By Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE, CLE
Today is the third post in the occasional series, “Doula Me This!” Each post in the series provides a common scenario that a birth or postpartum (or both) doula may face. The “correct” answer (if there is one) requires some synthesis of the situation and at times consideration of the DONA International’s Standards of Practice and Code of Ethics.
Today’s situation is applicable to postpartum doulas and may be a situation that you have faced before. There are many circumstances and feelings at play and this requires the doula to tread carefully. Read through today’s scenario and let me know how you would handle such a situation in the comments below. Have you been faced with this very situation? I am grateful to Ann Grauer, AdvCD/AdvPCD(DONA), BDT/PDT(DONA), LCCE, FACCE, IBCLC, RLC for her help in creating today’s question.
Doula Me This!
You have been working for a family as their postpartum doula and your six-week contract will be successfully completed at the end of this week. The family has requested an additional period of work and would like you to stay on.
The Details
- Doula: Kristi
- Postpartum Parent: Rochelle
- Partner: Anne Marie
You have been working for Rochelle and Anne Marie since their son was a week old. You are just reaching the end of your six-week contract. Jason was a healthy full-term baby and has been a healthy and happy little guy, with some of the usual challenges along the way. Rochelle had an uncomplicated labor and birth and seems to have made the transition to parenthood without complications. She’s had her moments of doubt and you have been able to help her build her confidence. She is feeling good, breastfeeding is working out well and Rochelle has just been cleared to start exercising. Rochelle will be taking a year off to be the stay at home parent. Rochelle’s partner, Anne Marie, returned to work three weeks ago after a month of leave and the entire household seems to be humming along smoothly.
You have been working three or four shifts a week, for four hours at a time and the professional relationship between you and the family has been very positive for all. This is the last week of your contract, you only have two shifts left. You don’t currently have another postpartum client lined up but you are a successful and respected doula and are confident that a new client will be available soon.
Your Dilemma
You remind Rochelle that you have two more shifts left and remark about how it has been a joy to work with her family and that you will miss them, but they are truly doing most things on their own and have thrived. Rochelle mentions that she and Anne Marie were talking and they would like to ask you to stay on for another four weeks. They would appreciate three four-hour shifts a week. Rochelle comments about how much she enjoys having you around. The past week and a half, you have been struggling to find tasks to fill your time. In your professional opinion, Rochelle is doing well, emotionally and physically, and the family has transitioned to life with a baby quite smoothly. You are mostly doing laundry and providing companionship at this time during your shifts and aren’t sure what you would do in the home for another four weeks.
What Would You Do?
What do you tell Rochelle and Anne Marie? Is it really a problem if you stay on for another four weeks? They are a great family, they can afford to hire a postpartum doula, the relationship is working for everyone and Rochelle really finds that she enjoys the time you are in the home. You currently have an open calendar and also feel sad at saying no. But if you stayed, what would you do during all that time?
Continue doing what I have been doing. Let her know I will have to leave at the end of this add on time .
I would say yes, however for only 2 shifts a week and eventually cut it down to one, which may naturally happen. Even if there is not tangible work to do, just by being in the hone the doula is supporting Rochelle.
I would ask the mothers what roles they see me fulfilling for them; what actions on my part provide them with a fuller family constellation; how can I be helpful; would it be best for (you) to cut back to less days?
Just a quick thought/option for the situation: This is where your Doula Resource List and networking comes into play! You could suggest a part-time nanny or mothers helper (like an Au Pair but with someone local) to come in and help a few times a week, and even provide some contacts if you know of them.
I would ask the clients what they envision me doing three times a week? And get a realistic understanding by listening what they want and what is really going on and talking to them about it.
I have continued working on occasion because it was still needed emotionally and appreciated. And do work with clients that feel lonely and need the doula for her professional “Companionship” . That is enough for me as a doula and vital for some new parents during their further adjustment to parenthood, I work with them and help prepare them for the next steps after I am not working with them.
Many of my clients have partners that work 12 hour days and without family nearby and they are not ready to transition to being alone all day or to go out and leave the baby with a sitter. So I continue to work and help prepare for the next steps in their Independence .
If their vision for me was to babysit for the 4 hours each visit and do laundry so they go out, at this point I would suggest I can help them find the next phase of helpers. Maybe I would only commit to a week or two if they wanted as they find and interview a trustworthy babysitter.
This is a very interesting question, and I am looking forward to hearing other replies. I am in training and have not actually had any clients yet, but I will start with a couple thoughts. I think it would be best to reiterate how well you think the partners are doing with the care of the baby. Maybe there is still some lack of confidence, so I would agree to coming on another 4 weeks, but with a smaller commitment. Maybe just once a week. Sometimes a gradual decline in support services are needed for certain individuals. During that time I would work with Rochelle to find a moms group of some sort to continue to get support.
I’d have a conversation about their goals for that time. Based on what their goals are, I’d decide if it made sense to take on the extension. Maybe they still really need the emotional support, maybe we can work together on how she gets more comfortable with outings while her partner is at work, or help her begin working in a new fitness routine, or something entirely different. If it really is down to just childcare, that’s when I offer to help connect them with different resources that better meet their ongoing needs. But just because you feel like everything is smooth, doesn’t necessarily mean someone else feels like it’s smooth for them yet.
I always recommend the option of tapering off towards the end, but ultimately that’s up to them, based on their needs.
My core professional services are not needed. I appreciate the offer but I believe that appropriate professional boundaries are threatened if I were to continue. I believe it is unethical to continue to grow the relationship noted by the “we like having you around” sentiment expressed by Rochelle.
Seems that this doula has done a beautiful job working herself out of a job! This is one of the bittersweet transitions of ending our care so I appreciate this post! I vote for talking with the family earlier about 1) their success and having fewer postpartum doula tasks to do and possibly reducing weekly visits so it’s a smoother transition to end of postpartum doula care, 2) investing in other resources that suit their needs from our resources list of other professionals (babysitter, mama’s helper, nanny) and going out for community engagement (groups with strong companionship and social support) that the family identifies as a sweet fit for their needs (and the doula for her scope of services) and 3) overlapping the new professionals toward the end of postpartum doula care. I love to get that new babysitter or mama’s helper over during one of the postpartum doula visits to sit with family and share what the family and baby love. Families love this smooth transition of care! In my experience, “fostering maximum self-determination for the clients” is helping them identify their changing needs and best matching services so we avoid creating an on-going paid companionship relationship. I’ve seen the latter backfire for the family and the doula in the long run.
I believe she has full filled her doula role. I agree with the comment that a referral (such as a mother’s helper or part time nanny) would be appropriate. It is rewarding to see clients ‘fly’ on their own. You know when your time has come to an end. Otherwise 4 more weeks could turn into 6 more weeks etc….and having a client rely on you or think they cannot ‘do it without’ you is not fullfilling the role of being able to foster self determination or simply put
empowering the client and family to make decisions on their own (which is also knowing they really don’t need the support anymore).
If the birth mother is feeling recovered at this point, I would say it’s time to move on and open up space for your next client.
I would gladly stay with this family, but on a week by week basis. You have no idea how just being there with the mom can make her feel not isolated and give her adult communication. Suggest that we can look for and attend mom/baby groups together making her comfortable to go with her baby alone when I move to the next family. This would help her in the transition. Also, help her with resources to find a mother’s helper.
Interesting question! Mom seems to feel more confident with doula present ( not all alone with baby.) It seems to be a part of her transitioning and gaining confidence as a new mom. I would discuss with mom what she hopes for Doula’s role to be at this point. Perhaps ( since relationship pleasant and good you might agree for another 2 weeks for shorter periods of time ( 2/3 hours.) Doula can perhaps encourage her to journal her post partum experience and do some light chores. Encourage her to do short outings and go along with her. Slowly mom will be more comfortable in her role without the Doula as a crutch.
Good luck. Would be nice to hear what was decided and how that worked out.
This is good, as I’ll be attending postpartum training next week! I believe the answer is to end at two weeks, and refer to possible a nanny or baby-sitter? Although I’d read somewhere else post partum can go to three months? I’m excited to know the answer, and to meet Ann next week!