Postpartum Doulas are for Black Women Too

I used to think doulas were white women, for white women in labor. I was wrong.

According to dona.org, doulas “support new families through the life changing experience of having a baby.” Prior to my own pregnancy, I had only seen doulas with pregnant women in labor. I worked with several doulas during my residency in obstetrics and gynecology. For the most part, my experiences were positive. They functioned as patient advocates who made my laboring patients feel at ease. Sometimes I saw them give massages to women in labor. Many supported women through non-medicated labors, and others helped women cope with labors that ended in C-sections. Some of them even took photos for the families during the process. Because I trained in Silicon Valley in a relatively affluent patient population, all of the doulas I knew happened to be white, and their clients were almost exclusively white. My perception was that doulas were for rich, mostly white women, who advocated for minimal medical interventions for women in labor.

Growing up poor and being half black and half Filipina, I never imagined I’d be in a position to hire someone like a doula. Many Filipinos, like many black American women, hold collectivist, family-centered cultural beliefs. All family issues are dealt with in the family, or maybe with the assistance of the church. In these societies there are often a wealth of women in the family, or in the church, who can share their skills and knowledge about womanhood. I did not have that kind of support built into my social network when I became pregnant. I moved every 3–4 years during my 15 years of post-high school doctor training, and I took my first job far from family.

In addition to my values around hiring help, I was concerned about cost. I learned that postpartum doulas can provide different levels of support, from remote support online or by phone, to 24/7, in-home help. Most of the doulas I found charged $20 — $35/hour for in-person support, and many had minimum fees. I thankfully found someone willing to do a combination of in-home and online support, which helped decrease the cost. I did pay her upfront based on my projected needs. It ended up being much cheaper than I expected. Additionally, there is increased awareness that doulas may be important to improving perinatal outcomes for black women, and free doula resources are being made available to address this.

My perception of doulas changed as I grappled with raising a newborn in a pandemic. My mom was coming from the Philippines two weeks after my delivery but could only stay one month. My partner is supportive but could only take two weeks of bonding time from his job during my maternity leave. For all my experience in delivering babies, the thought of raising one with little support was terrifying.

Late in my pregnancy, I heard a lecture from a black physician about black doulas. I was surprised to hear about black doulas and the benefits of black doulas for black women. Also, one of my midwife coworkers mentioned having a postpartum doula. I had never heard of that, but it seemed to be exactly what I needed. I was well-versed in pregnancy and labor, but I loved the idea of having a professional transition me into motherhood. She helped me find a resource for doulas in the Los Angeles area. I also heard on the radio about a resource for black women searching for black doulas. Against my own steeped cultural values, it seemed that all the signs were pointing toward hiring help.

Here are the main ways that having a postpartum doula helped me:

1. Pre-baby prep

Once I’d decided to hire a doula, I started by asking a friend who is a doula and massage therapist. Although she was not available to me postpartum, during my pregnancy she gave me tips to prepare for baby’s arrival. She guided me through setting up stations in different rooms — organizing supplies for breastfeeding, diapering, and baby’s sleep. I gathered snacks and water bottles ready at the bedside. In hindsight these tips seem intuitive, but for a first-time mom like me, this helped simplify my life immensely in the first weeks when I came home. Thankfully, I eventually found a doula through Village Birth.

2. Early breastfeeding

I’ve seen my share of breastfeeding as a physician taking care of women and with many co-worker physician moms. However, it is truly one of those things that you don’t understand until you’ve gone through it. Thankfully, there are also professionals trained to help women through it. I did see a lactation consultant in the hospital after my delivery, and she gave me the thumbs up when I showed her my cross-cradle hold. However, two weeks of holding my hand in the same position for 20 minutes at a time, every 1–2 hours while breastfeeding, I was hurting. My hands, wrists, and shoulders were very sore, but I was scared to change positions for fear of losing a good latch. Enter my doula. She helped me through different breastfeeding positions (laid-back, side-lying, football hold) to alleviate my aching upper body.

I also was not ready for the breast engorgement. When my coworker texted to check on me in my first weeks postpartum, I told her I felt like I had cement balls hanging off my chest and alligator clamps on my nipples. I also had a golf ball in my arm pit from the engorged breast tissue there (yes, breast tissue can extend into your armpits!). My doula talked me through relieving these discomforts using massage and warm compresses. These were all things I heard of and would even tell my patients when I used to take care of pregnant women (I only do urogynecology now…more on that in a different story). But, as they say now, if you know you know. I certainly learned, but I did NOT know before going through it myself.

3. Newborn sleep

“Is she a good baby? Is she a good sleeper?”

I hate this question. It’s often intended harmlessly, but many people say it without realizing that normal newborns do not sleep through the night. Normal newborns sleep sometimes 30 minutes to 2 hours at a time, wake up for about the same amount of time, then do it all over again. It does get better (THANK GOD!), but it takes months.

My doula gave me practical tips, like staying in bed until I’d accumulated my normal 6–8 hours of sleep. I was never the kind of person to be in bed until 10a or later, but sometimes that’s how long it took to get “a good night’s rest.” She also helped me with tips for positioning the baby’s bassinet to decrease moving a lot with nighttime feeds, and timing the diaper changes around the feeds. At 3.5 months postpartum this is all now second-nature. But while becoming a mother may be biological, being a mother is not always intuitive. All of my doula’s tips added up to help me be more efficient and save precious minutes for sleeping.

An in-home doula may even do overnight shifts. The doula may give the mother a break so that the baby is brought to her for feedings, then burped and put back to sleep while the mom may get some rest. I did not use a doula in this way, but it sure sounds nice!

4. General encouragement

You’ve got this. You’re doing it. Allow yourself to rest.

These reminders from my doula were exactly what I needed to relax into motherhood during these exceptional times. Becoming a new mom in a pandemic is beautiful and challenging. COVID precautions kept me from being around most friends and family. So on one hand, I appreciate the apps, forums, and mom blogs for their insights and for providing a sense of connectedness. But social media moms can give a warped sense of motherhood. Stories of difficult breastfeeding, colicky babies, and unfortunate newborn ailments are pushed to the forefront, making us forget that, overwhelmingly, healthy moms and babies are normal. At the same time, polished, social-media-influencer-moms also are in the spotlight. They may claim to “keep it real,” but how is that possible when they’re wearing makeup, have good lighting, and no spit-up on their clothes?

My doula helped me lean less into the self-sufficiency that got me through my medical training. With her encouragement, I allowed myself to rest when I could and lean more into the supportive people in my life.

Los Angeles doula resources cited in my story: Village Birth, Frontline Doulas, Black Infants and Doulas Los Angeles