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By Nikki Mather
Nuclear family life
Within the huge variation in the types of families that we see in society today, postnatal doula support is recognised as being hugely beneficial to all new parents. So many of us move away from our families for work or university and set up life in a different city, or move into a more rural setting to begin a nest of our own, so postnatal doulas can fill in the gaps that our wider family might have filled back in the day – as well as much more.
The support each family needs looks different; no two families’ requirements are the same, and even within families their needs will differ as each day arrives and as the landscape of parenthood changes. Doula support involves a range of skills to fully support each family as and when they require, and when we do not have the tools to hand we signpost to the most appropriate support. Doula preparation courses1 provide essential information and education as well as giving guidance on how to use reflective practice and emotional intelligence effectively when working with new families.
What does a postnatal doula do?
Emotional support is the very foundation of what doulas provide: A listening ear for parents to air their concerns, or to hear parents’ thoughts after a difficult time, as well as basking in the glow of oxytocin and their happiness together following a positive birth. The ‘doula superpower’2 of signposting must not be underestimated, sharing a plethora of different links, social media groups, local parenting sessions, support groups or organisations where parents can search for more information to support them where required.
Doulas listen to families’ birth stories and often hear them repeatedly, listening carefully each time parents play out the scene again. Parents report feeling better about their experience when they have been listened to, had their experiences validated and not judged for how their journey unfolded. The emotional labour of so many things to think about, all the task lists and meeting all the family’s needs can be difficult to navigate in the early days and weeks with a newborn baby. Doulas provide both emotional and practical support, which is flexible depending on the wishes and needs of the individual parents. Essentially, the emotional support provided by a postnatal doula and the action of just ‘being there’ matters; listening and providing consistent support are physiological needs of human beings for them to feel reassured and safe. The nurturing presence of a doula providing familiar and consistent support for some families is considered essential to the mental health and well-being of the family.3,4
Diverse skills for diverse situations
Each birth and each baby are individual and therefore have different elements of need in the postnatal weeks as each family navigates their way through the challenges of parenting. The way in which a baby is born may influence how parents feel in their postnatal recovery. Infant feeding may have a tricky start especially if interventions are required during birth or if any pain relief used has affected the baby’s biological responses in the early hours after birth.5
Some mothers may want a hands-on approach in the home to support the whole family, older siblings and partners, while they get to know their new baby in the early days: Having somebody else to take care of cooking a meal or two or filling the freezer with nutritional meals, or maybe just to pop in the kitchen and wash the pots piling up next to the sink; some infant feeding or breastfeeding support.
Practical support can make things a little easier on tired parents in the early days. In tales of days gone by, you may have heard of how our mothers, aunts, friends and neighbours would provide the role of a doula to new parents without even having to think about it. The local ‘wise woman’ or the ‘auntie’ of the neighbourhood would be called over to tend to the everyday household tasks and help with breastfeeding in the early days, ensuring any older children were fed and watered, dressed and off to school, or the washing was hung out on the line. They would hang around, ready to serve with any support required until the parents became confident in their own parenting skills, and remained a part of each family as the children grew.
Postnatal doula support from a practical aspect has not moved away much from those stories. Preparing nesting areas for a new mother to sit comfortably in whilst underneath a nursing or bottle-feeding baby, fetching drinks and snacks to keep her energy and hydration levels up, ensuring the things that are getting in the way of parents relaxing are done, the washing turned on, the dishwasher loaded and lunch prepared for the next day.
Listening, holding and nurturing parents as they navigate the transitional experience of parenthood is the very essence of postnatal doula support.
Why hire a postnatal doula?
Quite simply put, who wouldn’t want an extra pair of hands around? A listening ear, an extra shoulder to cry on. Parenting in the 21st century sometimes requires additional support to enable informed decisions to be made. With information available at the tips of our fingers, finding robust information and deciphering it and recognising evidence-based practice weaved amongst the stories and opinions of many, can be difficult to navigate for anyone – and new parents have the added challenge of sleep deprivation and the stress of new parenthood. An important element of being a postnatal doula is the ability to listen to parents’ concerns whilst making informed decisions, support them in finding the information to make those decisions and advocate for them where needed to ensure their voice is heard. Better outcomes are seen for families who engage in doula support.6
Are postnatal doulas a privileged accessory to parenting?
Despite the media portrayal of doulas as a recent fashionable ‘must-have’ of the privileged,7 doulas have been providing support to all sections of society for as long as there have been people giving birth. From the informal, unspoken agreement of friends and family who pop by and make meals, do school runs and tidy around for new parents, to organised meal plans from community centres and religious organisations, families receiving the support of others is not a new trend. For some families, the benefit of belonging to part of a community or having family close by is not possible in their lives for one reason or another. Postnatal doula support appears in many guises, ranging from the personal option of being able to hire and pay privately for postnatal support as an agreement between the family and the doula, to receiving charitable sessions from a voluntary organisation such as the Doula UK Access Fund or Doulas Without Borders. Charitable organisations request support and signpost to doulas who work voluntarily for families who are being supported by Refugee Action, Refuge, Women’s Aid and more. Many doulas also provide free support via local community birth groups and helplines. Payment plans and skills swaps are also seen, where families see the benefit of having postnatal support without the means to pay in full. The benefit of continuity, of dedicated support and of the empowerment families experience with doula support is clear regardless of socioeconomic status; however, improving the outcomes of marginalised groups is a key benefit where doula support is provided.8,9
A typical day in my life as a postnatal doula
I wake at 5am to a text message from a new dad providing me with a birth update and letting me know the placenta is ready to process (I’m a trained Placenta Remedies Provider).
I grab a coffee (or three!), and head out to my first family at 6am. It’s a half-hour drive and it’s icy this morning – the first frost of the year.
In my role as a postnatal doula, I arrive to support a family after they’ve had a sleepless night with their newborn baby. My visit is for 2 hours. I pop a sling on, ready for a baby to snuggle in should I need it whilst I fold up the dry cloth nappies and replace them on the drying rack with freshly washed nappies.
Mum is feeding her baby when I arrive and once he is fully satisfied with his belly full of breastmilk, mum hands over the smiley baby so she can head off and grab a refreshing shower and some much-needed breakfast. Making the best use of my time as a postnatal doula is important to this family. Both parents are exhausted, and mum tells me she’s not had time to brush her teeth in the past 24 hours, let alone grab a shower or enough water to drink. I pop the baby snugly into the sling and continue my way around the rooms; tidy around, sort any baby paraphernalia out around the house and make a tidy nest again on the sofa, complete with snacks and water for the day. I chop some root vegetables ready for roasting and pop them in the oven with the timer on as I’ll be gone when they’re ready to come out. As mum comes downstairs, I give her a hug, hand her a cup of tea and pop a sleeping baby down out of the sling and into his crib so I can head out again to the next family.
My next visit is to a new family I have not met before who are struggling to feed their baby. Mum has called me on the evening before my visit and wondered if she was doing something wrong because her baby would latch on well, and then sleep very quickly, not swallowing much at all, and then come back 20 minutes later. This cycle of on-and-off feeding was leaving her and the baby without any rest.
I arrived and made us both a cup of coffee. I listened to mum explain her journey so far, the issues she has been experiencing and a little about her birth story so I can build a picture of any external factors that may be affecting where they are currently. We discovered that baby was being held a little away from mum’s body, so baby needed to stretch and crane her neck to reach the breast. This quickly tired baby out and so she fell asleep after a couple of minutes of active drinking. I supported mum to change her position a little and hold baby close. She was a little hesitant because of her sore and lacerated nipples. Once baby was tucked in close and able to latch on quickly, she took a huge mouthful of breast and drank well for 20 minutes, falling off the breast fully satisfied. Mum couldn’t believe the baby was so relaxed and full – milk drunk! Such a little tweak to positioning can make all the difference.
My third stop is a mum with a 5-week-old baby, another breastfeeding visit. I am trained as a breastfeeding counsellor, which is additional training to being a doula, and it’s an invaluable skill when supporting parents postnatally.
Off I go again to collect this morning’s placenta. It’s 12pm and I am aware I need to eat. I grab a salad from a cafe as I drive towards the new family’s house. Being a birth and postnatal doula quite often means I skip a meal if driving lots on a busy day and so protein bars, dried nuts and fruit seem to be my go-to snacks to keep me going.
I arrive to collect the placenta and congratulate the new parents who are now at home after their birth in the middle of the night. I pop on some gloves, check the temperature of the placenta to ensure it is sufficiently cooled and, after showing the parents the amazing placenta and all of its fascinating functions, I take off a piece for the smoothie. My smoothie kit is already at their house and I leave dad with the piece of placenta to blend with fruit for his wife as he gets his gloves and apron on – he has been very excited about preparing this for his wife. The remaining placenta is safe in the cool bag and I head home to process it into capsules.
After preparing the placenta and placing it in the dehydrator overnight, I settle down with a hot drink. I log on to the laptop to check my messages and emails. I organise my diary for the next few days and set up some games with the kids who have been with their dad at home today as he took a day off to be with them. Dinner will be ready soon and I have some admin for my volunteer roles to do too before the evening is over.
I am hyper-aware throughout the day that I am also on call for a birth. There is always an acute awareness of the possibility of leaving everything with very short notice, dropping everything as soon as the call comes for me to be with a birthing family. Parents-to-be keep me updated with any changes in how they feel or any signs of labour and I often have some notice before the time comes to jump in the car. No babies today, so I continue my evening with emails, follow up calls and texts, and relax with my children after dinner. I aim to sleep early so I can start over again tomorrow with the next placenta encapsulation step and a trip to the post office to send the capsules to their owner. Doula Last Words – ‘unless I’m at a birth’.
Nikki Mather is a birth and postnatal doula at The Doula Element, covering Greater Manchester and Cheshire. Alongside her doula role, Nikki specialises in infant feeding and works alongside Yorkshire- and Cheshire-based Milk Matters.
AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.
The AIMS Journal spearheads discussions about change and development in the maternity services. From the beginning of 2018, the journal has been published online and is freely available to anyone with an interest in pregnancy and birth issues. Membership of AIMS continues to support and fund our ability to create the online journal, as well as supporting our other work, including campaigning and our Helpline. To contact the editors, please email: email@example.com
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