—Darla Burns, CAPPA Executive Director of Postpartum Doula Programs
In Part 1 of this article, “A Birth Doula for Every Mother” published in Midwifery Today, Issue 104, Winter 2012, we discussed one of the helpful ways a woman can reclaim the magic in her childbirth experience—by hiring a birth doula, who supports the mother emotionally and physically in childbirth. In Part 2 we will discuss what happens after pregnancy and what can be especially helpful for a woman during this time.
In the case of live births in the US, women are usually sent home from the hospital a few hours to several days after birth with a few formula samples and a little bag of diapers; friends or family members drop by with meals and flowers or stay a few days to help around the house.
In the case of miscarriage and stillbirth, a woman is usually sent home with no postpartum care instructions other than perhaps a list of negative signs to watch for that may indicate further complications with her health. In these instances, many friends and family members, often not knowing how to respond, leave the mother to grieve alone and recover physically by herself. Of course she will share her grief with the father of the child (when he is involved), but men’s need for support and time to heal is also underestimated and neglected. Both parents are usually expected back at work almost immediately, unless they claim vacation days or take unpaid leave. (The US is one of three countries in the world that provides no mandatory paid family leave, the other two being Swaziland and Papua New Guinea.)
Whether a mother is left to care for herself and her new baby during the postpartum time or is working to recover from her loss, she is in almost all cases expected to “bounce back on her feet” in a few days.
Is our approach to postpartum falling short?
While postpartum women are naturally appreciative of any help, this common modus operandi in the US indeed falls far short of offering the full healing, bonding and growth that can be experienced in the first several weeks postpartum. Consider these statistics published by the Illinois Department of Public Health (http://www.idph.state.il.us/about/womenshealth/factsheets/pdpress.htm 12/5/12):
- Mild depression is common to many new mothers (approximately 50%).
- Ten percent to 20% of new moms will experience a more severe form of depression known as postpartum or perinatal depression, which can interfere with daily life.
- Postpartum psychosis is a rare, serious mental illness that affects one in 500 to 1000 new mothers. The onset is usually within the first six weeks after delivery and may cause the mother to completely lose touch with reality.
The depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child.
- The numbers to the above statistics are likely higher since so many cases go unreported. This suggests that something significant is missing in the way we approach the postpartum time.
- In the Far East, Southeast Asia, India, many nations of South America and Africa and in Muslim societies around the world, there are varying practices for the postpartum time. They go by different names, a few being confinement (English term used in Asia) and zuò yuèzi (Mandarin for “sitting moon”), ansei (Japanese for “peace and quiet”), but they have several things in common.
- They are an expected part of pregnancy—not just for live births and not just for the wealthy. In fact, any woman from a culture that practices traditional postpartum care would be shocked to learn how women in the US essentially receive nothing in the way of a recovery routine.
- They last approximately 30–60 days. Amy Wong, an internationally acclaimed author and expert on postpartum writes, “Natural delivery requires at least 30 days of rest, while cesarean delivery, miscarriage and abortion require at least 40 days” (Wong 2012, 11).
- They involve constant support, physical and emotional, for the mother and baby. An experienced female family member or a hired professional may provide this care.
- They involve a diet of specific foods and herbs for the mother’s rapid return to vitality and her ability to produce abundant, highly nutritious milk.
- The mother is supported and natural remedies are offered in case of nursing problems.
- Specific, gentle exercises are encouraged to support the mother’s return to strength. In China, the exercises come with inspiring names such as “Get Rid of Big Fat Butt” and “Improve No Saggy Breast.”
- They involve certain prohibitions to protect the mother’s health (i.e., no consumption of cold beverages, no exposure to cold air/wind).
- These practices are considered vital for the mother’s short- and long-term health and her subsequent pregnancies.
I discussed the topic of postpartum care with Valerie Lynn, author of The Mommy Plan: Restoring Your Post-pregnancy Body Naturally, Using Women’s Traditional Wisdom. This is what she had to say:
In Western countries the notion of a “resting period” after childbirth is deemed an extravagant and self-indulgent act by a mother. I find this generalized opinion to be uninformed, outdated and baseless when there is an overabundance of statistics indicating some of the highest rates of postpartum-related illnesses belong to high income or developed countries, such as the United States.
Through living and working in Asia for over 16 years, I have conducted in-depth research on various after-birth traditions and recovery methods in East Asia. Deemed as essential or necessary, most traditional after-birth recuperation periods range from 30 days to six weeks (Lynn, personal communication).
I believe such traditions are directly linked with low rates of postpartum depression. For example in Malaysia—a country that has well-developed postnatal recovery traditions—the national rate of postpartum depression is just 3.9%.
Though we don’t have a complete, traditional method of care for postpartum mothers, we do have one resource that can be of great benefit: the postpartum doula.
New families hiring doulas to help care for them—to whatever degree the family desires—is not a substitute for complete postpartum care routines, paid family leave or medical support, but it is an enormous step forward for individuals and society as a whole.
The services and skills offered by postpartum doulas vary greatly. Some will be highly trained and certified in various skills including: lactation consulting, postpartum massage, infant massage, infant CPR, support for families experiencing loss, nutrition and meal preparation. Others will serve primarily as an extra set of hands and help mom have quiet time to nap, groom and care for herself.
The timeframe of service also varies. Some postpartum doulas will work fulltime, even living with the family for a month or more, while others schedule certain days and hours—even just a few hours a week if that is what the family wishes.
The fees vary, too, and can be a flat rate for the entire time booked or hourly rates that range widely. One common denominator: almost all doulas are willing to reduce rates and offer payment plans for those in need.
There is another advantage of working with a hired postpartum doula rather than relying exclusively on friends or family. While they likely have good intentions, family and friends (again, in the US) are normally not experienced in caring for a postpartum mother, often lack special skills a doula will offer and do not understand the mother’s physical and emotional needs. Though we love when friends and relatives share wisdom and ideas, emotions can run high and postpartum is not always the best time for such guidance!
Evidence shows the tremendous need and benefit of postpartum support. Doulas offer a range of expertise and services and their rates can fit into almost any budget. In other words, all new moms could benefit from hiring a postpartum doula, and there’s a postpartum doula for every mother!
- Lynn, Valerie. December 8–9, 2012. Personal communication.
- Wong, A. 2012. Madam Wong’s Confinement Dishes. Kuala Lumpur, Malaysia: Seashore Publishing.