The Trend Toward Night Doulas: Exploring the Original Vision of Postpartum Doula Care
By Vicky York, IBCLC, CPD
There is a growing trend toward hiring a postpartum doula to spend the night with a family after the birth of their newborn. Although it is wise to support a newly delivered mother's need for rest after birth, the financial cost to families for this service is great; therefore other key needs for this time period are being set aside.
When a family chooses night help, which usually costs $175-$250 per night, they often feel they can't additionally afford to pay a doula during the day. The family then misses out on guidance with breastfeeding, newborn care dilemmas, and postpartum depression support. Professional, effective help with these concerns by an experienced and knowledgeable doula can often eliminate the need for someone to be hired to just come get up with the baby all night for as many weeks as the money holds out. That set-up is a throwback to the days when parents hired baby nurses who came and lived with the family for 6 weeks, undertaking all the newborn care, then leaving the mother still feeling insecure about how to care for her child herself. Our original goal as postpartum doulas was to enable the mothers to become independent of us, by giving them confidence in their ability to mother their babies. We can teach them to understand and care for their new baby by sharing our wisdom, training, experience and modeling behavior.
It has been said, "Give a man a fish and he will eat for a day, teach a man to fish and he will eat for a lifetime." It can be more effective to give mothers education and skilled professional "mother nurture" from trained, certified postpartum doulas during the day. This will boost mom's confidence in her mothering abilities while receiving practical household help during the day and letting her nap, enabling her to endure the night challenges.
A new mother needs to be mothered herself, preferably by her family members. In our current societal structure that is very often not possible and these women suffer in isolation. This is a time to learn the art of mothering from other women, a time to be protected, fed, and cared for in special ways by women who know. New mothers need to begin the process of communicating with this child who they will be raising for the next 18 years. Dependence on a night doula does not afford a new mother the intimacy of communication that begins between mother and baby, as they then miss that nighttime connection.
The typical service of a night doula consists of getting up when the baby does and bringing the baby to the mom to nurse, then changing the baby, burping him and getting him back to sleep. Once a family has decided to hire a doula to help at night, it is natural to wish to maximize on this support, leading many tired parents to ask the doula to feed the baby a bottle of pumped breast milk and mom then gets up and pumps only when her breasts are so full and painful they awaken her. Breastfeeding is a supply and demand process. When the baby skips a nursing session and gets a bottle and the mom doesn't pump at that time, her breasts get the message that less milk is needed and after a period of engorgement they will lessen their supply. In addition, there is the risk of nipple confusion with the very new baby, as the rubber nipple demands a different sucking technique than the mother's breast.
It is a shame for parents to spend so much money on night help that they then can't afford baby carriers, CranioSacral therapy and other bodywork or even a housekeeper. For less than half the price a postpartum doula can come during the day and educate, cook, help the mom through a breastfeeding session while folding the laundry and teach her a swaddling technique that calms the baby. She can demonstrate infant massage and watch the baby while the mom naps or runs an errand. Not to mention the mom's need to talk to someone about her feelings at this time.
New mothers can more easily and naturally manage the postpartum time when they are cared for in the ways common to many older cultures around the world – gently, thoroughly, and wisely in support of the deeply transforming process of bringing forth a new life. Certified postpartum doulas extend basic postnatal care in the form of household management, baby care, sibling care, lactation support, newborn care tips, and providing resources within the birth community. They charge, on average, $20-$35 per hour across the nation.
During the time of childbirth, it's as if a woman's heart is opened up; she is so sensitive to her baby and her surroundings. She would give her life for this new little being and will give infinitely. Her relationship with her husband is being tested and strengthened. Her instincts are finely tuned and she is undergoing the acute phase of lifelong bonding with her infant. This bonding is partially influenced by hormones such as Prolactin. Prolactin levels are associated with the frequency of suckling: the more frequent the feedings, the higher the level of serum Prolactin. (Breastfeeding and Human Lactation by Riordan and Auerbach) There is likely a natural reason why babies awaken and want to nurse frequently at night.
Night doula work is one avenue for doulas who want to supplement their income and it can be a lifesaver for the mom who desperately needs the sleep, as with postpartum depression. However, we need to be careful with this service. Postpartum doulas have been through specialized training to support new moms in managing the issues that come up during the months after a woman gives birth, and little of this training is called upon during the course of a typical nights' work, which mostly amounts to babysitting. Mothers often don't realize the extent of a doula's expertise; and they may see her as a housekeeper; and considering night work as an extension of this image. Often a doula who solely does night work doesn't bother to get certified because she doesn't feel there will be a need to utilize the other skills acquired in training. Thus, when she feels pressed to hand out advice and information she may find herself short on accuracy.
Someone said that the purpose for pain in labor is to allow a woman to find her unique inner resources for the strength to face other painful experiences in her life and to use this birth power to begin the journey of parenthood. Subsequent challenges she faces after the pain of childbirth are breastfeeding and getting up with her baby in the night. Many women cite a sense of satisfaction and trust in their own "mother nature" after having gotten through this period using their own skills, learning to read their baby's cues, discovering his needs and personality. Perhaps finding that they can rely on their own inner resources is the thing that is so empowering about birth and motherhood.
The inter-communication that develops between mother and baby during quiet intuitive times develops precious wisdom and understanding needed for a lifetime. One new mother nursing her baby in her rocking chair in the middle of the night said it gave her a feeling of peace imagining all the other mothers sitting with her in the night nursing their babies. She chose to perceive it as a fraction of her lifetime and although she lost sleep she gained that special bonding that occurs in a dreamy state in the quiet by lamplight, undistracted by the world. As postpartum doulas we can support a mother's sleep by teaching her to nurse in the side-lying position. Through a doulas' caring presence mom learns to understand the joy of knowing she can care for baby entirely herself with her milk, body warmth and protection.
Many moms hire a night doula beginning the first night home from the hospital. I will always hold special memories of my first night home with my new son. I wouldn't have wanted someone else to come in and get up with him, however loving, gentle and motherly she may have been. It is surely his own mother whose odor and movements he is wishing to become familiar with. Perhaps a new mom who so quickly gives up this experience is full of fear. Some mothers book night doulas before the babies are even born! They often become dependent on them and keep them for weeks or months. In trying to be helpful to new parents, are we actually supporting them in giving up even before they start? As doulas we can do a lot to instill confidence in these women rather than just show up at bedtime and take over. It is certainly natural to feel fearful as a new mother responding to this important little being, and this is where the support and wisdom of doulas can help to alleviate new parents' anxious concerns
There are times when a night doula can save the day, literally. There are some women who simply can't function at all when they don't get enough sleep. However, a family member or doula during the day can assist far less expensively.
We may not understand all that happens within a woman during this time, but we can be sure that she undergoes such a huge change that she needs to be listened to and served in a manner that opens the way for her to have every opportunity to bond profoundly in loving nurturance with her baby while flowing with the changes of her heart and psyche. Doulas better serve new mothers as role models of heart centered mothering, offering support as wise women elders who've been down this path before them. We can remind a woman to be present for this part of her journey. We can hold her hand; be willing to watch her dark side without judgment, while teaching her to surrender to an age-old process as she wrestles with one of the hardest aspects of parenting. Perhaps on some level this prepares us for later adolescent years. It's a difficult initiation and at some points every woman struggles and fights against it, often crying along with her baby.
I called my heroine, Jean Liedloff, author of The Continuum Concept, as she is open to consultation calls, to ask her how lack of sleep is handled in indigenous cultures. She said "what lack of sleep? The mothers and babies sleep together. The babies are crying because they want to sleep next to their mothers, not down the hall." She is right; when babies are sleeping with their mothers they can nurse while mother sleeps. She quickly adjusts to the presence of her child next her and soon sleeps right through his little noises and movements and she would awaken if the baby was in distress because her instincts are working while she's asleep. Jean Liedloff says babies must be made to feel worthy and welcome in our beds right from the beginning. She says they will feel safe to leave our beds, at around the age two, when they feel absolutely assured they are welcome to come back.
Sharon Wesolowski, an ordained minister who is trained in various modalities of energy work, peacemaking and spiritual transformation is still getting up in the night with her nine-month old. She offers this: "We know that nighttime parenting brings you face-to-face with all the demons within, all the memories of how you were or were not parented, and asks you to push past them to find the heart-centered authentic way to parent from the present, to give to this little babe all that she/he is most needing (and ultimately all that you are most needing). It is very unclear and confusing psychological territory."
The newborn night stage can be a confusing time for parents; it often stymies the doula as well, as she wonders how to best model this part of the journey for families. However it is not a time for a mother to be separated from her baby. Being together and reinforcing the mothers' confidence that she is the best person to nurture her child better serves them both
Vicky York, board certified lactation consultant and certified postpartum doula, has served nearly 600 families in Oregon since 1992 helping families through the postpartum period. Her assistance has included adoption, gay couple support, twins, preemies, and perinatal mood disorders, whether first or eighth babies. She can be reached at 503.241.3668. email@example.com mypeoplepc.com/members/vmyork/
Read also Response to Vicky York's Night Doula Article.