There were many things about being a new mom that Courtney Lee-Ashley didn’t know: How often she’d need to pump, how hard infant poop stains would be to get out, and how many times she must sterilize baby bottles. But there was one thing she did know: She and her husband, Matt, would be primarily on their own, with limited family help after baby Everett arrived in April.
So Courtney did what her planning instincts told her to do: Before Everett was born, she sat down and interviewed Betsy Quilligan, a postpartum doula. For $3,600, Courtney and Matt purchased 100 hours of Betsy’s time, to come to their home two to three times each week for the first three months of their son’s life to help the Lee-Ashley family adjust to their new arrival.
“Matt and I both have nieces and nephews, but we have never spent the night with a baby by ourselves,” Courtney said. Courtney knew that new mothers were at risk of postpartum mood disorders, including anxiety and depression; she wanted to be sure that she had support ready, should she have any symptoms. And while both Courtney and Matt have doting parents willing to visit from out of town, Courtney’s dad is undergoing treatment for cancer and her mother would have limited ability to visit from North Carolina. “I didn’t know if she would have the flexibility to come if we needed her,” Courtney said. I thought [hiring Quilligan] would relieve the anxiety that she was having, too,” Courtney said.
Postpartum doulas are different from birth doulas, who support a mother during labor and delivery, and have different training than night nurses, who typically watch and feed a baby while parents sleep.
Neither of the Lee-Ashleys knew much about postpartum doulas before they met Quilligan, but both are emphatic that Quilligan dramatically shaped their newborn experience. Courtney credits Quilligan with helping her establish a successful breast-feeding routine, something she struggled with initially, giving her confidence, and facilitating better communication between her and Matt. Even as the Lee-Ashleys prepare to return to work, they say Quilligan’s advice and presence eased their transition: Courtney now has a pumping routine, and during several of Quilligan’s visits, they’ve left Everett with her to do brief errands. For Courtney, symptoms of postpartum mood disorders never materialized.
“It’s nice to have a woman here, a woman who has been through it, who understands the changes your body is going through and can regularly monitor your moods,” Courtney said.
The results of such visits can be significant; countries with routine home visits after birth, such as the Netherlands, where professionals check in on the mom and baby at home and investigate any problems before they escalate, have lower rates of postpartum mood disorders, higher breast-feeding rates, and better maternal and infant health. The American Congress of Obstetricians and Gynecologists recently changed its own postpartum recommendations to include such supports, since such visits can have a marked effect on postpartum mood disorders and on breast-feeding rates.
Quilligan, herself a mother of two, left her career as a staffer on Capitol Hill to become a postpartum doula after her own experience with postpartum anxiety. After her son Harrison was born in 2011, she suffered panic attacks and would wake up gasping for air. She sought psychiatric care for postpartum anxiety and relied on her parents and husband for support. “That experience has really become part of my self-identity as a parent,” she said. “Seeing how common an experience it is for new parents really made me want to help others going through it.”
To earn the title of postpartum doula, she enrolled in a three-day, 30-hour workshop through DONA, focusing on maternal and infant care, breast-feeding, and perinatal mood disorders. Postpartum doulas are not certified to give clinical advice, although they are well versed in research and training related to infants and postpartum mothers. When needed, they will provide professional referrals for additional assistance.
At the Lee-Ashleys’ town house in Washington, D.C.’s Navy Yard neighborhood, Quilligan has her own key and can quietly let herself in without waking anyone. (“It’s far worse to wake a sleeping parent than a sleeping baby,” she says. “Babies you can soothe back to sleep.”) She’ll ask the mom whether she’s eaten yet, and will either prepare a meal or offer to hold the baby while the mom eats. If it’s time for a feeding, she’ll assist, either assuring the baby gets a good latch while breast-feeding or helping parents introduce bottle feeding. She’ll ask how things are going, and offer advice and support as necessary. Often, Quilligan encourages the mom to nap, and she’ll wear the baby in a Moby wrap while doing light housework — sterilizing bottles, restocking diaper caddies, running a load of dishes or laundry — all designed to ease the burden on the parents.
But postpartum doulas are not housekeepers. Nikki Wray, one of the founders of Metropolitan Doulas, the D.C.-based doula agency where Quilligan works, encourages her clients to ask for any assistance. But if it’s outside their realm, she will help them find a cleaning service. “It’s not always the best use of our time,” she explains.
Wray moved to the United States from the United Kingdom to be with her husband, and initially worked as a nanny before realizing the mothers she worked with were overwhelmed with juggling work and children. “They had no support,” she said. She noted that many parents didn’t have family nearby, and even if they did, the grandparents didn’t know the current best practices. “It was a different time,” Wray said. “Most of our clients had parents who didn’t return to work” after having children.
Wray trained as a postpartum doula, working on nights and weekends. Within six months, she had enough work to quit her job as a nanny and work as a postpartum doula full time. Within another year, she’d hired additional doulas to help with her caseload, and she now runs Metropolitan Doulas, which has more than 20 postpartum doulas in the area, all certified with a doula organization such as DONA. The demand for services is more than Wray’s supply of trained doulas.
Both Wray and Quilligan agree that the at-home visits can be a better barometer of how the parents and newborn are adjusting than the neonatal pediatrician visits and the six-week checkup with an OB/GYN. “Parents can put on a brave face when they go out of the house. When we see families in their own homes, we get to see how things are really going,” Quilligan said.
Postpartum doulas are not covered by insurance, unlike pediatrician visits and many lactation consultants, although some of Wray’s clients pay with FSA or HSA dollars. A typical four-hour visit costs between $140 and $160. Often, grandparents or friends will purchase postpartum doula services as a baby shower gift.
Wray says when clients do call, often sobbing and needing support, she will stay on the phone to work out a plan, and reduce the cost if necessary.
“As long as people know about it, they know they have options,” Wray said. “They don’t feel stuck.”
Courtney felt the cost was justified. “My personal trainer costs more,” she explained. Matt, who had been reluctant to pay such a hefty fee up front, acknowledged that Quilligan’s services were well worth the cost.
“People do figure newborns out, but for us it’s been universally positive,” he said. Quilligan has provided “such a difference in the quality of our experience,” he said.
Rebecca Gale is a journalist based in Bethesda, Maryland. She wrote this for The Washington Post.