The Value of a Doula

Imagine that you’re the quarterback of a football team. Take a deep breath, because the big game is almost here. You’ve been practicing, studying the game, strengthening, and buying new gear. You’re anxious, but you’re ready. It’s just before kickoff, and your coach invites you into his office. He runs through dozens of possible plays for dozens of possible scenarios, and he hands you a thick playbook. “Good luck,” he says with finality. “I’m heading home.”

When I describe the work of a postpartum doula to others, I often use this metaphor of the quarterback and the coach. It never fails to bring a smile—no one could imagine a quarterback facing the big game without a coach by his side. The coach helps the quarterback keep his cool when tensions are rising. He helps him pivot when things don’t go as expected. He encourages him when he stumbles and congratulates him for working hard.

In life, the quarterback is the expectant parent, and the big game is new parenthood. The expectant parents I work with are so full of nervous excitement. Nearly all of them read dozens of books, follow the social media accounts of influencers in the world of parenting, and take hospital courses to prepare for infant care and breastfeeding. But then the “big game” of parenthood arrives, and they are expected to analyze and source all of the information they’ve absorbed, without a coach close at hand to support them and help them adjust to situations that are no longer just hypothetical. Many modern families lack the close support previous generations received from the village of relatives who shared the work of raising children, and parents are left to face their most important job—raising a child—on their own in many ways.

The postpartum doula serves as just the coach that these new parents need. As doulas, we stand by the mother and father during the “fourth trimester,” providing judgment-free, evidence-based support from the sidelines. We serve as a much-needed buffer through which new parents can filter unsolicited advice and opinions found online or absorbed in person. We serve as the caring listener when a new mother wants to vent, to cry, to process her birth, or to voice her anxieties. We assist by covering the tasks she doesn’t have the bandwidth to get tackle, such as laundry and meal preparation. We build “team morale” by counseling all members of the family, including older siblings, on postpartum adjustment and infant care.

But we don’t play the game for the parent. Doulas do not, for example, babysit while the parents are not home; we are trained professionals who serve the entire family unit and not just the infant. And we don’t make decisions on behalf of the parent. We also do not cross outside the boundaries of our scope of practice by giving medical examinations or advice. In fact, we don’t provide advice at all; we provide information rooted in fact. Never does a doula’s sentence start with “You should…” We come armed with a knowledge base of referrals that are designed to suit all of the other needs a client could have, and if we don’t have a referral that fits a given need, we research to find one.

Research shows the supreme importance of having a support person during the period of postpartum adjustment. When new mothers have the support of family members, peer groups, providers, and counselors, they see greater rates of success with breastfeeding and lower instances of postpartum depression.[1][2] We doulas often hear of the mothers in the Goto Islands of Japan, who are expected to stay in bed, wrapped in a quilt, for an entire month while her relatives take care of her and her home so that she can do nothing but feed the baby, bond, and recover.[3] But in the United States, our friends and neighbors often show their support by giving gifts, offering advice, or perhaps even by keeping their distance to stay out of the family’s hair.[4] It’s an unlikely scenario for the modern American mother to be in bed for a full month, but we doulas can work to help mothers echo this same focus on feeding, bonding, and recovering by helping mothers focus on being in the moment and growing confident through learning.

As doulas, our goal is to foster the self-determination of our clients. We will not be around forever, but we are there as guides in the critical moments in which parents gain confidence. Even the quarterback graduates—and may even someday become a coach himself. As a doula, I work to encourage this growth by positioning myself as a teacher to the parents I serve; I show and describe how to used paced feeding, for example, and then I let the parent perform the learning herself.

We would never imagine a quarterback facing the big game without a coach on the sidelines. As a doula, I will strive to build a society where we would never imagine a new parent pacing the fourth trimester without a doula in her corner.

[1] J. Newman, and T. Pitman. The Ultimate Breastfeeding Book of Answers. Roseville, CA: Prima Publishing, 2000.

[2] C. MacArthur et al. “Effects of Redesigned Community Postnatal Care on Women’s Health 4 Months After Birth: A Cluster Randomized Control Study.” Lancet 359:9304. 378.

[3] Brazelton, T. Berry, and Joshua D. Sparrow. Touchpoints Birth-3: Your Child's Emotional and Behavioural Development. Da Capo Lifelong, 2006. 35.

[4] Jacqueline Kelleher, Nurturing the Family: The Guide for Postpartum Doulas. Xlibris, 2002. 2.

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