How Postpartum Doulas Transform the Fourth Trimester

Instagram has completely blown up in many ways for the postpartum space. There are so many services and products available now, which is very exciting, but there’s still a fundamental lack of care for postpartum in the U.S.

The stats are pretty shocking, with the United States being the worst wealthy country to give birth in. There are inexcusable numbers of preventable deaths related to birth and rising postpartum suicide rates. New mothers and their newborn babies are some of the most vulnerable citizens, so ensuring they receive proper care is crucial.

Most mothers are often discharged within 48 hours of giving birth, leaving very little time to recover, let alone learn important skills or bond with their child. There are still so many other experiences in that gray area that we can address and support with, in order to make the postpartum experience a much more positive one.

Mandy Major, certified postpartum doula and the founder of Major Care, joins Sarah to discuss how doulas can play a vital role in one of the most challenging times as a parent.

Together, they walk us through:

Mandy’s journey to becoming a postpartum doula
How the My Fourth app prepares people for postpartum
What a good care team looks like
The difference between a birth doula and a postpartum doula
The kinds of activities doulas can support with
In-person and virtual doulas
The most common questions doulas get
The transition from a solo person who only cared about themselves to a whole new foundation of responsibilities
What Major Care does to support postpartum women

How does My Fourth prepare people for what they’re going to experience postpartum?

My Fourth takes a less is more approach to avoid overwhelm. Even with the guided education in My Fourth, it’s bite size and it’s bite size for a reason. The Doctor Google concept is super overwhelming, and the more there is, the harder it is to retain.

When it comes to postpartum planning, sometimes it’s just acknowledging that you need to tack on a little bit of time to that birth plan and answer a few basic questions. The postpartum prep section in the app has a few guiding questions to help people think about the basics.

If you were having knee surgery, you would think about how to get home, who you’d want around, how you’ll feed yourself, which important numbers or contacts you’ll need etc. so bringing that mindset is really helpful.

Although it sounds really simple, feeding yourself is monumental in postpartum. It’s very challenging and what tends to happen is you get so busy in the doing and the caregiving, you forget to feed yourself, you forget to drink enough water, and then that small thing takes a big toll on your recovery. If you’re breastfeeding, body feeding or pumping, it makes a big difference, so you need to be sure you’re eating good food, and staying hydrated.

During pregnancy, you have a little bit more head space to answer some of these basic questions. It doesn’t have to be a crazy big plan. Plan out a few basics to touch base on, be aligned with the people you love and who will be in your space. This way, you know you will be cared for.

What does a care team look like?

Identifying the crucial parts of your care team is essential in preparing for postpartum. Start thinking about who you would choose as a lactation consultant, a mental health person, a pelvic floor pt etc., if you should need one. It’s so much easier to research this beforehand, than when you’re lying on the kitchen floor crying because you have to summon the energy to call those specialists to get help.

When you do have that capacity to think through what support you might need, take into consideration your personal history and personal needs. Then even if you’re not going to use them, you’re at least aware of who’s in your community. For example, if there’s a history of anxiety or depression, even if it was a while ago, know who your providers are and some hotlines you can have in your pocket.

What is the difference between a postpartum doula and a birth doula?

A birth doula is there to support the actual birth, whether it is a planned vaginal birth, planned cesarean, or a combination thereof. They usually work with you ahead of time, working on the birth plan, and then they’ll be at that birth, hopefully. They’ll usually meet with you once or twice afterwards, and that’s really their scope of practice.

A postpartum doula will typically meet with you once or maybe twice before the birth, but really they focus on getting set up for that return home from hospital or from the birth center.

They’re typically around for the fourth trimester, which is the 90 days post birth.

Doulas can be trained and or certified – CERT certification isn’t required but it’s always encouraged to ask about a doula’s scope of practice, their training, who they have worked with, and some basic questions like that.

What kinds of things would a doula or postpartum doula do?

Doulas are non-medical caregivers and it can mean different things to different people. They are essentially there as a guide and resource to help the birth person and by extension, the whole family. That looks different for birth versus postpartum, but in postpartum it’s really about giving you evidence based practices around the norms of postpartum, your postpartum body and healing.

For postpartum care, it’s in their scope to scan for perinatal mood and anxiety disorders. This could involve asking basic questions to get a sense of if there is a clinical concern for anxiety and depression.

They also focus on lactation and that’s a huge part of their role. Lactation doesn’t just mean breast or body feeding, it also encompasses pumping and formula. So postpartum doulas are there to support you with those decisions and help give you the best postpartum experience.

What is the difference between a baby nurse and a postpartum doula?

Most baby nurses are RNs or have a nursing background and/or are certified in infant care and their primary goal is to care for the baby. They are baby first whereas doulas are really about the mother and are really centered on your experience as the birth person.

What is Major Care and what are the benefits for postpartum mamas?

Major Care connects new parents with virtual certified postpartum doulas to provide affordable and accessible remote care. It could be for somebody who wants to focus solely on virtual care or you might have an in-person doula or other support systems, but you want to add to that.

My Fourth, which refers to the fourth trimester, is the app and it’s a web app, so if you go to www.majorcaredoulas.com, you’ll be able to find where to download it. It’s also on the Instagram page @majorcaredoulas and it’s free.

Most of the postpartum prep content is free as well as the daily guides, which currently spans six weeks, with a view to go up to 90 days. Eventually there will be a year-long curriculum with videos, best practices, inspiration and daily tips on all of the things that folks don’t talk about, like your nipples, bleeding or emotional support.

You can also level up and choose a plan for additional support such as texting an on-call doula or being paired with a dedicated doula to have video sessions with.

Major Care’s aim is to make postpartum care as affordable and accessible and mainstream as possible. It’s not a question of ‘Do I need a doula?’, but that everyone deserves one.

Everyone can benefit from it, no questions asked.

More about Mandy

Mandy’s goal is to change how America handles the fourth trimester. She learnt from experience just how little support and information new parents get in postpartum, so she left her career in digital media to dedicate herself to birth work and closing the gap in postpartum care.

She’s now a certified postpartum doula PCD(DONA), founder of Major Care, and creator of the My Fourth app, which blends asynchronous education with text-based doula care to support expecting and new parents.

She currently serves as the postpartum expert for BabyCenter’s medical advisory board. Mandy holds a M.A. from Columbia University Graduate School of Journalism and has written as a perinatal expert for HuffPost, Healthline, Motherly and other publications.