Fourth Trimester Podcast Episode 1: What is the Fourth Trimester? What is a Doula?
The introductory episode of Fourth Trimester answers questions around doula care, postpartum care, and helps provide parents with an overview of some care options.
The “Fourth Trimester” refers to the few months immediately following the birth of your baby.
A Doula is “a trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.” (source: dona.org)
In this episode we touch on:
- Strategies for taking care of the partner and the rest of the family while looking after your newborn
- Midwife vs Night Doula vs Birth Doula vs Postpartum Doula
- What to expect when you hire a doula – the practical things they offer in their scope of practice
“It felt good to know that I was supported by my husband, by my doctor, and also by someone else who had seen hundreds of births and had seen many different types of complications. My postpartum doula was seasoned and able to talk me through what was happening, what the options were, in addition to what I was hearing and receiving from the other professionals that were present.”
— Sarah Trott
Selected links
Connect with Esther Gallagher esthergallagher.com
Learn more San Francisco Doula Group | Top 3 Episodes of the Fourth Trimester Podcast – Start here!
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Episode Transcript
Sarah Trott: [00:00:05] So just to get us kicked off and started we wanted to use this first introductory podcast to talk about some of the basics. So to start us off, and I’m here with Esther Gallagher who’s postpartum Doula, why don’t we talk about just what is a doula?
Esther Gallagher: [00:01:41] Generally we think of the term Doula as somebody who supports a family and in its popular usage, mostly these days when people hear the word Doula they think about somebody who supports families during labor and delivery of their baby, maybe makes a few visits prenatally and is on call for them and then shows up at the labor and birth then maybe makes a visit to process the birth afterwards.
But originally the term, which is ancient Greek, was applied to the woman who took care of the family after the midwife left. So the midwife was responsible for pregnancy and birth. She had to be available for pregnancy and birth. After that while the mother was recovering and needed to stay in bed and rest and recover, breastfeed the newborn baby and really do the intensive work of newborn care for several weeks, someone else was there to take care of her and also take care of the household while she was unavailable. That’s the basic idea of postpartum doulas.
Sarah Trott: [00:03:02] So then there is a definite difference between doula and postpartum doula these days.
Esther Gallagher: [00:03:08] Yes it is. If you’re looking for postpartum care you have to find somebody who uses the word postpartum because if you just use the word doula and noodle around you’re most likely going to find somebody who probably primarily does birth. You may get lucky and find somebody who does Birth and Postpartum care but unless you’re googling using the keyword postpartum you’re unlikely to find a postpartum doula.
There’s variations in what people do, when it comes to postpartum, there are actually some choices within the realm of how you get cared for there as well. So for instance there are women like me who give birth and postpartum care and the postpartum care may consist of daily visits in your home where we do any number of support tasks, anything from breastfeeding support to cleaning out your tub, making sitz bath herbs so you can heal your perineum. Then there are night Doulas who only come in at night.
They may or may not provide similar services to mom. They often are taking care of babies while parents sleep. Maybe they’re also preparing foods or doing household tasks. So as you can see there’s a whole 24 hours that can be covered. Most postpartum doulas have some degree of flexibility in terms of how they’ll work with, when they’ll work, for how long. So they may or may not come in days after you deliver and they may be willing to provide services to you any time during the fourth trimester up to say 3 or even 6 months after you have your baby. So there is quite a variation. These things require that you have some idea of what to ask when you’re interviewing somebody who says they provide support.
Sarah Trott: [00:05:12] And for those of you listening and wondering what that sound is in the background we have our guest cohost my baby! Who’s speaking up right now; she’s helping us out. Okay great. That’s a perfect overview because when I was starting out looking for someone I didn’t really have a lot of that information. I thought, I want care. I want support. I want emotional support for this whole process as well as some practical advisory type support and to be honest I was typing things into Google like what is the difference between a midwife and doula because I honestly didn’t know. It’s not something that I think people research much. Until they come down to their own decision.
Esther Gallagher: [00:05:55] And those are really great questions to ask. When we ask the question, what’s the difference? Scope of practice is a phrase you’re going to hear when you go out into the world of care providers and scope of practice is a good phrase to know because you can ask someone who’s either a midwife or doula or even your obstetrician when you go visit them and say, “What do you consider your scope of practice?” That’s a great open-ended question; you’re going to learn a lot about what they think they’re there to do with you and when and how.
Sarah Trott: [00:06:33] In a nutshell what is the main difference between a midwife and a doula?
Esther Gallagher: [00:06:37] The scope of practice of a midwife includes medical care. They are going to be checking your blood pressure, checking your temperature, making sure you’re gaining the right amount of weight. So a midwife is someone who takes medical responsibility for her clients. She’s concerned with the underlying physiological health of her clients, in addition to emotional and social.
Doulas don’t take that kind of responsibility for their clients. It’s not that they might not be aware of the physiological parameters of a healthy birth and postpartum, but they’re not there to actually address those issues. Certainly a doula who has a background and training and experience to alert her clients to anything that looks like a health issue in her clients is going to refer you to the appropriate person with the appropriate scope of practice. And a doula might be somebody you call up and say, “Gee I noticed today that my hands were really swollen. What do you think?” But those are the sorts of questions that ultimately you would refer to your medical care provider whether it’s your midwife or your obstetrician.
Sarah Trott: [00:07:54] Yeah that makes a lot of sense. And so when someone is thinking about what they want for their birth midwife and doula are not interchangeable.
Esther Gallagher: [00:08:03] No they are not. You can still have a doula at your home birth with your midwife or your clinic birth with your midwife or your hospital birth with your midwife depending on what kind of midwife you have. But you would still need in my opinion somebody to attend your birth who has the experience and training and is licensed to have the scope of practice that takes responsibility for you and your baby and your physiological well-being.
Sarah Trott: [00:08:34] And is there a place where someone could go to see if their midwife is licensed.
Esther Gallagher: [00:08:39] Oh sure. Anybody who is out there now practicing midwifery either is a certified nurse midwife or a licensed midwife and either those licenses would be something that you’d be able to access.
Sarah Trott: [00:08:53] What would be interchangeable then would be having a doctor present or a midwife present at the birth. You can choose in California between an obstetrician and either a certified nurse midwife who are nurses who have a degree in midwifery and who usually but not always practice in a hospital setting or you can choose a nurse midwife or a licensed midwife who will attend you in your own home. If you want to have a home birth.
Sarah Trott: [00:09:26] And of course it’s possible to have a doctor and a doula, a midwife and a doula present to see the before and after of the entire process.
Esther Gallagher: [00:09:35] The reason why people choose doulas these days is so that they can have a continuity of care that particularly in a hospital setting they won’t be availed of. So, for instance, you go into labor, you go to the hospital that you decided to have your baby and the doctors and the nurses and midwives will all be doing shift work. So at some point they’ll have to go home and then a new shift will come on. Your doula typically will stay with you during the whole course of labor.
They will come to your home in early labor and attend you there before it’s even time to go to the hospital and they’ll be there to help you make decisions about when to go to a hospital. So that’s the main difference in terms of the kind of care you’re going to be availed of, that your doula is there on call for you in a way that typically your medical care providers can’t be and aren’t great.
Sarah Trott: [00:10:44] What are the pros and cons between different types of doulas? I know you mentioned the night doula. I mean what is that?.
Esther Gallagher: [00:10:53] Night doulas are typically now certified they’ve taken a postpartum doula course right, or they shouldn’t maybe be calling themselves Doula. It’s hard to say some people just have a lot of experience, maybe a lot of collateral training. For instance, maybe they’ve taken breastfeeding support courses or nutrition courses or baby care, CPR, all those sorts of courses that kind of set them up to be great care providers. And the main difference between a night and a day doula is when they work right?
A night is typically going to come say around 10:00 p.m. and stay till maybe around 6:00 am and are going to be in your home the whole time. And if you’re awake and need some breastfeeding support, hopefully they have the kind of training and experience that will allow them to give you good breastfeeding support just like a day doula. Hopefully they have the kind of breastfeeding experience that they’ll give you good breastfeeding support. They may be able to help you troubleshoot breastfeeding issues that you might pursue with a lactation consultant during the day if necessary for instance. Hopefully they’ll bring you snacks in the middle of the night. I mean new moms are always hungry.
I hope that if you have someone who calls themselves a doula that they’ll be sure that you’re well nourished. It’s unlikely that you will be bathing at night, for instance a shower or a sitz bath is probably not something you do while your nighttime doula is there but you never know. If you only have a nighttime doula and not a daytime doula, maybe that person will set you up with a sitz bath if that’s something that would be really nice for you. But generally the idea is that you’re going to have support with your new baby.
By the way, newborns are often awake a lot at night. They sleep and all newborns sleep in short bursts throughout the 24 hours. And so your nighttime doula is somebody who’s going to help you accustom yourself to sleeping at night and your baby at night. Now different doulas whether day or night have different philosophies about things like how to follow your baby versus say getting your baby on a schedule.
So that’s a question you’re going to want to ask a potential Doula, whether they are daytime or nighttime doulas, “What’s your philosophy of newborn care? What’s your philosophy of parent care?” These are open-ended questions. So that you’re not leading your doula down the path; you’re getting a sense of who she thinks she is in this world and how she comports herself and what she thinks is important for you.
And that’s just a good thing to find out when you’re looking to be supported in postpartum. Now what I hear from people often is they have no idea what they want or need and without interviewing an array of doulas you might think the first person you interview is the perfect person for you.
We really want to encourage those of you out there who are pregnant to get on this project early and think about all the possibilities and hear from as many doulas as you get the chance to, about how they comport themselves because it’s like so many things in life. We all have a philosophy and we all comport ourselves along the lines of those values and philosophy. And so that may fit really nicely with the first person who you call up. But if it’s not going to it will be nice to have found out before your postpartum and not afterwards.
Sarah Trott: [00:14:33] And let me just say it is so important to start looking early if you know this is something that you even may want to do because doulas have schedules that are filled up because the window around the birth has to be pretty flexible. Am I right?
Esther Gallagher: [00:14:50] Yes. Right. So if you’re looking into having a birth and postpartum Doula which is a wonderful form of continuity of care, you know that doula may only take two or three birth clients a month and that means they’re going to be on call a lot. So the amount of bandwidth they’re going to have for also providing day time postpartum care might start to shrink the more clients they’ve booked. If you get them early and you find out that they’re available and you know how many births they are typically taking that’s good information.
Sarah Trott: [00:15:30] So when I first started looking I knew I wanted emotional support I wanted support during the birth itself. Being a first time mom you know it’s for a lot of people and for myself I can certainly say there is a bit of terror inside of me about the physical process. A lot of joy. Overwhelming amount of joy but you know some uncertainty there. And it felt good to me to know that I was supported by my husband, by my doctor, but also by someone else who had seen hundreds and hundreds of births and had seen all different flavors of complications and had that experience.
And someone who is seasoned and able to talk me through what it was that was happening, what the options are, in addition to what I was hearing and receiving from the other professionals that were there. So that was pretty fantastic for me. Now I didn’t even know what a postpartum Doula was, like I said. And now when I talk to my friends about the whole birth process for me I say to them if I had to choose between having a birth doula and a postpartum doula I would choose postpartum care any day of the week.
It was so impactful for me because although Esther you were quite helpful for me during the birth, you know that time period right after you got home is just so emotional. It’s exhausting. It’s wonderful. It’s different from anything that I never experienced and so having that support from someone who was able to anticipate my needs, anticipate my husband’s and my baby’s needs was far beyond anything I’d anticipated. So I think the main thing that I would want new parents to consider is the postpartum care aspect because it is surprisingly beneficial for anyone who is not familiar with even the concept like I was. What inspired you to become a doula?
Esther Gallagher: [00:17:29] Well it’s a long story but in a nutshell- a big nutshell, I was inspired to become a postpartum doula when I had my daughter. I was a young mother and I was determined to have a home birth and was able to find a midwife and I had a relatively healthy pregnancy and the labor birth went well for the most part. A little minor hemorrhaging was handled at home by the midwife and her apprentice.
Then I had the postpartum midwifery visits which were essentially clinical but also helpful in an emotional way and my midwife did provide me with some little healing tips and helped with a couple of things. But really she was there for an hour or two to just check in and make sure everybody was OK, which we were for the most part. I mean you know she definitely kind of helped me with the fact that I had really sore nipples and kind of said things like you know it’s going to get better and things like that. I didn’t have family members who could stay long term.
I didn’t have family members who were well-versed in the sorts of issues that I might have. I have a wonderful mother and she showed up for three days which is all she could take off of work and it was just lovely to have her. And it was a real heartbreaker when she had to go. I was just bereft when she was going to be gone. Then I was left mostly on my own with a partner who just happened to know not much about what was going on. And the challenging moments were really in some ways desperately challenging and I really didn’t know much about what was appropriate from one day to the next in my recovery.
I was young and strong and it went relatively well. But I do feel like, looking back, that there was a mood disorder that somebody who had been around on a daily basis might have been able to flag and get me to some resources that would have helped, for instance. Somebody might have been able to tell me what appropriate exercise would be for me. Nobody did. Nobody was doing any sort of Mothercare other than the midwifery visits but on a day-to-day basis and nobody was there to say this is really normal for today. And this is what you can expect tomorrow without loading me up with too much information and then the next day say OK this is what’s happening, and this is where we are today.
And nobody was there to say, “Call me at 3:00 AM if you’re really worried about anything” and talk about whether it’s normal or not. So those were just the sorts of things that I didn’t have. And a few months later I was chatting with my new best friend who also had a newborn baby and we’re talking about this postpartum trajectory and how amazing and fraught it was and because she was an apprentice midwife and sort of lived in the world that was looking into these things, she said, “Well yeah there’s this thing called a doula they’re sort of about the postpartum era. You know yeah we have these people in Santa Cruz where I lived or there’s one woman who is interested in this stuff and she works in this realm.” And I thought, “Why didn’t i know about this right?” Much like you, thirty-eight years later.
You still have the same question interestingly and I hear this all the time. You know 37 years ago when I had my daughter I thought, “Gee, by the time my daughter’s an adult this will be common practice: everyone will have a midwife and doula and postpartum care and the whole culture will understand what new mothers need and what mother care is.” And here I am thirty seven years later doing this work and while there are many more birth doulas, that’s for sure, and several more postpartum doulas, in much of the United States they don’t exist even if people know the word they don’t exist.
There aren’t trained women to provide that care. So slowly but surely I set about doing my life in light of the fact that I look around me and see women not being cared for now after they’ve completed a pregnancy and are now dealing with and their bodies are gone through profound changes and are going through in some ways even more profound changes after having had a baby. I just got very involved in this and so have a lot of other women who find this very compelling the way I do.
So that’s what brought me to this work. I think there’s a whole social-emotional and what I would call a spiritual component to this of finding ways to be present for each other when we’re going through profound transitions that just doesn’t get addressed by the medical community naturally. I mean, I’m not sure why it would, but I think it’s there to be held and supported and to be present for. I think it’s all important stuff so that’s why I’m here doing it. Yeah not a very small nutshell, I know.
Sarah Trott: [00:23:13] You know I signed up for every single class that was offered by the hospital. I attended the courses, I did prenatal yoga and had a lot of information at my fingertips. And the one thing that seemed to be a bit of a gap for me that I was Googling on my own was specifically topics around doula support and you know postpartum support that wasn’t even top of mind for me. A lot of the courses were focused on how you take care of a newborn and what is the birth process.
What does it look like end to end when you’re in the hospital? What are they going to do? And even within those courses they weren’t specifying what was optional and what was not. I found that pretty fascinating. Their best practice was communicated as standard rather than you know an option for doing something one way or another. I think the thing that might be helpful for our listeners now would be maybe to point them in a direction. So if someone is interested in speaking to a doula and getting information where do they start? How did they find someone?
Esther Gallagher: [00:24:14] Well I think in urban areas these days doulas have really caught on and often there are doula groups. So for instance in San Francisco we have the San Francisco Doula Group and you can just google us and you’ll go right to a Web site and we’re professional organizations so that women who are part of our organization are independent workers but they’ve met minimum criteria for being part of our group and you go to a Web site and there are several women and you can click on any one of them and find out a little bit about her and maybe go to her professional website.
And in any case get her contact information. Find out what kind of care she provides and look her up and ask to speak with her. And I would say that generally that’s the way you’re going to find a doula in any community. There are often more than one doula group. There might be other groups that are just birth. Maybe there’s just postpartum groups. Maybe there are groups that not only provide these services but provide them to specific populations. For instance there’s a Bay Area group that identifies as providers who are LGBT. So they are not only themselves self-identified but they have gone to work to be well resourced to provide services to LGBT families.
You know that leads me to an interesting side note which is you know people who are in an adoption process may think well what does this have to do with me. Well you are going to have a new person in your family and that is going to be a really big trajectory in your life. Not only the process of bringing the baby home but in the process of getting to know the baby within your home system. And there are doulas like myself who will happily come to you and support you in that transition. So this is about family-making inclusive of any kind of family that you’re trying to have. When people listen to me they tend to hear how important it is to me to provide Mothercare to a biological mother.
But I have much experience in providing care to parents who haven’t necessarily gestated a baby in a womb of their own but I think that that process of bringing the baby home is a gestation however metaphorical and so I think it’s important to potential parents to know that this is a broad source of support. I’ll circle around and say that I think it’s important to women who are going to be giving birth that they understand that their bodies, minds and spirits are going to be going through profound changes. So the evolution of postpartum care is an evolution from that core principle. There are profound changes going on for this woman who has given birth.
Sarah Trott: [00:27:57] And even if someone is living in a not very built up urban environment they could probably get a lot of support just by speaking with someone on the phone on a regular basis or having a Skype call or some kind of Internet video call. I think that could be very useful as well.
Esther Gallagher: [00:28:15] Yeah there are all kinds of ways. Not only that, perhaps you have family members who have come forward, or friends and said, “Oh, we want to help in any way we can.” Now they no doubt have vague ideas in their minds about how that’s going to happen. They think if they just show up they’ll figure it out and that may or may not be really great for you. It’s really probably a great idea to look into what a doula would be doing for me. How would that work? And is there a way for that eager family member or friend to learn a thing or two about how they could actually really help me?
Sarah Trott: [00:28:59] And let’s talk about what is a typical day with a doula visit in the first week or so. What are those practical things?
Esther Gallagher: [00:29:07] So those practical things are nourishment right, in the forms of nutrition and nurturing. Ok so my friend Mindy and I came up with this phrase for our erstwhile cookbook that still has yet to be published, Nutrition plus Nurturing Equals Nourishment. So there’s nourishment for the soul and there’s nourishment for the body and the two can be in one nice package. So nutrition means nutrient dense foods; foods that a mom can eat that are really going to support her healing and recovering trajectory. And we are not talking about empty calories here, people! We are talking about good strong proteins, good healthy fats, lots of vegetables of every variety and not limiting the amounts.
So that’s nutrition right. Nurturing is in the form of a) recognizing that this is a vulnerable soul, very vulnerable, very wide open because she has a new baby or they have new babies and recognizing their need for sleep which they can only have when a baby sleeps. If that baby’s awake those parents Are Awake. Babies don’t sleep eight hours at night. They sleep 20 minutes to three hours at the most intermittently throughout the 24 hours and they’re not on a schedule for that. So, noticing when a baby’s asleep and reminding the mother, “OK now is your chance to have some rest and respite” and helping her get there by not talking more, by not doing more, by not expecting she’s going to be on any longer.
These are good supportive practices. Being available to bring that nourishment to her or set up that nourishment in such a way that it is there when she needs it. There are all kinds of tricks for that. And then really taking care of the home so that she doesn’t have to: cleaning the bathroom and keeping the kitchen clean so that when she does have to walk out to go to the fridge to get a snack she doesn’t look around and go “Oh my god a bomb just dropped in my house.” And when I say she could be anybody really I’m using that pronoun but that could be any parent who’s really trying to take the time to heal, recover and be in the love bubble of getting to know their newborn infant and learn who they are and what they need.
Sarah Trott: [00:32:09] Perfect. Thank you so much for the overview. We’ve learned so much in this conversation. So we’re going to sign off and I’ll say thank you very much and I look forward to talking to you next time. Thank you.
Esther Gallagher: [00:32:22] Thank you, Sarah, this is so nice!
The content provided in this article(s) is provided for informational purposes only and does not constitute medical or other professional advice. Neither Sarah Trott nor Fourth Trimester Media Group LLC are liable for claims arising from the use of or reliance on information contained in this article.