“Am I doing it right?” I asked my husband sheepishly, my tiny, hours-old baby pressed with a frenzied hand over my cloth-draped shoulder. Neither one of us had ever burped a newborn, and, as it turned out, he had no idea how to do it either.
Two weeks later, alone with the baby for the first time, exhausted and overwhelmed, I cried for three hours over a load of undone laundry. I didn’t know then what I know now, after mostly “winging it” through my fourth trimester: Postpartum doulas are a thing, and they help with that kind of stuff.
So who are these modern-day heroes and why did no one mention them to me? The issue is more complex than I thought. I had a conversation with Mary Killeen, a preschool teacher and nanny turned postpartum doula and owner of West Seattle Doula Services, about the importance of postpartum care, why it’s lacking in the U.S. and how our communities benefit when we support women and parents after childbirth.
What is a postpartum doula?
Unlike a birth doula who provides partner support and emotional and physical support for the birthing person throughout pregnancy and during labor, a postpartum doula does so after the family returns home with their baby. They provide in-home assistance during the [six week period after birth defined as the] “fourth trimester.”
Postpartum doulas Nurture Educate Assess and Refer. Emotionally, postpartum doulas help you process your birth experience, are trained to look for signs of perinatal mood changes and use reflective listening with the birthing person or other family members. Physically, they prepare meals, care for older children, perform light housework and hold baby so parents can shower or sleep.
Postpartum doulas also provide evidence-based information and education and have a referral network of medical care providers in the area they serve, to whom they can send their clients when the clients’ needs are outside of their scope of care. For example, a postpartum doula may give advice about co-sleeping or baby-wearing based on reputable sources like the World Health Organization, or may refer a parent to a physical therapist for pelvic floor and abdominal healing after birth.
There are also so-called “Full Spectrum” doulas, who provide their services for all pregnancy and postpartum experiences, including abortion, adoption, surrogacy, miscarriage and stillbirth.
Why should someone hire a postpartum doula?
Many places in the world, both historically and currently, have postpartum care built into their culture. Depending on where, this care is usually provided by family members (usually a group of other women in the family). Research shows us that postpartum doulas facilitate superior outcomes in postpartum adjustment including reducing perinatal mood disorders, improving breastfeeding success and increasing self-confidence but currently, fourth trimester support is often overlooked in the States.
Our healthcare system has immense room for improvement generally, but women’s care — specifically maternal, birth and postpartum care — is particularly dismal. We have the worst maternal health among the “developed” countries. Most birthing people in the States who use clinical care (doctors, OBs, hospital births) will not see a provider until 6 weeks after birth. And families are rarely provided any tools to sift through information on healing and newborn care in those early weeks. This ignorance — combined with sleep deprivation — can be dangerous.
The physical healing that needs to take place for the birthing person is often not given enough consideration by providers and families. This is important for short- and long-term health; how a birthing person heals during the early postpartum period effects their long-term vitality and health.
Both science and common sense tell us that the health of the birthing parent is linked to the health of the infant (and therefore, the family). The fourth trimester can be clinically defined as 6 weeks (what doctors use as a benchmark for the birthing person’s healing) or 40 days (period of “confinement” in some countries), but theoretically the fourth trimester lasts the rest of your life. Postpartum doulas are important for this reason; they aid in the transition into parenthood for you, and the transition into personhood for your new baby.
In your opinion, why is postpartum support so lacking in the U.S.?
The lack of postpartum support in the U.S. is a result of a patriarchal, profit-driven economy and culture. Women’s health is continually up for debate politically, which I believe reveals our cultural values around women’s autonomy and quality of life. Because the cis men that embody and enact violent patriarchal values still dominate our societal positions of power and still hold the most amount of wealth, women’s bodies and health are not a priority in our systems and institutions.
Research shows the improved birth and postpartum outcomes for women who have patient-centered care and doula support, but midwives get paid very little (especially relative to other maternal healthcare providers) and doulas are not covered under insurance. The birthing parents who can afford postpartum doulas are often white, upper-middle class, college educated and living in urban areas which means these types of holistic services are inaccessible to the average person. This also means that the people providing care are often of the same demographic, which is a cyclical problem.
It’s ironic because the people in the most need of this kind of care, like Black women, have little to no access to it. Double irony is that Black women have been nursing and raising white babies in the United States for much of its colonized history. I think that’s why so many white European-American women have little to no knowledge about birth and postpartum norms. We outsourced and commodified the labor long ago, and as our resources have dwindled (and as we have been incorporated into the masculinized workforce) we are forced to educate ourselves again.
In short, quality postpartum care takes a large amount of feminized labor, the U.S. doesn’t value feminized labor and therefore does not provide the money or resources to provide and support it, and birthing people and families (our entire human community) suffer.
What is your philosophy as a postpartum doula?
My practice centers around mindfulness in caregiving. This is important for Westernized parents in the States because the rhythm of our day-to-day lives does not foster this state of being. Most parents literally cannot afford to be physically present with their child for the majority of their childhood.
“Everyday Blessings: The Inner Work of Mindful Parenting” is a wonderful resource for this kind of parenting, and mirrors a lot of my personal beliefs I use when supporting families. It asks parents to be present by listening to a child’s underlying needs, and to let go of expectations (for themselves and their child). I believe that parents know what is best for their child and family, and often they just need some encouragement to trust their intuition and common sense. I also believe that caring for children can and should be joyful, and I support parents in discovering that joy.
What is the single most important thing a new mom can do to ease the transition from pregnancy to parenthood?
The most difficult part of the transition to parenthood is the isolation, loneliness and doubt birthing parents experience in the early weeks after the baby arrives. Whether or not a parent can hire a postpartum doula, they can ease their transition into parenthood by having support system scaffolding in place for their postpartum period.
Birth plans get the most attention in terms of preparing for the unexpected, but I think parents should be equally as encouraged to create a postpartum plan. This might look like a list of chores on the fridge that parents can direct guests to, having a friend set up a meal train, or asking a family member to move in for the first few weeks. Parents and children are born simultaneously — they both benefit from the proverbial “village!”