When we look back through history it is rare to find cultures where a mother's extended family and community did not support her during the perinatal period, but the modern emphasis on independence and individualism has changed that.
Many of us do not have a built-in social support network to help us in those difficult days of early motherhood. A new mom in 2021 may find her close relatives live on the other side of the country, or she may still be social distancing, and she doesn't know her neighbor's names. Or, she may be surrounded by people who would love to support her—but simply don't have the experience or time to be of service to her.
This is why we need more postpartum doulas and why more women should have access to them.
Like birth doulas, who help a mother during birth, postpartum doulas aim to empower and support mothers during a vulnerable time in their lives.
They are part lactation consultant, part baby-whisperer, part parenting coach and part therapist, and they can help new parents feel less alone and more confident as their lives change so drastically. But getting a postpartum doula to help you through the fourth trimester can be expensive. According to Today , in America, the cost of hiring a doula "varies from state to state and most people pay out of pocket." It can be thousands of dollars, a cost too high for many families.
But in America and other western nations where mothers no longer have that built-in community, women are hoping to make doula services more accessible, and suggest we need to stop acting like hiring a doula is akin to hiring a housekeeper and incorporate the service into health care funding. "It seems like a luxury, but for many cultures [postnatal care] was just a necessity, and I think we need to start looking at it like that too," Shelley McClure, a postnatal doula and educator in Australia told ABC News.
One of McClure's clients, Taycee-Lee Jones, decided to pay for a postpartum doula after welcoming her fourth baby. Paying McClure to help her wasn't a luxury. It was what she needed to do to survive as her partner had to go back to work quickly. "We don't have that support that we used to have from our community. We don't have sisters and aunties all coming to provide that support," she says. "Shelley as a postpartum doula, came around, brought food, did my dishes, gave me a foot rub, checked in with how I was doing," she explains, suggesting that the kind of in-home care she received from Shelley could help prevent postpartum depression and should be standard.
Shannon Sproule, a postpartum doula with Full Circle Birth Collective in Edmonton, Canada, agrees. She told Global News her packages start at $120 for one four-hour session of in-home postpartum care. She recognizes that not everyone can afford that, and believed the future of postpartum care needs to include access to doulas through public programs.
"I think as the medical community starts to awaken to the idea that this is a really vulnerable time for parents and we need to support them better and more frequently during the 12 weeks postpartum, it will become more accessible," Sproule explains.
Access to postpartum doulas in America by state
If postpartum doulas are seen as a luxurious out-of-pocket expense in countries like Australia and Canada (both of which have universal healthcare schemes) can American parents hope to see these practitioners become more accessible?
Actually, yes. Some parts of America have seen real momentum when it comes to giving more women access to doulas.
This is really good news because research shows that the women who would most benefit from having a doula are often those who can least afford it. Oregon and Minnesota already permit Medicaid coverage for doula services, New York has a pilot program in action, Milwaukee is planning to provide doulas to 100 vulnerable new mothers and a bill has been submitted in Rhode Island to get the ball rolling in that state.
"Doula services are needed more than ever given that the experience of childbirth in the U.S. is increasingly lonely and medicalized," Helen Kim, a perinatal psychiatrist and director of the Mother-Baby Program at Hennepin County Medical Center said. "In our current system, with more isolated families, distant extended families, and more fragmented communities, pregnant and postpartum mothers and fathers can easily feel isolated and overwhelmed with the task of caring for their baby."
The Dutch model of postpartum care
In America (and other western nations including Canada and Australia) most women who have one are paying out of pocket for postpartum doulas, but in the Netherlands, a remarkably similar service—with the added benefit of medical expertise—is standard, and as Quartz reports, costs families just over $5 USD per hour as the rest is covered by health insurance.
In the Netherlands parents aren't visited by a postpartum doula, but a kraamverzorgster, or home maternity nurse who comes by for a few hours each day for up to 10 days after the baby's birth. These nurses help parents with the basics of babies: feeding, changing, swaddling and bathing, but they can also help mom with lactation issues, screen for depression and do things like bring over food and do a load of laundry.
"All parents deserve support to get through that difficult first week," Linda Leijdekker, a Dutch pediatric nurse who specializes in child development tells Quartz.
American women are creating change
As the New York Times reports, back in America activists are changing mothers' lives by providing postpartum doula care at low or no cost. Doula collectives are popping up across America to connect low-income families and women of color to invaluable support in the most vulnerable season of life.
But these postpartum services are often provided by other low-income women who are basically volunteering their time, and as Collier Meyerson reports for New York Magazine, even when American doulas are being paid through programs like the ones in New York or Minnesota, they're often not being paid a living wage.
Bottom line: Mothers need postpartum care. It's not a luxury, and it also can't be provided at the expense of other working women. Our society has evolved in a way that removed mothers' support systems and now we have to figure out a way to build a new one.
[This article was originally published on April 2, 2019. It has been updated.]