Letter to Parents

Dear Expecting and New Parents,
As Postpartum Doula Trainers, we have been receiving a lot of messages, comments, and inquiries about a Postpartum Doula’s Scope of Practice. It seems there’s still a bit of confusion as to what the role and Scope of Practice is for a Postpartum Doula. We are hearing about many “Postpartum Doulas” which were never formally trained nor certified, yet are calling themselves Postpartum Doulas and are working outside of the Scope of a Postpartum Doula. We hope to clarify titles and roles to help you choose a postpartum support person that meets the needs of your family.
What is a Postpartum Doula?
New parents, especially first time parents, need support every step of the way. The Postpartum Doula is there to not only mother the mother, but also mother the family. She supports the family in every way possible by teaching parents how to bathe, diaper, calm/soothe, feed, and burp their baby. The goal of the Postpartum Doula is NOT be to take over complete care of the newborn, but instead help ease parents into their new role as parents through education and support. The Postpartum Doula may help the family with older children to integrate the newest family member by assisting the new mother, baby, and the family within the first few weeks after the birth of the baby. The Postpartum Doula also supports the family by providing breastfeeding 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 mother or the baby, nor do they perform clinical tasks like checking blood pressure or glucose levels. Postpartum Doulas support the adjustment of siblings, are non-judgmental, and knowledgeable about newborn care and breastfeeding. Although she may not be a certified lactation educator or consultant, general breastfeeding support is included in Postpartum Doula training and certification. A Postpartum Doula understands signs of perinatal mood disorders and can help find local resources where the mother 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 for up to the first 12 weeks, also referred to as The Fourth Trimester. Unless there are severe breastfeeding issues, postpartum mood 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 Newborn Nanny role where she is taking over care of the newborn and siblings rather than “working herself out of a job” by fostering maximum self-determination on the part of the parents. 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 mother and baby together rather than foster separation of this dichotomy.
A Postpartum Doula supports and educates new mothers and their partners 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 a “Baby Nurse” or Newborn Care Specialist
It is significant to explain that the title of “Baby Nurse” is not allowed in many states (including California) unless the person is a certified nurse. The responsibilities of a “Baby Nurse”, or Newborn Care Specialist, encompass only the needs of the baby. Her 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, even if this is what the family needs. 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 breastfeeding, but this seems to be more from an experiential aspect where the women have had children of their own and have breastfed their own babies. Newborn Care Specialists may have taken a formal training and certification however, that is not always the case. The Newborn Care Specialist should have many years of infant experience. She actually may have more experience when it comes to sleep training and putting baby on a feeding or sleeping schedule. A Newborn Care Specialist typically works until the baby is sleeping through the night, but many families will use 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.
The Nanny and Night Nanny:
A Nanny is in a totally different professional role. 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 age children. The Nanny role is more of the employee that 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 just day care experience alone. Many Nannies do not have the book knowledge or formal training behind them that a Newborn Care Specialist and Postpartum Doula have. A “Night Nanny” may come in and do evening duty work, but will only do the basics; feed, burp, change, rock and put to sleep. Most of the time, no sleep training, advice, education, breastfeeding support, or scheduling help is given.
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? Do you want someone to teach you baby care and calming/soothing techniques? Do you want someone to support your breastfeeding efforts? If so, a Postpartum Doula may be the right choice for your family. If you feel that you just 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 Poula”, only to find out that they really just want someone to come in and do all the 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 changes into more of a Newborn Care Specialist role or a Nanny role. In those cases, it is highly recommended that the Doula create a contract for each of the roles she will be providing (i.e. initial contract will be for a Postpartum Doula, then a new contract for a Newborn Care Specialist will be provided when her role changes). The doula community is working hard to get 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.
If you have any further questions, please feel free to contact us:
Darla Burns CAPPA Executive Director of Postpartum Doula Programs CAPPA Certified Postpartum Doula Trainer CAPPA Certified Postpartum Doula. darla@douladarla.com
Kathrin Auger DONA Approved Postpartum Doula Trainer DONA Postpartum Certified Doula. kathrin@losangelesdoula.com

Kathrin Auger All Rights Reserved