Providing an Antidote for Those Baby Blues

Janet Powelson brought her newborn daughter home from the hospital and quickly discovered that the baby wasn’t the only one who needed a good deal of attention. Powelson, 30, was anxious, exhausted and overwhelmed by the experience, had lots of questions, and the list of undone household chores could have filled an entire notebook.

She enlisted the services of a doula--a woman trained to provide in-home assistance for new mothers--the first week after she returned home to Valencia in July. The doula, Elaine Johnstone, did laundry and shopping, helped prepare meals, provided valuable advice on breastfeeding and offered emotional support.

With Powelson’s husband at his job as a field service manager for McDonald’s Corp. and their parents living in other cities, “It made my life so much easier,” she said. “It helped me get through a very difficult time a lot more smoothly.”

Unlike a nurse who specializes in caring for the newborn infant, a doula (the term comes from a Greek word meaning “to serve”) is a child-care specialist, housekeeper, counselor and nurturing friend all in one.

Typically, they spend three or four hours a day with the mother--for a period ranging from one to six weeks--watching over older children, doing housekeeping, running errands, answering questions and teaching hands-on parenting skills.

To find her doula, Powelson turned to Tender Care, a Newhall company that is one of a handful of firms in the Los Angeles area providing such a service.

Chris Morley, director of the firm and a mother herself, said: “For the first couple of weeks, most of the attention is directed at the baby. But the mother needs a lot of support too. It’s difficult to drive with the child the first time, it can be frightening to leave the child alone for the few minutes it takes to shower. A doula helps ease the transition to having a new member of the household.

“Years ago, people had family and friends that would provide these services,” Morley said. “In today’s society, where people are increasingly isolated and don’t have a neighborhood support system, it is something that’s missing.”

Doulas have been used in Europe for generations. The concept came to the East Coast of the United States about 1983, spreading west and gaining popularity. Lamaze classes, introduced to the American public in 1958, followed a similar course and became popular 15 years ago.

It’s an idea that’s quickly gaining acceptance among parents, childbirth educators and doctors. Nationwide, about 40 doula companies exist, according to the Indianapolis-based National Assn. of Postpartum Care Services. Virtually all have cropped up during the last five years--mostly on the East Coast.

“Some people can take on the added burden of a new child without too much difficulty. But a lot of patients encounter a lot of strain. Taking care of the baby in addition to all the regular chores is like adding a new job on top of what is already a full-time job. In those cases, a doula can be helpful--both physically and emotionally,” said Dr. Gary D. London, a Valencia obstetrician who is a past president of the Los Angeles Obstetrical and Gynecological Society and director of the Valley Birth Center at Henry Mayo Newhall Memorial Hospital.

Morley has lined up work with nearly 20 clients since she started the business in April. Presently, Tender Care does business in the Santa Clarita Valley and portions of the San Fernando Valley with six doulas, including Morley. Early next year, the company hopes to expand to West Los Angeles and more of the Valley.

Locally, “a few others are doing this, but not as a professionally run business,” said Tanya Brooks, executive director of the Gentle Birth Center Medical Group, a Glendale facility that has referred several patients to Tender Care.

The standard rate for a doula is $225 a week, which besides the daily service includes an initial questionnaire and consultation, an in-home orientation before the delivery, and a 24-hour hot line for questions or problems that crop up after the birth. The doulas also can provide labor support and even coach the delivery. They generally stay in contact with the parents beginning with the seventh month of the pregnancy.

According to Morley, it doesn’t take “a degree to be a doula. The women who work for this program are just a very caring group of people. Most of them have been through the birthing experience and could have used some help so they want to be there for someone else.”

Johnstone, 30, is a typical doula. “I enjoy helping somebody who otherwise wouldn’t have any support. The first week or two can be scary, there’s a lack of sleep and a lot of emotions involved. There’s often a lot of confusion and anxiety about whether a mother is doing things the right way.”

Morley pointed out that doulas do not perform any medical services, and they defer all such questions to the appropriate authorities. California doesn’t require licensing for doulas and there are not any minimum training requirements. A few states in the East, including New Jersey, have set standards that include a certification and licensing process.

Tender Care’s doulas take 20 hours of classes in postpartum care education, which entails everything from psychology to postpartum depression detection, diet, physiology and labor coaching. They are certified in infant CPR by the Red Cross and attend lectures on various topics.

It’s a concept that appeals to many health care professionals. “When a mother doesn’t get help, we get calls at all hours of the day and night,” Brooks said. “Most of the calls are not from women who need medical or technical information They’re mothers who simply need reassurance or advice.”

London recommends the service to his private patients and is in the process of integrating doula services into the hospital’s short-stay obstetrics program. “It’s a need that most people don’t recognize,” London said. “It’s viewed as a luxury rather than a necessity. In reality, the expense is fairly modest compared to the benefits.”

Indeed, several HMOs on the East Coast have begun to underwrite the cost of doula services. But it doesn’t take a sanction by the medical establishment to convince mothers that it’s a cost-effective idea.

Tami Pagen, an Acton resident who used Tender Care for five weeks, said: “It can save trips to the doctor, it can make everyone’s life a lot easier. When you have a newborn, it’s easy to think that every minor occurrence is a major problem.”

Powelson added: “There were times when it was very reassuring to have someone around. It really made a difference for my peace of mind.”

Of course, the idea isn’t for the doula to become a crutch for the mother, but to help her become confident, knowledgeable and independent. That’s why the doulas spend only three or four hours a day with a family, and Morley refuses to have doulas work for a family for more than six weeks. “After that, we suggest they hire a nanny or a maid,” she said.

Yet that’s enough time for close emotional relationships to occur. It’s not uncommon for the mother to later invite the doula over for coffee or lunch; a few have even become good friends. Morley said: “I look forward to the day I can leave a family without crying. You can’t help but feel a bond, you’re with them during a very intimate, vulnerable time.

“It’s rewarding to leave a new family that is off to a healthy, happy start together,” she added. “Mothers with newborns usually don’t get the kind of support they really need.”