By Jackie Kelleher
I am a longtime reader of Mothering, and buy subscriptions for friends and clients. I love the way that Mothering makes me think and question myself. Vicky York's recent article on night doula support had just that effect on me. As a doula and board member for DONA International, I truly enjoyed the mirror that the article held before me. Below is my response.
In my role as Director of Postpartum Services for DONA International, I am always pleased to find publications addressing doula services, especially in a publication as treasured in the birthing community as Mothering. I found many points of interest in Vicky York’s recent web exclusive, “The Trend Toward Night Doulas: Exploring the Original Vision of Postpartum Doula Care”. As a doula, I found Ms. York’s article to be insightful and thought provoking. Upon reflection, I realized that I had further thoughts to add to the discussion.
I was moved by the wisdom and passion in Ms. York's article, and I agree that the doula's role is never to separate mother and baby. That said, there are many situations in which the doula can provide top-notch support to new parents while providing overnight support. The doula who is mindful of her role of “working herself out of a job” approaches overnight support with a goal—making herself unnecessary. She can come alongside the parents and teach them skills that will make their nights easier. She might briefly provide these services (modeling), then have the parents try them alongside her, then have the parents perform the tasks on their own with her supportive presence building their confidence.
Postpartum doulas can provide tremendous support to breastfeeding families at night. Many people—new parents or not—find their problems and fears to be exaggerated at night. For new parents, nights are exactly the same as days. Babies need to feed, burp, fill their diapers and feel the warm nurturing of their parents' arms, day and night. During the day, if a new mother finds herself challenged within her nursing experience, she hopefully has the support of friends, professionals and peer counselors. At night, she will be reluctant to call these people. Many babies receive their first bottle of formula at 2 AM for this very reason. For parents who are able to afford postpartum doula services, or who have saved and asked for doula hours as shower gifts, the doula's support may very well be the deciding factor in maintaining the breastfeeding relationship.
We all know that the partner's support is critical in breastfeeding success. On the occasion when the partner is physically or emotionally unwilling to support breastfeeding at night, the doula can fill the gap. As with birth doula support, removing the burden of sole responsibility for support can free partners and gently bring them into the parenting role. Parents of children with nursing problems, children or parents with disabilities, parents of multiples, and parents experiencing or at risk of postpartum mood disorders (PPMD's) can all especially benefit from night support from a postpartum doula. In addition, a mother who is nervous and overwhelmed by her new role may also benefit from a few nights of support and organizational suggestions as she grows into being a mother.
There are times when night services can solve puzzling breastfeeding problems, such as damaged nipples when the mother's technique has appeared to be excellent. A night of doula support might uncover a mother who does not have sufficient lighting or positioning to accomplish a good latch during the night. This detective work at night can help to solve problems during the day. The doula can ensure that the mother nurses at least every 2-3 hours, rather than rejoicing if the baby sleeps and sleeping through those important night-time feeds. The doula working herself out of a job will remind the mother that frequent feeding is crucial to building her supply.
Ms. York voices her concern that if finances and emotional energy are focused on overnight care, the important work of supporting the family during the day can be minimized or completely overlooked. This is accurate, and it is expressly the reason why DONA International is very clear on the role of the postpartum doula in providing overnight support. DONA describes the doula's role as “working herself out of a job”. Much like the role of a parent, the doula fosters maximum self-determination and independence in the new parents, to include providing non-judgmental support, teaching coping skills, modeling skills and behaviors, supporting breastfeeding, helping parents to stay well nourished and hydrated, and providing an opportunity for rest. It is true that some doulas provide night support without meeting any of these objectives, and when doing so, they are operating outside of the recommended standards of care as defined by DONA International. Night nurse care, or taking the place of the parents at night, does not meet any of the objectives of the postpartum doula, and should be avoided with the exception of special circumstances. These might include mothers with serious illness or complications of birth, to include severePPMD's in which sufficient REM sleep cycles are a part of the prescription for recovery.
The responsibility of defining and maintaining her role falls upon the doula, as with any profession. As doulas move into the limelight with tv specials, news clips, and magazine articles, it is critical that we maintain the highest standards and continue to elevate our profession, one doula and one family at a time. The doula can indeed provide excellent and pivotal night support if she is mindful and maintains the integrity of her role. If the doula finds herself in a "night nurse" situation, she should take steps to bring her role back on target. Having reviewed her role when hired, it is sometimes necessary for the postpartum doula to revisit this conversation during the course of her relationship with clients. Whether during the day or night, doulas sometimes find themselves in non-doula roles—providing childcare so mom can attend Pilates class, for example. In any such situation, whether day or night, the doula can ask the parents to set aside a bit of time to discuss her services to date. This is the appropriate time for the doula to ask for feedback, and to offer suggestions. It is important that the doula recognizes the priority of maintaining the integrity of her role. While acting as a night-nurse or a babysitter can provide an income, they are not postpartum doula roles. The consequence of providing these services impact both the doula herself and her doula peers, who will also receive requests for these services.
Personally, I am of the opinion that it is possible to for the doula to foster rather than to interfere with the bonding experience. Ms. York eloquently describes an ideal, in which babies are born gently into their mothers' arms, never leaving the “outer womb” before they themselves are ready. Many doulas hold this ideal close to their hearts, and certainly I am among them. However, experience has taught me that this is a rare experience for parents of newborns in the US today. Best-sellers like On Becoming Babywise and the AAP recommendations against cosleeping, are symptoms of a culture of detachment between parents and their infants. The doula who simply tells parents, “Your baby should sleep with you”, against the advice of everyone else in their lives, may make a difference. Even more success is sometimes accomplished by building bridges—helping parents to recognize for themselves the peaceful results of having the baby's needs met during the stillness of the night, with the advice of well-intentioned friends and family far away. In this quiet moment, the presence of the doula encouraging parents to trust and follow their instincts can make all the difference. This is one of the many ways in which the doula can quickly make her services no longer necessary.
Above all else, my role is to honor and serve what my clients feel will benefit them most. I feel that my willingness to do this non-judgmentally still remains the greatest gift that I can offer my clients as a doula. At my heart, and in my practice, I strive to balance this priority with my own philosophies toward birthing and parenting, and encourage my doula sisters to do the same.