A week after the birth of their son, Kelly and Koda Sanborn waved their white flag. The constant screams from their “colicky” newborn combined with extreme lack of sleep prompted the couple to seek help from an unfamiliar source.
“We found out quickly that we needed a lot of extra help with our baby,” Kelly Sanborn said. “I was extremely worried all the time and my husband was having hallucinations and suicidal thoughts.”
They turned to a postpartum doula. It’s a decision that more and more millennials entering parenthood — and fully aware of the associated risks of depression and other mental health issues — are making.
Doulas are nonmedical professionals typically hired to provide emotional and physical support to mothers before and during childbirth. But now they are increasingly being brought into the home afterward: For $30 to $45 an hour, they will plan meals, change diapers, walk dogs, run errands, tidy the house and care for babies at night so that new parents can sleep.
The surging demand has led to a 40 percent increase in the past few years in the supply of postpartum doulas certified by Doulas of North America (DONA) International, which calls itself the largest doula-certifying organization in the world.
“Doula services are needed more than ever given that the experience of childbirth in the U.S. is increasingly lonely and medicalized,” said Helen Kim, a perinatal psychiatrist and director of the Mother-Baby Program at Hennepin County Medical Center. “In our current system, with more isolated families, distant extended families, and more fragmented communities, pregnant and postpartum mothers and fathers can easily feel isolated and overwhelmed with the task of caring for their baby.”
To combat the social isolation that can lead to anxiety and postpartum depression, the American Congress of Obstetricians and Gynecologists recently changed its recommendations to include more postpartum supports.
Research shows that moms who are cared for and supported after having a baby are more likely to feel confident, have a lower incidence of postpartum depression and be more successful with breast-feeding.
“If mom, grandma, sister or aunt isn’t available to come, who is going to come?” said Tory Kielas-Jensen, the director of Welcome Baby Care, a Twin Cities doula agency. “This isn’t a hippy sort of thing; it’s solid, knowledgeable support for families.”
When Tracy and Nick Hettwer announced they were pregnant with twins, friends and family advised them to get comfortable asking for and accepting help.
After the twins came home from the hospital, the Blaine couple hired a doula with Better Beginnings to care for them two nights a week. The doula cleaned the house, folded laundry, made bottles for the next day, and fed and rocked the babies so that the couple could sleep.
“It was a lifesaver,” Tracy Hettwer said.
While postpartum doulas are common on the coasts and in countries like the Netherlands, in the Midwest there’s a perception that “women have to do it all on their own,” said Hallie Rogers, owner of the Better Beginnings doula agency. “We have families who hire us to help them and still struggle to accept the help.”
Asking for help didn’t feel natural for Hettwer and, initially, neither did the idea of having a stranger in her home caring for her sons.
“It wasn’t as strange as I thought it would be,” Hettwer said. “After the first full night of sleep, your worries melt away.”
Rogers estimates that a third of her clients show signs of postpartum depression or anxiety, but the majority of families are like the Hettwers and are simply looking for overnight support and someone to take care of the mundane tasks of laundry, trash and dishes so that they can enjoy their baby.
Many doulas are also CPR-certified and get special training around breast-feeding and sleep training.
“As the public becomes more aware of the positive impact of including a postpartum doula in the newborn care plan, we will continue to see a rise in the use of postpartum doulas,” said Melissa Harley, DONA International marketing and public relations director. “We are now seeing research and recommendations from bodies such as the American College of Obstetricians and Gynecologists recommending doula support as a beneficial part of the birth and postpartum team.”
As it is for many women already prone to depression and anxiety, the postpartum period was a scary time for Becky Bormann. After the birth of her second daughter, Bormann enrolled in the Mother-Baby Day Hospital, an intensive outpatient program at Hennepin County Medical Center for pregnant women and mothers struggling with mental health issues.
It was that supportive experience that led Bormann to become certified as a postpartum doula through Welcome Baby Care, a Twin Cities postpartum doula agency.
Creative ways to cover costs
Bormann then started her own postpartum doula business, Cocoon Postpartum Doula Services, and devoted herself to helping new moms avoid postpartum depression and anxiety. She quickly realized a little-discussed truth about cost.
“Every family can benefit from having a doula,” Bormann said. “Sometimes the women who can afford it the least need the services the most.”
Many families receive postpartum doula hours as a gift or use their HSA accounts, but doula services are poorly covered by insurance. As part of its certification process, Welcome Baby Care requires doulas to complete 16 hours of pro bono care for families who wouldn’t otherwise be able to afford it.
The state of Minnesota mandates Medicaid coverage of traditional doula services, but the program doesn’t yet include postpartum care.
Back at the Sanborn home in Maple Grove, Melissa Ellis, owner of Twin Cities Doulas, quietly let herself in the front door for the start of her twice-weekly overnight shift. As if on cue, 9-week-old Kai began to cry.
Ellis quickly picked up the baby from his crib, checked his diaper, then soothed him with a pacifier as she checked a feeding chart in the kitchen to see when he last ate.
“He was right up there with one of the hardest babies I’ve seen among hundreds of babies,” Ellis said. “He’s doing so well now. Everyone is.”
After working with the family for a few weeks, Ellis was able to help the baby establish a better sleep routine. She provided emotional support for Kelly and Koda and suggested they ask their pediatrician if acid reflux could be causing Kai’s discomfort.
“I wouldn’t have even thought of something like that,” Kelly said. “It’s nice having someone here who can guide us through these things.”