As any veteran parent will tell you, adding a baby-whether the first or the fifth-to the family is a big adjustment. That's like saying a tornado blows up a little dust. The truth is, many new parents are shocked to discover just how much chaos one little miracle-in-a-diaper can create. Parenthood, especially in the beginning, consists of messier emotions and experiences than the cute, romanticized images of family life that are so prevalent in our popular culture. While awareness of serious problems like postpartum depression has increased in recent years, we still don't seem to have a realistic handle on the everyday challenges new families face, and the ways in which they can best be supported as they adjust to their new life.

American culture is fast-paced and high-tech. We like to feel we are in control of most aspects of our lives. Therefore, the experience of giving birth and caring for a new baby can come as a shock. Parents of newborns find they suddenly have little control over their lives. Mothers are often exhausted from giving birth, possibly recovering from surgical delivery. They are also on an emotional roller coaster as hormones re-adjust to the non-pregnant state. Partners feel the burden of added responsibility, and may experience uncertainties about their parenting abilities, just as mothers do. In addition to the endless cycle of feedings and diaper changes, sleep deprivation and bouts of colic, there are phone calls and visits from friends and family, thank-you notes to write, pets to feed, errands to run, siblings who need attention, meals to fix, showers to take, and thousands of unanswered questions about newborn care. Forget about cleaning the house or stepping outside for a breath of fresh air. A quiet chat over a cup of coffee? Not in the next few months!

In years past, and across virtually all cultures, families have not had to face the overwhelming tasks of new parenthood by themselves. There has been a tradition of nurturing the new mother (and by extension her partner and other children) in the postpartum period. For a period of weeks or even months, a new mother would have no responsibilities beyond recovering from the birth and nursing and tending to her baby. Her other duties were taken over by her own mother, sisters, and other women in her community.

Though it still exists in many other cultures, the U.S. has largely lost this tradition. While some new parents are still fortunate enough to receive ample help from friends and relatives, a great many others do not have that option. Extended family may live far away. Grandparents are often still working and unable to take time off to help with the new baby. Family relationships may be strained. The new parents may also be new to their area, and might not have had time to establish a support network before the baby arrives.
Even when help is available, many new parents feel uncomfortable accepting much of it from friends and family, perhaps because they have bought into the expectation that they should be able to do it all themselves. So they struggle with everything alone, at a time when they should be able to just recuperate and enjoy their baby.

For these families, there is another option. Many people are already familiar with the idea of the birth doula, a trained companion who is with a woman throughout her labor and immediate postpartum in order to provide information, emotional support, and physical comfort measures. Fewer have heard of postpartum doulas, since as a profession, the field is relatively new, but they can be an invaluable resource to new families.

The postpartum doula can do the work of absent extended family and friends, but she also plays a unique role in caring for new mothers and families. The doula is typically hired to help out in the days or weeks immediately following the baby's birth, or sometimes as late as several months postpartum. She wears many hats: errand running, light housekeeping and cooking, entertaining siblings, breastfeeding support, education and help with newborn care, providing a nonjudgmental listening ear, and answering many of the questions new families inevitably have. She may come in to help the family just once or twice for a few hours, or she may be a daily visitor for many months, particularly following the birth of multiples or a special-needs baby. She can give the family hands-on help, practical advice, or refer them to the appropriate local resources for issues beyond the scope of her practice. She is a sort of Jack (or Jill!) of all trades when it comes to alleviating the stresses of life with a newborn.

Even for families who already have help from friends and relatives, it can be an enormous relief to have the assistance of a neutral, outside party. The postpartum doula is there to support the new parents in developing their own parenting style. She is not going to tell a mom she's holding her baby too much, that her breastmilk is making the baby colicky, or that the family cat will smother the baby. She respects cultural differences and religious values other than her own. What the postpartum doula will do is help the new parents tune into and trust their own innate parenting skills, and build their confidence. The family's priorities are the doula's priorities.

A good postpartum doula will have received training in newborn care and development. She will have had lots of hands-on experience with infants, and knows all kinds of useful tricks for easing baby and parents through fussy spells and sleepless nights. She will be able to assist the mother with breastfeeding, and will know when to refer her to a lactation specialist, should it become necessary. While the doula does not provide medical care, she is trained to understand the normal changes that a postpartum mother's body goes through, and can answer many of the mother's questions and provide practical advice and recommend comfort measures. Though doula support can reduce the likelihood of postpartum depression, the doula also helps to screen for signs that professional help is needed. The doula will take the time to make sure everyone is adjusting to the new baby, and will be able to offer suggestions for ways to cope when difficulties arise.

In addition to the practical skills they have acquired through experience, most doulas train and certify with professional organizations such as DONA International, CPPA (Childbirth and Postpartum Professionals' Association) or Full Circle Childbirth Consultants (a local, Richmond-based organization). A family who is interested in postpartum doula services can search through these organizations' websites for doulas in their area. Hospitals, obstetricians, childbirth educators, midwives, and lactation consultants should also be able to refer them to local doulas.

It is always a good idea for the family to interview the doula to make sure she is a good match; if possible, it is nice to have arrangements made for doula service before the baby arrives. The services of a postpartum doula can even be given as a baby shower gift, especially when family members who would like to help find that they cannot be personally available.

The needs of new families are diverse, influenced by culture, income, values, and so many other factors. What is universal, though, is every family's need for nurturing and support that meets their unique priorities and helps them start off right on the journey of parenthood. I hope that the emergence of the postpartum doula is just the beginning of a rebirth of the fine tradition of caring for new mothers and families with the compassion they deserve.

Heidi Horner, mother of two, is a Certified Postpartum Doula (Full Circle) and birth doula in Spotsylvania. She can be contacted through their website: www.birthandbeyonddoula.com, or at hmhorner@hotmail.com.