such as pediatricians, lactation consultants, ‘Baby and Me’ classes, single parent groups, and Mom’s clubs.
The postpartum doula is often the only link a new family has. The relationship between the doula and the mother and father sometimes lasts beyond the actual working relationship. Calls may come weeks and months later when a new family is seeking other assistance.
Active Listener. The doula is by no means a professional counselor, although some doulas may have a counseling background. Sometimes a doula just listens. This is a skill that often takes some time to develop. Mom may need to share her birth story or her feelings of insecurity.
Often, there are family problems that come to the forefront when a child is born: marital issues, relationships with parents, grief over a recent death, financial difficulties, feelings of inadequacy, etc. The new mother needs someone to talk to who will listen without judgment. The doula is there for this.
Just having somebody present and not feeling isolated greatly reduces the stress of certain environmental factors that can contribute to the blues,depression, or some form of anxiety or mood disorder.
Household Organizer. This role varies depending on the needs of the new family. Most doulas will do laundry, prepare simple meals, run errands, and perform day-to-day tasks such as emptying trash and washing dishes. This is an invaluable service to the new mother. She shouldn’t be doing anything except caring for her newborn and herself. Chores and other physical work should be avoided for at least several weeks. This is especially true when the mother has given birth by cesarean section.
Sleep deprivation requires that Mother nap when possible, and reserve energy for caring for her baby. If the mother is breastfeeding she must eat balanced, nutritious meals, as her body uses some of those calories to produce milk for the baby. The doula also gives dads or partners a chance to bond and to spend time with his partner, without having to think about the daily chores. He or she also needs sleep and relaxation.
Mediator. This role does come up sometimes. Often a new mother is being torn in different directions by well-meaning members of her extended family. Everyone has some advice for her. The doula will often be the go-between when this circumstance arises. She may be able to put out a fire or prevent one before it begins. The doula often provides up-to-date information about newborn care and breastfeeding so the relatives know what current evidence shows. The last thing a new mother needs is any additional pressure, besides those that come with a “normal” transition into motherhood.
Public Education and Outreach. All of us need to educate our providers, legislators, and the expectant and new parents we work with. We must pass on knowledge. Informed decisions by parents, and well thought out policies regarding birthing, breastfeeding, and postpartum care are critical for women to regain control of the birth process.
The doula plays a vital role in shifting the paradigm in birth to a physiological approach, to improve outcomes for MotherBaby, fathers, partners, and families.