Evolution of Midwives & Doulas to Fill the Void in Postpartum Support

I am a full believer in the benefit of doulas–both birthing and postpartum doulas.  Had I known about them, I would have considered hiring one or both.  I definitely regret not knowing about postpartum doulas, especially while I was suffering from postpartum depression (PPD)!

Following is why…and this goes hand in hand with one of my older posts, which happens to be about the importance of social support, the increasing gap that doulas happen to be filling in this country.

If there are no relatives or friends nearby that can help during the first few months, and if finances allow, consider doing the following as an investment in your mental health:  1) hiring a cleaning person once a month, 2) hiring a doula that can provide both practical support around the house and with the baby, and 3) ordering out a few nights a week.  Even if you and your husband have always been adverse to ordering out and hiring a cleaning person or someone to come into your home to care for your baby, now’s the time to be open-minded and explore other options you may never have considered before.  While continuous social support during childbirth has been in practice in other countries for centuries, the increase in doulas in this country is occurring due to the decrease in support provided to mothers from their extended families.

Until I started reading up on postpartum depression a few years back, I didn’t even know the difference between a midwife and a doula.

  • A midwife is medically trained to perform vaginal exams and deliver babies in either a patient’s home or in the hospital.  A doula is not medically trained to perform clinical tasks and deliver babies but instead is professionally trained to provide support during labor and after delivery in terms of childcare.
  • The word “doula” comes from the Greek word for the woman who helped the lady of the house during and just after childbirth.  [Mothering the Mother by Klaus, Kennel & Klaus] The word has come to refer to a woman who provides physical, emotional, and informational support to the mother before, during, and just after childbirth.  If you don’t know of any doula services in your area and your pediatrician and friends can’t refer you to one, it would be helpful to check out www.dona.org, the website for Doulas of North America.

Taken straight from DONA International’s Position Paper on the Postpartum Doula’s Role in Maternity Care, 2002:

“In traditional societies women and men grow up around birth, breastfeeding, infants and children.  After giving birth, women are surrounded by caring family members who have a great deal of experience and wisdom to offer.  This kind of help is rarely available to new parents in North America.  The doula’s support is intended to fill the gaps left by our customary postpartum practices, which usually include only medical procedures, occasional checkups and the purchase of baby-related paraphernalia.  The doula’s education, quiet support and guidance are a manifestation of the traditional postpartum support that our society is missing.”

Through the training that doulas receive through DONA International, they become knowledgeable about the physiology of labor, emotional needs of a woman in labor, infant care, breastfeeding and even postpartum mood disorders.  Doulas are trained to enter into the homes of new parents, providing them with any help they require, including the following:

  • Assist the woman and her husband to prepare for and carry out their plans for the birth.
  • Stay by the woman’s side during labor to help provide comfort during labor by way of massage or continuous reassurance, as well as facilitate communication between the woman, her husband and the doctor and hospital staff.
  • Provide guidance with adjusting to parenthood
  • Provide training on the basics of baby care and addressing concerns as they come up, like colic, cradle cap or eczema
  • Take care of any other children in the household
  • Provide guidance with breastfeeding and/or bottle feeding, including latching techniques, quantity of milk or formula intake, feeding schedules, what type of formula to use, what type of bottles and nipples to use, how to pump and store, and what to do when/if the baby has gas, reflux or spits up
  • Provide non-judgmental emotional support/companionship
  • Help with the baby whenever the mom and/or dad need to sleep/rest or even to take a shower
  • Help around the house, including cooking, cleaning, laundry, answering phones, taking messages and fielding visitors
  • Help with errands like shopping for groceries
  • Provide referrals to professional/community resources like doctors, therapists and/or PPD support groups, if necessary

Ultimately, the doula’s role is to help ensure the childbirth experience is as positive, easy and stress-free as possible. Having someone in your household who is experienced with baby care can provide the first-time mother with a much greater sense of security.  Knowing someone is there with you providing nonjudgmental guidance and addressing any concerns that come up can boost your comfort level and lower your anxiety level.  Other benefits of having a doula include:

  • Increased breastfeeding success
  • Content baby and better overall infant health (e.g., less issues with colic)
  • Moms get more sleep, which helps with postpartum recovery and prevention of PPD.
  • Studies have shown that having a postpartum doula can help reduce PPD rates.  The new mom can get more sleep, get help with breastfeeding and feel comforted knowing there’s someone in the house with them that is experienced with childcare (i.e., no need to feel anxious in terms of what to do).

Hey, if you were asked if you’d prefer to read a book or have a human being with experience in baby care show you what to do, address your concerns/questions as they come up, and help you transition into parenthood for the first time, which would you choose?  I would choose the latter, hands down.  In fact, had my husband and I known about doula’s and how they would benefit us, we would have hired one.  In all likelihood, having a doula would’ve helped keep my anxiety levels down and PPD may not have reared its ugly head.

The new parents would learn about PPD early, and the knowledge can reduce feelings of isolation and despair, if PPD were to occur anyway, despite all of the doula’s help. Having a doula that provides reassurance, encouragement and guidance from the very get-go, when a woman is at her most vulnerable, provides the best kind of start to motherhood there is.  It paves the way for a better motherhood experience overall.  The whole family—the mother, the baby, the father and any other children—benefit from having this kind of support.

You would think such services would be valued by society and the healthcare system, but they aren’t.  Insurance companies don’t typically cover the cost of doula services.  Hopefully, one day doula services are accessible to everyone who is in need of those services.  In order for that to happen, some sort of insurance reform needs to occur so that families who wouldn’t ordinarily be able to afford doula care can have access to it if need be.  Society should encourage and support anything that helps ensure families start off on the right foot, such as the work of a doula.

2 thoughts on “Evolution of Midwives & Doulas to Fill the Void in Postpartum Support

  1. I am going to try to have a baby next year and decided to start on some research. I am confused from the decision of natural birth to the type of bottles. Now I want to hire a doula upon reading this. How much do they usually cost? Thanks for the post.


    • Leslie,
      Sorry, I really don’t know what doulas usually cost. But if you go to the http://www.dona.org site, they have a toll-free number listed and I’m sure they can answer that question and any other questions you might have re: doulas. I wish you all the best as you embark on your parenthood journey. Let me know if you ever have any questions!


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