Doulas in the Hospital

Postpartum doula Kimberly Bepler with a new mom shortly after birth. Doulas can play a key role even once baby arrives as mom recovers and gets to know her newborn baby.

Postpartum doula Kimberly Bepler with a new mom shortly after birth. Doulas can play a key role even once baby arrives as mom recovers and gets to know her newborn baby.

Do doulas offer overnight care in the hospital after the baby is born?

Doulas are increasingly being asked to work overnight in the hospital due to hospitals implementing the Baby Friendly Initiative and becoming certified Baby Friendly. (This means they have completed all 10 steps to support breastfeeding families. One of these steps is mandatory rooming in for families with healthy newborns.) Now that there is no ‘healthy baby nursery’ services, families who have older kids or mothers who have partners who need to go home to sleep might be needing overnight care for their immediate recovery. Enter the postpartum doula.

But wait, you say! Don’t the nurses help with recovery? Yes, indeed they provide medical care, check vitals, and administer medication—all very important! However that beautiful 1 to 1 ratio that women get to experience with labor nurses vanishes into a 4-5 patients to 1 nurse ratio once you hit the postpartum floor. When you are keeping moms and babies together, there is not as much need for a full staff of nurses. The need for constant monitoring has ended, and nursing staff give parents space to learn all about their newborn.

And the research shows that this increases breastfeeding rates. Greatly.

Where this breaks down is when a mom doesn’t have support throughout the night, or when her recovery is greater than expected and no coverage is in place. Fathers and partners often have to return home to care for older children, pets, the home, or other needs. They cannot always spend the night with moms to care for them and baby. And they don’t get the shot of adrenaline that moms get after birth, so they are TIRED once baby is safely here. Mothers on the other hand, if not overly medicated, tend to be wide awake the first 24 hours, watching their baby intently, and feeding on demand every few hours.

Can’t you just push the button and call the nurse? Yes, certainly. But a nurse can’t be with you 24/7 and you might have many needs at night—dozens more than during the day, especially that second night after birth—and if she is with another patient, she just cannot help at that time.

Postpartum Doulas provide continuous care—just like in labor—and can be right by your side to bring baby to you, assist you with feedings, or snuggle the baby if the bassinet is not feeling like a cozy place and mom needs to close her eyes. Doulas can fill your water (with plenty of that awesome hospital ice), grab you a snack, change a midnight diaper, and reassure you what your newborn is doing IS indeed normal.

In our experience, the majority of moms who are asking for this service have been 2nd or 3rd time moms. Want to guess why? Of course the biggest reason is that they have precious littles at home that need a daddy or partner to care for them at night. However we understand that it is also because they KNOW the difference between the labor floor and the postpartum floor of the hospital, and they have learned to ask for what they need! Maybe because they didn’t get it the first time around, and they seek a smoother start this time, or maybe they are just more realistic about counting on their spouse to be all things to all people (who can do that?).

So who benefits from overnight doula care in the hospital? Moms having cesareans, planned or unplanned. Moms who lose a lot of blood, hemorrhage, or who experienced a difficult delivery. Moms having any kind of medication reaction, as pain can be serious if not well managed and sometimes side effects of medication are worse than the pain of recovery. Moms that don’t have their partners available, in the case of a single mom, a mom with an ill partner, or moms whose partners might not be available at the time of delivery are also great candidates.

Is it covered by insurance? Sadly, not at this time. Someday the insurance companies will realize what a treasure postpartum doula care is, in keeping mom and baby together to preserve the breastfeeding relationship, helping to avoid health care costs long term as well as speeding up healing and providing emotional support to help with any potential postpartum mood disorders. But for now, it is out-of-pocket only, unless you have an HAS or FSA that doula care qualifies for.

What can you do if you are interested in some doula support during the hospital? Contact a doula you are interested in hiring and GET ON HER CALENDAR! Most postpartum doulas do not work on call so you will want to make sure she can accommodate a last minute request if you go into labor spontaneously. Some labor doulas might offer this as a service as well, however many labor doulas need to rest and recuperate after the hard work of birth support, so check in with your doula about utilizing her backup doula, or another postpartum doula she knows.

Make sure your doula has experience supporting early breastfeeding. Days 1-3 are very different than 4-6 even (yes, the first few days are a huge change!) so having someone experienced in supporting moms in very early breastfeeding will be key.

You also want your potential doula to work collaboratively with the hospital staff. Most postpartum doulas are a natural at this, but you will want to ask her how she feels about hospitals and working with the infrastructure there, as they will be taking on all the medical needs while the doula covers the emotional, physical, and logistical needs. The early postpartum time is not a time for conflict, but rather for calm, sensitive support. If your doula isn’t comfortable in the hospital or disagrees with the medical care you are being given, it might not be the best fit for her to care for you in this setting.

Of course your partner is your first supporter, and if they are up for trying to sleep in those uncomfortable hospital guest ‘chairbeds’, then by all means, grab their help and make some memories of the first few nights together as a family! But if you fall into the ‘needs more help’ category, don’t wait too long to book your postpartum doula. They are truly the care that gets to go home with you once you leave, and having them there might mean the difference between a well-rested mom and baby pair who is breastfeeding and a cranky new mom who had to supplement her baby against her wishes. They certainly will make a difference in a better rested daddy or partner at home to begin the adventure of raising this new little one.