Nurturing the Family-The Guide for Postpartum Doulas by Jacqueline Kelleher
Reviewed by Cristin Tighe
Jacqueline Kelleher proposes that- “A postpartum doula’s primary objective should be to work herself out of a job.” (p.6). There is value in her ideas about a doula’s role as “fluid” (p.1), as a “teacher” (p.1) and as “generalist” (p.6), providing information to support women, particularly those who experience isolation as new moms and may have limited communities and traditions to support them. For new doulas (and for families new to the idea of working with a doula), the books gives great advice about the logistics and the significance of doula work, and the importance of active listening for the doula to fulfill this role and serve families. More importantly, it lays out with simplicity and clarity the key areas where postpartum doulas and families work together – cultural issues, postpartum changes in the mother, mothering the mother (and the father!), newborn care, integrating a new baby into the family, breastfeeding, supporting families with multiples, postpartum mood disorders, loss and grief, and processing birth experiences.
Initially, it is clear that the doula must learn about the family, usually through a prenatal visit (p.14-15), and must be clear about her role (what reasonable tasks are/are not part of the job) and policies (length of time working together, hours and pay). In context, it seems important for each doula to share their strengths and be honest about themselves/their job’s limitations (e.g. shopping, cleaning, babysitting) and who/what they are comfortable working with (p.110). Obviously, conscious clear communication and developing a complete understanding of expectations, helps everyone make sure things work as smoothly possible once the baby comes. Jacqueline describes a Spanish word educado, meaning “the quality of treating others with respect and cordiality” (p.28), which is about remembering that each culture, mother, situation and birth is unique, so everyone is worthy of respect for what they offer and for where they are through the process. The success of the relationship between the doula and the family may come first and foremost with the doula being clear with herself about who she will/will not work with, and what she will/will not do.
Given that a doula can set boundaries and communicate well, the book shares the key thing to keep in mind… the great changes happening with the mother during this time, both physically (p.31-33) and emotionally- “no aspect of life remains unchanged when a woman becomes a mother” (p.36). Given this, a doula best supports the mother by helping her concretely solve problems, so her self-confidence can strengthen, so she is safe emotionally (p. 36-37). The doula also, very significantly, empowers the partner/father, often by modeling what works best for mom and baby. The partners’ role is key as an active parent and as a support -- “The greatest impact on breastfeeding success comes from the father. The case is the same in the area of postpartum depression.” (p.42)
Newborn care modeled by doulas includes: focus on safety, handling diapering/changing (including circumcision care), umbilical cord care, and bottle-feeding (p.45-53). On the less logistical side, the doula can help inform parents about how interactive their baby is and his/her preferences for interacting (p.56). These interactions are enhanced if other areas are put in place, like happy older siblings, space for parents to find their own parenting style, and breastfeeding success. On a deeper level, a doula can help assure adequate time for processing of the birth experience (and grief if necessary), adequate social support for the family (especially mom), and give information/tools/resources/connections to experts to deal with postpartum blues, breastfeeding, connecting to other new parents, or whatever else new moms, dads and babies need to be nurtured.
If a postpartum doula’s job is actually “to work herself out of a job,” (p.6) she does that by giving what is needed sometimes, and other times, starting to step out of the way when the family can handle the changes and transformation of having a new baby. Jacqueline’s advice is: “Remember that those of us working with these families have a role that is sacred” (p. iv). Keeping this thought at heart, doulas can have perspective during the process and can know that they are empowering those who just need to learn to find their own way and their own capabilities.
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