Letter to Parents

 

Dear Expecting and New Parents,

As a Postpartum Doula Trainer, I realized there seems to be a bit of confusion as to what the role and Scope of Practice is for a Postpartum Doula. I often hear about many “Postpartum Doulas” who were never formally trained nor certified and yet refer to themselves as Postpartum Doulas, working outside of the scope of a Postpartum Doula. I’d like to clarify titles and roles to help you choose a postpartum support person who meets the needs of your family.

The Role of the Postpartum Doula

New parents, especially first-time parents, need support every step of the way. The Postpartum Doula is there to take care of the entire family. The Doula supports the family in every way possible by teaching parents how to bathe, diaper, calm/soothe, feed, and burp their baby, and educates about baby carriers and postpartum physical recovery etc. The goal of the Postpartum Doula is NOT to take over complete care of the newborn, but instead, to help ease parents into their new role through education and support. The Postpartum Doula may help the family with older children to integrate the newest family member by assisting the new parents and other family members within the first few weeks following the birth. The Postpartum Doula may also support the family by providing infant feeding tips, household help, nursery organization, sibling care, meal preparation, and errand running. Postpartum Doulas do not perform medical procedures or give medical advice regarding the parent or the baby, nor do they perform clinical tasks like checking blood pressure or taking temperatures. Postpartum Doulas support in the emotional adjustment of siblings, offer non-judgmental care, and present knowledge about newborn care and infant feeding. Although the Postpartum Doula may not be a certified lactation educator or consultant, general infant feeding support is included in Postpartum Doula training and certification. A Postpartum Doula understands signs of perinatal mental health disorders and can help find local resources where the parent can access help. A Postpartum Doula is a professional with a wealth of knowledge, gaining experience from training, continuing education, and hands-on work.

The Postpartum Doula typically works with new families during the day or night for up to the first 12 weeks following the birth, also referred to as The Fourth Trimester. Unless there are severe infant feeding issues, perinatal mental health disorders, multiple newborns, or a baby with special needs, a Postpartum Doula typically works only within The Fourth Trimester. Beyond that time period, the Postpartum Doula has likely shifted into more of a Newborn Care Specialist or a Newborn Nanny role, where she is taking over care of the newborn and siblings rather than “working herself out of the job.” A ‘Postpartum Doula’ who is hired to handle all nighttime feedings without waking the parent(s) to participate and is taking over complete care of a newborn at night is truly working in the capacity of a Newborn Care Specialist or Night Nanny. The role of the Postpartum Doula is to keep the parent and baby together rather than foster separation of this dichotomy which is a more prevalent part of the work past the Fourth Trimester. 

A Postpartum Doula supports and educates new parents in such a way that they gain confidence in their new roles and feel that they can care for their newborn on their own.

The Role of the “Baby Nurse” or Newborn Care Specialist (NCS)

It is significant to explain that the title of “Baby Nurse” is not allowed in many states (including California) unless the person is a licensed registered nurse. The responsibilities of a “Baby Nurse,” or Newborn Care Specialist, encompass only the needs of the baby. The NCS’ responsibilities are partially similar to that of the Postpartum Doula in that she provides newborn care instruction; however, most are not willing to do light housekeeping or light cooking. The Newborn Care Specialist’s role is focused on the care of the baby. There are many Newborn Care Specialists that are capable of helping with body feeding, but this seems to be more often from an experiential aspect where the Newborn Care Specialist has had children of her own and has body fed her own babies. Newborn Care Specialists may have received formal training and certification in infant feeding; however, this is not always the case. The Newborn Care Specialist should have many years of infant experience and may actually have more experience when it comes to sleep training and putting baby on a feeding or sleeping schedule.

A Newborn Care Specialist typically works nights until the baby is sleeping through the night, but many families will hire a Newborn Care Specialist for just the first four weeks to adjust to baby’s schedule. Unlike a Postpartum Doula, a Newborn Care Specialist may come in after the baby is a few months old and “sleep train” them.

Role of the Nanny and Night Nanny

A Nanny may care for an infant, but does not always start working with the family during infancy; she may even care for only school-aged children. The Nanny role is more aligned with an employee who follows the family’s direction. Typically, Nannies are employed by a family for a year or longer. The Nanny may come with previous Nanny experience or daycare experience. Many Nannies do not have the formal training that a Newborn Care Specialist and Postpartum Doula have. A “Night Nanny” may come in and do basic evening duty work: feed, burp, change, rock, and put to sleep. Most of the time, no sleep training, advice, education, body feeding support, or scheduling help is given.

Choosing Who is Most Helpful to you?

When looking for a referral for postpartum care, it is advisable to begin by assessing your needs. Are you looking for experience, education, and guidance? Do you want someone to come in and help care for you so you can care for your newborn? Would you like someone to teach you baby care and calming/soothing techniques? Are you seeking support in your body feeding efforts? Would you like to have help days and/or nights? If so, a Postpartum Doula may be the right choice for your family. If you feel that you may want someone to take over care of the baby so you can sleep at night, then a Newborn Care Specialist or Night Nanny may be the right person for your family.

As Postpartum Doulas, we stress the importance of finding out what the parents’ expectations are before we begin working with them. Many times, parents say they want a “Postpartum Doula,” only to find out that what they really want is someone to come in and take over nighttime feedings so they can get a full night’s sleep. We also realize that sometimes we are hired on as Postpartum Doulas and the needs of the family change into more of a Newborn Care Specialist role or a Nanny role. In those cases, it is highly recommended that the Postpartum Doula creates a contract for each of the roles that she will be providing (for example, the initial contract will be for a Postpartum Doula, then a new contract for a Newborn Care Specialist will be provided when the role changes). The doula community is working hard to have Postpartum Doula services covered by insurance companies. We are concerned that if we are not holding true to our Scope of Practice as Postpartum Doulas, we are likely jeopardizing the process. It is our understanding that an insurance company may reimburse for a Postpartum Doula rather than for a Nanny—  yet another important reason to keep our roles defined and protected.

I hope this helps you clarify these roles. If you have any further questions, please feel free to contact me.

 

With warmest regards,
Kathrin Auger

DONA International Approved Postpartum Doula Trainer
DONA International Certified Postpartum Doula
DONA International Certified Birth Doula
Retired NICU RN

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