As postpartum doulas, one of our major roles is that of communicator/coach/counselor. The skills we develop to successfully fill this role can greatly enhance our support as we become enmeshed in the family’s life. This role of communicator/coach/counselor enables us to be one of the best lines of defense against some of the emotional and medical problems that can follow pregnancy and birth. Using our communication skills that include asking open-ended questions; reflective and active listening; and reframing. We can help our clients positively process some of the myriad of emotions they experience in the vulnerable time after birth. These include the following:
It’s normal for them to cry over little things, like not knowing how to change a diaper very well—or when they find out Netflix stopped airing their favorite series before they had the chance to see the finale. They’re a common part of the baby blues, a temporary state of mood changes that last no more than a few days or weeks.
They’ll quickly see that being a mother brings with it a whole set of new fears, even if they were never the worry-wart type before. From minor fears to more complex ones, the feeling of fear can be overwhelming for many birthing people in the early stages of parent-hood. They’re not alone on this one…being afraid that they won’t do what’s right for their child because they don’t know the first thing about babies and parenting.
They know their baby will bring great joy into their life, but they don’t really know how overwhelming that joy can be until their little one is born. Their positive emotions are exaggerated post-delivery just like their negative ones, and this overwhelming happiness usually finds its way into the mix, making them feel an incredible natural “high” at times. It’s almost unbelievable that someone so tiny, who doesn’t do much, can bring them so much joy that it moves them to tears.
Maybe no one admits it, but it’s perfectly normal to have some feelings of anger in the days after delivery. Whether it’s being angry at themselves for not knowing the first thing about breastfeeding, or being downright mad at the world because they don’t know how to get their baby to stop crying…it’s normal. If their symptoms prevent them from coping and your support is not enough, refer them to their OBGYN or midwife or to mental health providers in your area.
They may find themselves on edge in the weeks after giving birth. They may be more easily startled, very tense, or even very anxious. This can be unsettling to someone who has never really felt this way in life before. Let them know this is not unusual. They aren’t sleeping, they’re worrying…oh yeah, and they just had a baby!
A very normal feeling after giving birth is that of sensitivity. They may feel deeply affected emotionally by everyone and everything. Watching the news could have them in tears, leaving them feeling deep sorrow for total strangers. Their emotions are all over the place, and their instinct to nurture everything may be coming into play.
Not many birthing people will admit to it, but the feeling of doubt—as in doubting whether they should have even had children or whether they’re capable of doing the job—is actually normal. We tend to think that parenting is an instinct so we will know exactly what to do when our babies are born, but that isn’t the case. Though these feelings are normal, let them know not be too hard on themselves. The post-delivery weeks are a learning process for both the birthing person and the baby.
While the above mild mood changes are typical for most postpartum people after the birth of a child, at least 15 to 20% experience more significant symptoms of depression or anxiety. Some studies show that 25% of postpartum people seek treatment for these mood disorders. It is important for postpartum doulas to understand and recognize the more extreme symptoms and refer clients to the medical professionals when needed. Women of every culture, age, income level and race can develop perinatal mood and anxiety disorders. Symptoms can appear any time during pregnancy and the first 12 months after childbirth. There are effective and well-researched treatment options to help them recover and the support of a postpartum doula in the home can be a critical piece of their recovery.
The postpartum doula role includes nurturing, guiding, and validating parents during an extremely vulnerable time, providing a crucial continuity of emotional support for birthing people, especially those with high-risks. Postpartum doulas help clients develop a solution that includes more sleep for the birthing person, more time spent outdoors, a referral to a support group, or an appointment with a medical provider or therapist; however, doulas cannot diagnose or treat mental health issues, only provide referrals and empower the client to seek help. Our non-judgmental communication, empathy and support provide a safe space for parents to express their concerns and fears, and increase the likelihood for them to connect with the appropriate professionals when necessary.
“In all cultures and countries there is a universal message given to the women and their families who are experiencing pregnancy related mood disorders. This is expressed in three simple phrases: 1) you are not alone (validation), 2) you are not to blame (reassurance), and 3) your experience is real, it is treatable and you will be well (hope). This message reflects the dynamic process and principles of mutual help and social support (Honikman, 2002).” Postpartum doulas provide these exact messages and this not only helps to normalize the situation, but allows our clients to process their concerns and explore solutions.
According to the British Health Visitors program, the six key elements in the prevention of postpartum depression are: 1) continuity of care, 2) social support, 3) preparation for parenthood, 4) stress management, problem solving, and a plan of action, 5) referral to additional resources, and 6) education about emotional reactions to pregnancy, birth, and parenting. Postpartum doulas are trained in each of these areas and can walk with their clients through all these steps.
CAPPA postpartum doula trainings cover the perinatal mood disorders with definitions of symptoms and risk factors, as well as the practical support doulas can provide. More information and support is available through Postpartum Support International.
- An Examination of the Knowledge, Attitudes and Perceptions Regarding Perinatal Mood Disorders Among Birth and Postpartum Doulas
- Jane Honikman
- The effect of health visitors’ postpartum home visit frequency on first-time mothers: Cluster randomised trial
- CAPPA Postpartum Doula Training Manual
- The Fourth Trimester by Kimberly Ann Johnson
- Depression in New Mothers by Katleen A. Kendall-Tackett
- The Doula Book by Marshall H. Klaus, John H. Kennell and Phyllis H. Klaus
- Nurturing the Family-Guide for Postpartum Doulas by Jacqueline Kelleher
About the Author
Carolyn’s birth philosophy is pretty simple: Women’s bodies were created to have birth be as natural as possible. When they trust their bodies, amazing things can happen. That being said, supporting women in their births can be as different and as personalized as each woman is. It is their birth and can look many different ways…Carolyn is there to help make it the best way it can be for the birthing mom. She has supported many varieties of birth including all natural, medicated, C-sections, adoption and relinquishment, and surrogacy. Carolyn believes that if women and their support people are educated about birth and all the variables, they can make more informed choices and be extremely empowered, creating more satisfaction with their births, no matter what happens.