This article originally appeared in the November 2007 issue of Fredericksburg Parent Magazine -
What New Families Need by Heidi Horner
As any veteran parent will tell you, adding a baby-whether the first or the fifth-to the family is a big adjustment. That's like saying a tornado blows up a little dust. The truth is, many new parents are shocked to discover just how much chaos one little miracle-in-a-diaper can create. Parenthood, especially in the beginning, consists of messier emotions and experiences than the cute, romanticized images of family life that are so prevalent in our popular culture. While awareness of serious problems like postpartum depression has increased in recent years, we still don't seem to have a realistic handle on the everyday challenges new families face, and the ways in which they can best be supported as they adjust to their new life.
American culture is fast-paced and high-tech. We like to feel we are in control of most aspects of our lives. Therefore, the experience of giving birth and caring for a new baby can come as a shock. Parents of newborns find they suddenly have little control over their lives. Mothers are often exhausted from giving birth, possibly recovering from surgical delivery. They are also on an emotional roller coaster as hormones re-adjust to the non-pregnant state. Partners feel the burden of added responsibility, and may experience uncertainties about their parenting abilities, just as mothers do. In addition to the endless cycle of feedings and diaper changes, sleep deprivation and bouts of colic, there are phone calls and visits from friends and family, thank-you notes to write, pets to feed, errands to run, siblings who need attention, meals to fix, showers to take, and thousands of unanswered questions about newborn care. Forget about cleaning the house or stepping outside for a breath of fresh air. A quiet chat over a cup of coffee? Not in the next few months!
In years past, and across virtually all cultures, families have not had to face the overwhelming tasks of new parenthood by themselves. There has been a tradition of nurturing the new mother (and by extension her partner and other children) in the postpartum period. For a period of weeks or even months, a new mother would have no responsibilities beyond recovering from the birth and nursing and tending to her baby. Her other duties were taken over by her own mother, sisters, and other women in her community.
Though it still exists in many other cultures, the U.S. has largely lost this tradition. While some new parents are still fortunate enough to receive ample help from friends and relatives, a great many others do not have that option. Extended family may live far away. Grandparents are often still working and unable to take time off to help with the new baby. Family relationships may be strained. The new parents may also be new to their area, and might not have had time to establish a support network before the baby arrives.
Even when help is available, many new parents feel uncomfortable accepting much of it from friends and family, perhaps because they have bought into the expectation that they should be able to do it all themselves. So they struggle with everything alone, at a time when they should be able to just recuperate and enjoy their baby.
For these families, there is another option. Many people are already familiar with the idea of the birth doula, a trained companion who is with a woman throughout her labor and immediate postpartum in order to provide information, emotional support, and physical comfort measures. Fewer have heard of postpartum doulas, since as a profession, the field is relatively new, but they can be an invaluable resource to new families.
The postpartum doula can do the work of absent extended family and friends, but she also plays a unique role in caring for new mothers and families. The doula is typically hired to help out in the days or weeks immediately following the baby's birth, or sometimes as late as several months postpartum. She wears many hats: errand running, light housekeeping and cooking, entertaining siblings, breastfeeding support, education and help with newborn care, providing a nonjudgmental listening ear, and answering many of the questions new families inevitably have. She may come in to help the family just once or twice for a few hours, or she may be a daily visitor for many months, particularly following the birth of multiples or a special-needs baby. She can give the family hands-on help, practical advice, or refer them to the appropriate local resources for issues beyond the scope of her practice. She is a sort of Jack (or Jill!) of all trades when it comes to alleviating the stresses of life with a newborn.
Even for families who already have help from friends and relatives, it can be an enormous relief to have the assistance of a neutral, outside party. The postpartum doula is there to support the new parents in developing their own parenting style. She is not going to tell a mom she's holding her baby too much, that her breastmilk is making the baby colicky, or that the family cat will smother the baby. She respects cultural differences and religious values other than her own. What the postpartum doula will do is help the new parents tune into and trust their own innate parenting skills, and build their confidence. The family's priorities are the doula's priorities.
A good postpartum doula will have received training in newborn care and development. She will have had lots of hands-on experience with infants, and knows all kinds of useful tricks for easing baby and parents through fussy spells and sleepless nights. She will be able to assist the mother with breastfeeding, and will know when to refer her to a lactation specialist, should it become necessary. While the doula does not provide medical care, she is trained to understand the normal changes that a postpartum mother's body goes through, and can answer many of the mother's questions and provide practical advice and recommend comfort measures. Though doula support can reduce the likelihood of postpartum depression, the doula also helps to screen for signs that professional help is needed. The doula will take the time to make sure everyone is adjusting to the new baby, and will be able to offer suggestions for ways to cope when difficulties arise.
In addition to the practical skills they have acquired through experience, most doulas train and certify with professional organizations such as DONA International, CAPPA (Childbirth and Postpartum Professionals' Association) or Full Circle Childbirth Consultants (a local, Richmond-based organization). A family who is interested in postpartum doula services can search through these organizations' websites for doulas in their area. Hospitals, obstetricians, childbirth educators, midwives, and lactation consultants should also be able to refer them to local doulas. In the Fredericksburg area, postpartum support is available through Motherwit Birth and Postpartum Doula Services(see author's bio below).
It is always a good idea for the family to interview the doula to make sure she is a good match; if possible, it is nice to have arrangements made for doula service before the baby arrives. The services of a postpartum doula can even be given as a baby shower gift, especially when family members who would like to help find that they cannot be personally available.
The needs of new families are diverse, influenced by culture, income, values, and so many other factors. What is universal, though, is every family's need for nurturing and support that meets their unique priorities and helps them start off right on the journey of parenthood. I hope that the emergence of the postpartum doula is just the beginning of a rebirth of the fine tradition of caring for new mothers and families with the compassion they deserve.
(Bio):
Heidi Horner, mother of two, is a Certified Postpartum Doula (Full Circle) and birth doula in Spotsylvania. She runs Motherwit Birth and Postpartum Doula Service. Contact her at (540) 972-3878 or at hmhorner@hotmail.com.
Ways to Nurture New Families (Advice from a Doula)
1) Arrange a network of friends and family to rotate the task of bringing the family a nutritious meal each night for a couple of weeks. It doesn't need to be fancy, or even home-cooked. A rotisserie chicken, bagged salad, and loaf of bread from the supermarket deli is almost effortless for the giver, but it will seem like manna from heaven to ravenous, exhausted new parents. Don't forget paper plates and disposable silverware!
2) Again, arrange for a few people to share the responsibility of coming by to see what chores or errands need to be done. Sometimes new moms are resistant to accepting help, but if this rotation of helpers is set up in advance, it gives the mother a chance to plan ahead so she can make specific requests. This is often more comfortable for her than taking someone up on an offhand offer like "Call me if you need anything."
3) Consider hiring some professional help, like a maid service or a postpartum doula, as a baby gift to the family. The expense can easily be shared among a few extended family members. Often, this kind of service is more valuable to new parents than baby clothes, gear, and toys, particularly if there are older children whose gear can be handed down.
4) Offer to entertain siblings for a few hours. When second or subsequent babies join a family, parents are often guilty and frustrated over not being able to pay as much attention to the older children as they might like. Siblings may feel displaced and neglected. Playtime with favorite friends, or a simple trip to the library or ice cream parlor might be just the way to soothe everyone's feelings.
5) Come by and walk the dog or pet the cat. Fido and Fluffy feel displaced, too, and pet care can seem like a colossal burden in the early weeks with a new baby, even for parents who are avowed pet lovers.
6) Don't forget the parents! Offer to hold the baby and supervise siblings so Mom or Dad can shower, or just take a nap. Don't feel put out if the parents aren't ready to leave the baby in someone else's care for a whole date night yet. Sometimes just a quick shower or nap while baby is safe in a friend's arms is all that's necessary to rejuvenate.
7) Don't overstay your welcome, but do check in, just to say "hi". Feeling isolated is a huge contributing factor to postpartum depression. A quick visit or phone call may be more important than you think.
8) Just listen. Sometimes new parents simply need to vent to someone who won't judge, criticize, or advise without being asked.
9) Focus on the positive. It's easy for new parents to feel inept and overwhelmed. Make sure to call attention to something you can see they're doing well. Sing their praises, and remind them that it's not all about diapers, spit-up and sleep deprivation!
The Purpose and Value of Labor Support
By Heidi Horner
(This essay was written as part of my certification process through DONA International.)
On the front of my favorite jacket, I wear a badge that reads "Doulas: Mothering the Mother." People ask me about that badge, how to pronounce the word, and what on earth a doula is. I believe in educating the public, but it is difficult to explain my work in a minute-long chat with a librarian or waiter. "Is that like a midwife?" they want to know. My friend Amy, a veteran doula, would respond, "Midwives catch, doulas coach." It's an accurate reply, but I suspect for many it conjures images of breathing patterns and raucous encouragement like you'd hear at the Super Bowl, not in the birthing room. Frequently, I describe what I do as "labor support," but even that term results in a lot of blank stares. I have to go back to the beginning.
Historically, women have always helped and supported one another through pregnancy, birth, and the postpartum period. Childbearing was part of daily life, not a separate event removed from home and community. Most women probably acted in a doula capacity sometime in their lives, just as they raised children, cared for the sick, and prepared the dead for burial . As hospital birth became the norm, the art of attending another woman during birth all but disappeared from mainstream culture. Many, if not most women in our society have never attended another's birth.
The doula profession has emerged to fill this gap. The form a doula's support may take at a birth varies enormously, and I think that explains the difficulty of describing what we do. Sometimes, as studies by Drs. John Kennell and Marshall Klaus, as well as other researchers, verify, the simple continuous presence of another woman in the room will have a positive effect on labor. The doula may simply be with her client, sitting quietly beside her, and that is enough. At other births, however, the same doula may do so much hands-on support that she goes home sore, hoarse, and exhausted.
Research comparing outcomes of doula-attended births with births where women were cared for only by regular hospital staff (i.e. nurses and obstetricians) has shown that doula care tends to reduce the number of interventions and improves maternal-infant bonding and the mother's overall level of satisfaction with her birth experience. Doula-attended births are less likely to end in cesarean sections or instrumental deliveries. Mothers supported by doulas are less likely to use epidurals or narcotics during labor, or to have oxytocin (Pitocin) administered. Length of labor appears to be shortened by an average of about 1 and a half hours. Babies' 5-minute Apgar scores are less likely to be below 7. Mothers who received doula support tend to have less trouble starting breastfeeding than moms receiving usual care, and they are more likely to still be nursing, and on a flexible schedule, at 6 weeks postpartum than are moms without a doula. Mothers who received doula care are also more likely to report that they feel the transition to motherhood has been relatively easy, and that they feel able to manage their infants well. Clearly, scientific research supports doula care as an invaluable aid to having a happy, healthy birth experience.
Women's needs during childbirth vary so widely that it seems impossible to say precisely what being a good doula requires. More than training and book learning, it takes compassion, full presence, and the ability to be empathic with a client and responsive to her needs. I was amused to receive an email from a client's mother-in-law, thanking me for having "mothered" her son and daughter-in-law through a challenging labor. This woman and my client's mother had both been present during the labor, and had, in my eyes, done the mothering! But I took the email as an indication that I had done my job well.
As the badge says, doulas mother the mother. We do not provide medical care. I am careful to explain to prospective clients that I am not qualified to give medical advice. Likewise, I cannot make decisions for my clients. This last seems obvious, but during labor, when a couple turn their eyes my way, silently questioning whether to consent to an intervention, it can be a fine line to walk between influencing with some subtle expression or intonation, or just presenting options to facilitate an informed decision, which is the appropriate role for the doula. I've found that my opinion may carry great weight, and it's important to be aware of boundaries. I remind my clients that this is their birth, and they don't need to please anyone else, including their doula! I will support their choices.
An obstetrician in my community recently told one of my doula colleagues that she couldn't imagine why anyone would want to hire a doula. (This doctor is not known for supporting natural birth.) However, both my colleague and I received good evaluations from her; the highest scores were in the perceived value of our emotional support to our clients. I have to take her evaluation as grudging proof of the value of labor support. Even she had to admit that continuous compassion, encouragement, and support from a doula contributes to a positive outcome, and empowerment and satisfaction for the mother.
Last night I spoke to a hospital based childbirth class about labor support. The couples were all expecting first babies; most didn't know what doulas are, or why anyone might need one. "You have the same nurse stay with you through your whole labor, right?" one mother asked. Another said, "I'm having my baby with a nurse-midwife who supports natural birth. Why would I need a doula?" A third couple felt positive that the husband would provide all the support the mother needed.
I started by explaining the origin of the word "doula," how it refers to a woman whose work is to serve childbearing women. I explained how the doula's role is unique: Nurses see to the clinical care of several laboring women at once, and leave when shifts change. The nurse-midwives in our area work in obstetric practices, rotating call with so many doctors from other practices that it's unlikely a woman will deliver with a familiar caregiver. I pointed out that even when a woman has excellent support from her husband, a doula can still provide relief, reassurance, and an extra set of hands during a long or difficult labor. Even when a female relative or friend is present, the doula's support is useful. We are devoted to our clients' welfare, yet we can view events with enough detachment to give perspective, to remind a couple of their full range of options and their authority over their birth, rather than being swept away in the emotional tide that washes over loved ones at a birth.
The doula stays with the family, keeping them centered through labor. She reassures them in the early weeks of parenthood. Some of the dads I've worked with have described me as their "go-to" person, or-my favorite-their "prenatal mentor." Word-of-mouth recommendations like these, combined with the substantial scientific evidence, make the value of doula care easy to understand, even when its exact parameters are difficult to explain. The doula, through her knowledge, skills, and loving support, facilitates not only the birth of the baby, but the birth of a new family.
Sources: DONA International Position Paper: The Birth Doula's Contribution to Modern Maternity Care and The Doula Advantage by Rachel Gurevich (2003)
