Postpartum Doulas and The Fourth Trimester

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The fourth trimester is the time when a baby is changing and developing rapidly—as if they were still in the womb—for the first twelve weeks or so. Simultaneously, their parents also change and develop rapidly to learn their baby and learn themselves in their new roles as parents of this baby. As beautiful as this concept of the fourth trimester may be, it can still leave many people wondering what postpartum doulas actually do, and how we fit into that specific and unique journey in a family’s life. To help illustrate this, we'll share a little glimpse of what a typical daytime postpartum doula visit looks like in Week 1, Week 2, Weeks 3-4, Weeks 5-7, and Weeks 8-12 for a full-term baby (adjust for gestational age if you have a preemie in mind). These are just a sampling; in reality, we often do much more.

Week 1:  Baby is fresh to the world, and mom is freshly postpartum. Babies tend to sleep a lot during the day at this point, so the baby care is often less demanding than it might be later. However, especially for first-time parents, the learning curve of newborn care is pretty steep, so postpartum doulas spend more time in this first week answering newborn care questions and demonstrating how to do things such as diapering, bathing, umbilical cord care, swaddling, clipping tiny fingernails, etc. Since mom is so fresh from the birth, we really strive to help her stay in bed or on the couch as much as possible and to aid her healing by doing everything we can around the home so that she can focus on resting her pelvic floor, her perineum, and/or her wound from her cesarean birth. Often, parents are still thinking about their birth experience, so it's common to talk about the birth and aid in processing it. If the mom is breastfeeding, this week is extremely important for lactation guidance, to make sure baby is latching properly and that as mom is supported as her production is changing from colostrum to more mature milk. The early weeks of breastfeeding are key to establishing a good milk supply, so we help new parents understand best practices for ensuring baby is getting fed frequently enough, for example.

Week 2:  Baby is beginning to wake up to the world, and mom is beginning to feel more normal physically. With baby sleeping a bit less during the day, it's tempting for parents to jump back into a faster pace, especially if they have older children who need attention and care. This is still the "danger zone," though, in terms of a postpartum mother needing to take it easy so her body can properly heal. Most midwives and doctors will tell moms to wait about two weeks before doing any real walking, lifting, stairs, etc. (And for cesarean births, they often will advise to wait more like 4-6 weeks!) So, a postpartum doula helping out this second week will continue to assist the mom in her recovery so she doesn't jeopardize her future health by getting "back at it" too soon. Also, by now, most parents feel more comfortable caring for their baby, so the doula can begin to do even more assistance with the household, such as tidying, walking the dog, and meal preparation.

Week 3-4:  Baby is more demanding in terms of care and attention, mom's healing is going well, and partner is often back to work. The return of one parent to work is another transition point for families. This is a time for learning new skills for infant soothing, juggling household demands, and initiating and maintaining longer-term breastfeeding/bottle-feeding solutions for each family's unique situation. It's often around 4 weeks of age that we help parents introduce a bottle to a breastfed baby, if they're choosing to use bottles at some point. Most parents we work with want their babies to accept and successfully feed from a bottle, whether that's to prepare for once mom is back at work, or just the freedom to have a date night without baby along. As lactation counselors, we can help families learn how to introduce bottle use to promote the continuation of a successful breastfeeding relationship if that's what the family values. It's usually around this time when we can also teach moms, dads, and other support people how to wear baby in a wrap, sling, or carrier so that baby can be happy and safe even while the adult has two hands free.

Weeks 5-7:  Babies cry. Around week 6, many babies cry a lot. Six weeks seems to be the peak in many baby’s "fussies.” This is another time at which having a postpartum doula's support can be crucial, as we can teach you all the tricks for a baby that's having a tough time. And, to be honest, as seasoned postpartum doulas, we know that even with all the best tricks, tips, and gear, some babies just simply have a stretch of time (a week or 3-4 weeks) during which they are generally unhappy. During this challenging time for the family, we can provide calm, gentle, and nonjudgmental presence. Sometimes, the best thing a parent can do is to allow baby to be cared for by someone else for a bit so that s/he can take a break.

Weeks 8-12:  The next big transition. Given that many parents have about 12 weeks of maternity or paternity leave, this is commonly a time when we turn attention to preparing for the return to work. The return to work is a huge time of transition for families, so if a mom is breastfeeding, we can help with fine-tuning the ins and outs of pumping, milk storage, cleaning pump parts and bottles, figuring out daily schedules to best meet the parents' work demands and the needs of baby, setting up systems for success for household management once life enters a new level of complexity, and work together on baby's bedtime routine and sleep habits to empower parents to move toward getting more sleep at night while still making sure baby's developmental needs are honored. Frankly, this is all helpful even if nobody is returning to work outside the home!

As you can see, our role and time spent during the fourth trimester will vary from family to family, and often does change over time to match each client's current situation and needs.   Each family will decide how frequently they want visits from their postpartum doula(s). We find that often our clients want 3-5 days of support per week those first few weeks, and then gradually taper off over the course of a couple of months or so. That's a lovely way to do it, because it means we are doing our job by empowering our clients to parent their baby/babies and they are gaining confidence in this time of great transition. Like a birth doula helps you have the birth you want to have, our goal is to help you have the postpartum experience you want to have. This looks different for every family, and we love that. We enjoy working with you to meet your goals. We accompany you as your journey through the fourth trimester progresses, helping you find your parenting peace in life with your newest tiny person(s).

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