THE RISE OF THE postpartum helper
Doulas offer support and expert guidance for families just after childbirth
There were many things about being a new mom that Courtney Lee-Ashley didn’t know: How often she’d need to pump, how difficult infant poop stains would be to get out, and how many times she must sterilize baby bottles. But there was one thing she did know: She and her husband, Matt, would be primarily on their own, with limited family help after baby Everett arrived in April.
So Courtney did what her planning instincts told her to do: Before Everett was born, she sat down and interviewed Betsy Quilligan, a postpartum doula. For US$3,600, Courtney and Matt purchased 100 hours of Betsy’s time. She came to their home two to three times each week for the first three months of their son’s life to help the family adjust to their new arrival.
“Matt and I both have nieces and nephews, but we have never spent the night with a baby by ourselves,” Courtney said. She knew that new mothers were at risk of postpartum mood disorders, including anxiety and depression; she wanted to be sure that she had support ready, should she have any symptoms. And while both Courtney and Matt have doting parents willing to visit from out of town, Courtney’s dad is undergoing treatment for cancer and her mother would have limited ability to visit from North Carolina.
“I didn’t know if she would have the flexibility to come if we needed her,” Courtney said. “I thought (hiring Quilligan) would relieve the anxiety that she was having, too.”
Postpartum doulas are different from birth doulas, who support a mother during labour and delivery, and have different training than night nurses, who typically watch and feed a baby while parents sleep.
Neither of Matt nor Courtney knew much about postpartum doulas before they met Quilligan, but both are emphatic that Quilligan dramatically shaped their newborn experience. Courtney credits Quilligan with helping her establish a successful breastfeeding routine, something she struggled with initially, giving her confidence, and facilitating better communication between her and Matt. Even as the couple prepares to return to work, they say Quilligan’s advice and presence eased their transition: Courtney now has a pumping routine, and during several of Quilligan’s visits, they’ve left Everett with her to do brief errands. For Courtney, symptoms of postpartum mood disorders never materialized.
“It’s nice to have a woman here, a woman who has been through it, who understands the changes your body is going through and can regularly monitor your moods,” Courtney said.
The results of such visits can be significant; countries with routine home visits after birth, such as the Netherlands, where professionals check in on the mom and baby at home and investigate any problems before they escalate, have lower rates of postpartum mood disorders, higher breastfeeding rates and better maternal and infant health.
Quilligan, herself a mother of two, became a postpartum doula after her own experience with postpartum anxiety. After her son, Harrison, was born in 2011, she suffered panic attacks and would wake up gasping for air. She sought psychiatric care for postpartum anxiety and relied on her parents and husband for support. “That experience has really become part of my self-identity as a parent,” Quilligan said. “Seeing how common an experience it is for new parents really made me want to help others going through it.”
To earn the title of postpartum doula, she enrolled in a three-day, 30-hour workshop through doula-certifying organization DONA, focusing on maternal and infant care, breastfeeding and perinatal mood disorders. Postpartum doulas are not certified to give clinical advice, although they are well-versed in training related to infants and postpartum mothers. When needed, they will provide professional referrals for additional assistance. (In Canada, doulas mainly direct new moms to health-care providers for any further medical advice they might need.)
At the Lee-Ashleys’ townhouse, Quilligan has her own key and can quietly let herself in without waking anyone. She’ll ask the mom whether she’s eaten yet, and will either prepare a meal or offer to hold the baby while the mom eats. If it’s time for a feeding, she’ll assist, either assuring the baby gets a good latch while breastfeeding or helping parents introduce bottle feeding. She’ll ask how things are going, and offer advice and support as necessary. Often, Quilligan encourages the mom to nap, and she’ll wear the baby in a Moby wrap while doing light housework — sterilizing bottles, restocking diaper caddies, running a load of dishes or laundry — all designed to ease the burden on the parents.
Postpartum doulas are not covered by insurance in the U.S. or Canada, unlike pediatrician visits and many lactation consultants. A typical four-hour visit can cost between $140 and $160. Often, grandparents or friends will purchase postpartum doula services as a baby shower gift.
It’s nice to have a woman here, a woman who has been through it, who understands the changes your body is going through and can regularly monitor your moods. — New mother Courtney Lee-Ashley says of her postpartum doula