Module 1: Introduction to Postpartum Doula Work
IN THIS LESSON
Topics Covered:
1 Differentiating Roles
The difference between postpartum doulas, medical professionals, and therapists.
Clarifying that postpartum doulas do not provide medical advice or perform medical tasks.
2 Boundaries and Referrals
Establishing clear professional boundaries with clients.
Recognizing signs of postpartum depression or medical complications and knowing when to refer.
3 Personalization of Services
Adapting care to meet the unique needs of each family.
Respecting cultural, religious, and personal beliefs.
1. Differentiating Roles: Understanding the Scope of Postpartum Support
Postpartum doulas, medical professionals, and therapists each play distinct roles in supporting families. Understanding these differences ensures that postpartum doulas provide appropriate care within their scope of practice while empowering families to seek specialized help when needed.
The Role of Postpartum Doulas:
Postpartum doulas focus on non-medical, family-centered support. Their tasks may include helping with newborn care, meal preparation, emotional support, and guiding families through the postpartum transition. For example, a doula might teach a parent how to swaddle their baby or help establish a daily routine.
What Postpartum Doulas Do Not Do:
It’s important to clarify that doulas do not provide medical advice, diagnose conditions, or perform medical tasks. For instance, while a doula may recognize that a mother’s incision site looks inflamed, they would encourage the mother to consult a healthcare provider rather than offering medical advice.
Comparison of Roles:
Medical Professionals: Diagnose and treat health issues (e.g., managing infections, prescribing medications).
Therapists: Address mental health concerns, such as anxiety or postpartum depression, through therapy or counseling.
Postpartum Doulas: Provide emotional and practical support, ensuring the family feels cared for during the postpartum period.
Practical Example
Scenario:
Maria is a first-time mother who is about six weeks postpartum. She calls her doula, Sam, because she is feeling tremendous anxiety about her baby’s feeding routine. She fears “messing it up” and constantly worries whether the baby is getting enough. She checks and rechecks feeding times, becomes tense if the baby slows down, and feels guilty when she has to step away. Over the past few nights, she has had several episodes of crying and difficulty sleeping because she fears something is wrong.
When Sam visits, she greets Maria in a calm, nonjudgmental way and opens the conversation:
“I hear how stressed you are about feeding. You’re not alone in feeling this way. Let’s walk through what’s happening together and see what support might help.”
Doula Actions & Interventions:
Active listening and emotional validation
Sam invites Maria to tell the story without interrupting.
She reflects back: “It sounds like you keep second-guessing every feeding and that’s wearing you out.”
She says explicitly: “It makes sense you’d feel anxious — many new mothers worry about this, especially when they don’t have strong feedback yet.”
Normalize common early feeding challenges
Sam shares that in the early weeks, babies may cluster feed, vary their appetite day to day, or momentarily slow their suck as they regulate breathing — which is expected and doesn’t necessarily mean something’s wrong.
She points out red flags (e.g. poor weight gain, dehydration signs) and reassures that those are rare, and when they appear, that’s when clinical support is needed.
Observe a feeding session and give gentle guidance
Sam watches a feeding with Maria, asking her to describe her mindset, what she’s focusing on, and where she feels uncertainty.
Sam suggests one small adjustment (e.g. slight tilt, reposition, break suction gently and re-latch) rather than overwhelming changes all at once.
She invites Maria to try again while Sam verbally coaches, then step back to let her try solo, reinforcing what she does well.
Introduce coping strategies for anxiety in the moment
Suggests that before a feed, Maria take a 30-second grounding or breathing exercise (for instance: inhale 4 counts, exhale 6 counts).
She encourages Maria to journal her thoughts for a few minutes, noting fears or catastrophizing and then reframe with more neutral, fact-based thoughts (“Baby is feeding steadily for now; I can check with my pediatrician if I see weight concerns”).
She models a mantra she often uses herself (“Each feeding is a chance to connect — not a test”).
Create a realistic feeding plan & logging tool
Sam offers a simple, flexible feeding log (time, duration, baby behavior) for Maria to track patterns, but warns not to obsessively monitor.
They set a “soft goal”: e.g. “We’ll aim for 8–12 feedings per 24 hours but expect variability — if baby is feeding less, we’ll watch weight and diapers rather than panic.”
Sam helps Maria decide ahead what “thresholds” would trigger calling a lactation consultant or pediatrician (e.g. fewer than X wet diapers, >7 days of slow weight gain).
Referral and collaborative follow-up
Because Maria’s anxiety is intense and interfering with rest, Sam gently suggests scheduling an appointment with a certified lactation consultant to get an in-depth feeding evaluation.
Sam also offers to help Maria identify a therapist or postpartum support group (ideally one specializing in perinatal mood and anxiety).
If Maria agrees, Sam offers to be present via video or attend the first session with her (if boundaries and consent allow), or help draft questions in advance.
Check-in plan and emotional support
Sam arranges to follow up by phone in 24–48 hours to see how Maria is doing with her feeding log, anxiety, and referrals.
She reminds Maria that she (the doula) is not a replacement for clinical care but is a consistent support — a safe person to talk with, troubleshoot, and normalize.
Why this example matters:
This scenario shows how a doula can bridge emotional, informational, and logistical support, helping a parent feel less alone and more grounded, while also ensuring that professional referrals are made when needed. The doula builds trust, models calm, empowers the parent, and helps triage when clinical input is necessary.
Practice Suggestions & Tips for Postpartum Doulas
Use “micro-interventions.” Rather than trying to fix everything at once, suggest very small adjustments (e.g. “just tilt the head slightly”) that feel manageable.
Have scripts ready for common worries. For example:
“It’s okay that baby is nursing frequently — in fact, that’s often normal.”
“Your feelings don’t make you a bad mother; they make you human.”Role-play ahead. Before a visit, mentally rehearse how you might respond if a client is anxious, overwhelmed, or angry.
Carry grounding tools. A list of breathing prompts, progressive muscle relaxation cues, or a short mindfulness script you can guide verbally.
Maintain referral cheat sheets. Always have up-to-date contacts for local lactation consultants, perinatal therapists, and support groups.
Boundaries & scope clarity. Always remind clients: “I am not a therapist or clinician. I support you — but for mental health diagnosis or deep therapy, that’s someone else’s role.”
Document thoughtfully. After each visit, jot notes on emotional tone, new red flags, what was tried, and when to follow up.
Self-care reminder. When you support anxious clients, it’s emotionally heavy. Debrief or supervise regularly to avoid burnout.
Research Support
One relevant study that supports the point about social support improving outcomes is Cho et al. (2022), “Association between social support and postpartum depression.” This large national survey in South Korea looked at over 1,600 postpartum women and found that those with lower levels of perceived social support were significantly more likely to show signs of postpartum depression, even after adjusting for other risk factors. In plain terms: when new mothers feel they have less support from family, friends, or partners, their risk for depression is higher. Nature
Cho, H., Lee, K., Choi, E., Cho, H. N., Park, B., Suh, M., Rhee, Y., & Choi, K. S. (2022). Association between social support and postpartum depression. Scientific Reports, 12(1), 3128. https://doi.org/10.1038/s41598-022-07248-7
2. Boundaries and Referrals: Balancing Support with Professionalism
Knowing When to Refer
You visit a mother, Maria, who reports that for several weeks she has felt persistently sad, drained of energy, and unable to muster motivation to care for her baby. Instead of offering quick fixes or advice, you listen with compassion. You say:
“I’m hearing how heavy this has felt for you. While I’m here to support, I think your feelings deserve attention beyond what I can provide. I’d like to help you find a therapist who specializes in postpartum mood disorders and we’ll continue supporting you together.”
You help Maria make that first contact (e.g. phone call, draft questions, accompany via telehealth if agreeable). You also check in in two days to see how she’s feeling and whether she was able to connect with someone.
Clear Boundaries Create Trust
Families appreciate when doulas set professional boundaries. For instance, avoiding overfamiliarity, such as discussing your personal issues, helps maintain focus on the family’s needs.
The Importance of Boundaries:
Maintaining professional boundaries ensures trust and clarity in the doula-client relationship. For example, a doula might set clear expectations by explaining, “I’m here to support you with practical care and emotional reassurance, but I can’t offer medical advice.”
Recognizing When to Refer:
Doulas should be familiar with common postpartum warning signs to identify when clients need specialized care. For example:
A mother experiencing severe mood swings and withdrawal might have postpartum depression and benefit from a referral to a therapist.
A baby showing signs of dehydration, such as a sunken soft spot, should be evaluated by a pediatrician immediately.
Referring with Sensitivity:
When referring a client, emphasize that seeking additional support is a positive step. For instance, a doula might say, “I’ve noticed some symptoms that could benefit from a healthcare provider’s evaluation. It’s always better to address these concerns early.”
Practical Example: Father Showing Signs of Distress
Scenario:
During routine postpartum home visits, you notice that Daniel — the father of the baby — has become unusually quiet, disengaged, and emotionally distant. Previously, he was more involved — playing with the baby, helping with diapers, asking questions. But lately he’s spending long periods in the room scrolling on his phone, avoids eye contact, and makes minimal conversation. When you ask how he’s doing, he shrugs and says, “I’m just tired,” but his tone and body language suggest it’s more than fatigue. You also observe he’s not sleeping well (he mentions he’s up worrying), and his eyes seem weary, and he speaks less about how he’s feeling. The mother has hinted she’s concerned about him, but didn’t know how to bring it up.
As the doula, your priority is to support both parents’ well-being and to notice when one parent may be struggling. Rather than pressing or diagnosing, you approach Daniel gently, creating psychological safety for him to open up.
Conversation & Intervention Steps:
Open the conversation with care
“I’ve noticed you seem more quiet lately, and I’m wondering how you’re doing in all of this. This is a big shift for everyone.”
Use open, neutral language rather than accusatory or diagnostic phrasing.
Offer space: “If you prefer not to talk about it now, that’s okay — I’m here any time.”
Active listening, validation, and normalizing
If Daniel shares, reflect back what you hear: “That sounds heavy — you’re carrying worry and perhaps feeling a bit invisible.”
Normalize that new fathers can feel pressure, anxiety, or emotional strain, just as mothers can.
Avoid jumping to solutions or giving advice; instead, mirror and empathize.
Ask gentle screening or cue questions
“Have you noticed yourself withdrawing from things you used to enjoy?”
“Do you feel down, restless, or unable to relax?”
“Has your appetite or sleep changed?”
If he answers “yes” or expresses further distress, that’s a cue to move toward referral.
Explain scope and role as doula / lay support
“I’m not a counselor or therapist, but I care about your well-being and want to help you access professional support if you’d like it.”
“I can help you find someone who understands parent mental health, and we can figure out next steps together if you're okay with that.”
Offer a warm handoff or “walk with them” approach
Offer to help him search for a family counselor or therapist with experience in paternal or perinatal mental health.
Offer to be present during a phone call or help draft initial questions.
If telehealth is acceptable, help schedule or accompany via video chat.
If local in-person options exist, offer maps, contact info, or even transportation help if appropriate (within boundaries).
Continue practical, nonclinical support
Ensure he has small tasks or responsibilities that give him agency (e.g. baby burping, skin-to-skin time) to re-engage in fathering roles.
Suggest small self-care practices — e.g. 5 minutes of walking, breathing exercises, journaling.
Encourage him to talk with someone he trusts (friend, peer dads group) while waiting for professional help.
Follow-up and monitoring
Schedule a check-in within 48 hours to see how he’s faring emotionally and whether he has taken steps.
Document mood, comments, and referrals given (while respecting privacy).
Watch for red flags (e.g. expressions of hopelessness, self-harm thoughts) and be ready to escalate or connect to crisis services.
By treating Daniel’s mental state seriously, providing emotional space first, then moving toward connection with clinical care, you as a doula act as a bridge — reducing stigma, facilitating support, and helping maintain family wellbeing.
Tips for Postpartum Doulas: Preparedness & Best Practices
Be sensitive to gender norms: Some fathers may be reluctant to share emotional struggles due to social expectations. Use phrasing that respects masculinity and vulnerability.
Use “soft invitations” rather than demands: E.g. “If you ever want to talk, I’d be glad to listen or help you find someone” — this gives agency rather than pressure.
Create simple cue cards: Have a list of gentle questions you can use to probe mood, sleep, appetite, engagement.
Keep mental health referral lists up to date: Include therapists who accept fathers/new parents, sliding scale or free options, telehealth services, and peer support groups.
Know local crisis contacts: If someone expresses self-harm or severe despair, be ready with hotline numbers, emergency mental health services, or steps to escalate safely.
Document and revisit: In your notes after each visit, note emotional tone, what was offered, and plan a follow-up.
Practice self-regulation: When engaging emotionally heavy topics, use grounding for yourself (brief breath, short pause) so you stay steady and supportive.
Research Evidence
Evidence supports the importance of early intervention and timely referrals. A randomized controlled trial by Gjerdingen and colleagues (2013) examined the impact of postpartum doula visits combined with peer telephone support for mothers experiencing symptoms of postpartum depression. The study compared mothers who received doula and peer follow-up support with those who did not. Results showed that the intervention group experienced greater improvements in depressive symptoms, fewer episodes of depression, and higher overall satisfaction with their postpartum experience.
Put simply: when families receive structured, non-clinical support early on—especially when doulas help connect them to the right resources—they are less likely to struggle in silence and more likely to recover successfully.
Gjerdingen, D. K., Crow, S., McGovern, P., Miner, M., & Center, B. (2013). Postpartum doula and peer telephone support for new mothers with symptoms of postpartum depression: a randomized controlled trial. SAGE Open Medicine, 1. https://doi.org/10.1177/2150131912451598
What Exactly Is A Postpartum Doula and What Do They Do?
3. Personalization of Services: Meeting Families Where They Are
Every family’s postpartum journey is unique. Adapting care to align with individual needs, cultural backgrounds, and personal beliefs ensures that support is both effective and respectful.
Understanding Unique Needs:
Families differ in their parenting styles, values, and challenges. A doula might adapt their services based on whether a family is welcoming their first child or managing a household with multiple children. For example, a doula supporting a family with twins might focus on strategies for managing feedings and rest schedules.
Respecting Cultural and Religious Beliefs:
Cultural and religious traditions often shape postpartum practices. For instance:
A family observing “cuarentena” (a 40-day postpartum rest period) may require help preparing culturally appropriate meals.
A devoutly religious family may prioritize prayer or ceremonies during the postpartum period, which a doula should honor without judgment.
Creating a Flexible Care Plan:
Doulas should engage families in open conversations to tailor their services. For example, asking, “What’s most important for you during this time?” allows the doula to focus on priorities, such as breastfeeding support or emotional reassurance.
Practical Example
A doula is working with a mother who has just had a C-section. Over the first week at home, she notices that getting in and out of bed causes pain and stiffness, and the mother struggles to reach her diapering supplies without twisting or straining. The doula steps in to support her physical recovery in practical, hands-on ways while still respecting the mother’s autonomy and dignity.
During her first postpartum visit, the doula enters the mother’s room and takes a moment to observe the room layout, where the mother rests, and how supplies are arranged. The mother (Let’s call her Aisha) says quietly, “It hurts to turn over. I feel stuck in bed. And when I roll out, reaching the baby’s diapers across the changing table is hard.” The doula asks permission: “Would it help if I showed a few options that make movement easier and help you set up your diapering station so things are within reach?”
Once given permission, the doula suggests small modifications and assists in implementing them:
Bed mobility aids
Shows how to use pillows as rolling points or wedges to support turning in bed with less strain.
Suggests placing a firm pillow between legs when turning to reduce twisting of the pelvis.
Demonstrates the “log roll” technique (rolling as one unit) to protect the incision.
Assists the mother through a few guided motions, gradually letting her do more as she feels comfortable.
Safe getting-out-of-bed routine
Hands her a nonslip mat or grip socks so her feet don’t slide.
Encourages her to push up with arms, then swing legs to the side before standing, reducing torso twist.
Coaches breathing (exhale on the effort) to engage core support while moving.
Ergonomic diapering station setup
Moves diapers, wipes, extra clothes, and changing pads close to where the mother will be changing the baby (often at waist height or slightly below).
Places a stool or small step if needed so she doesn’t reach dangerously above her incision line.
Suggests a caddy or basket she can pull toward her rather than stretch across furniture.
Places a soft pad or towel under the baby so she doesn’t have to lean over far.
Pacing, rest, and micro-breaks
Reminds her that even small tasks should be spaced out—do five diaper changes, then rest.
Encourages asking for help early (with baby, laundry, meals) so she doesn’t overexert.
Offers to carry or fetch items she needs so she doesn’t push herself at the expense of healing.
Monitoring and communication
Observes her face, posture, and tone for signs of fatigue, pain, or frustration, and pauses to check in: “How does that feel? Do you need a moment?”
Encourages her to communicate when pain becomes sharp, or swelling/redness near the incision changes.
Notes in her doula visit log what movements worked, what needed adaptation, and plans to check again next visit.
By doing this, the doula not only eases the mother’s daily tasks but also supports her sense of competence and reduces fear around movement. These seemingly small acts can build trust and confidence, which can positively affect recovery and emotional resilience.
Research Evidence
Recent evidence supports the value of more frequent and individualized postpartum care in increasing satisfaction. In a multicenter Swedish study, individuals who received an extra postpartum care visit in addition to the standard one had much higher satisfaction with their care. In fact, 93 % of those in the “additional postpartum care” group reported satisfaction with the early visit, and many primiparous individuals especially appreciated the added contact and earlier support. (Sandberg Kedfors, Molin, & Lindh, 2025)
Sandberg Kedfors, K., Molin, M., & Lindh, I. (2025). Evaluation of satisfaction on additional postpartum care: a comparative, multicentre study. BMC Pregnancy and Childbirth, 25, Article 930. https://doi.org/10.1186/s12884-025-08061-6
👉 Knowledge Check
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A postpartum doula’s role is non-medical, focusing on holistic support rather than clinical care.
Clear boundaries help maintain professionalism, ensuring families receive appropriate care while understanding the doula's limitations.
Postpartum doulas should recognize signs of postpartum depression or medical complications and make timely referrals to specialists.
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Anna’s Story: Honoring Chinese Postpartum Traditions
Anna, a new mother, followed the traditional Chinese postpartum practice of “zuo yuezi,” or “sitting the month.” After giving birth, Anna’s priority was to recover while adhering to the customs passed down through generations in her family. These practices included:
Resting for 30 days to allow her body to heal.
Consuming nutrient-rich, warming foods like bone broth and red date tea to boost recovery and support lactation.
Avoiding cold environments and foods to protect long-term health.
Anna’s doula played a crucial role in ensuring these traditions were respected. She prepared meals based on traditional recipes, provided emotional support, and helped Anna rest by taking care of the baby during her recovery. The doula’s ability to blend traditional care with modern postpartum practices gave Anna peace of mind and allowed her to heal in a way that honored her cultural heritage.
Alicia’s Story: Supporting Black Postpartum Traditions
Alicia, a first-time mother, cherished the support of her family and church community during her postpartum period. For Alicia, the presence of extended family members and meals inspired by traditional soul food—rich in iron and protein—were essential parts of her recovery.
Her doula worked closely with Alicia and her family, respecting these traditions by:
Encouraging the involvement of Alicia’s mother and grandmother in caregiving.
Preparing meals aligned with their cultural preferences, like collard greens and cornbread, to aid postpartum healing.
Addressing Alicia’s concerns about health disparities and advocating for her at medical appointments.
Through culturally respectful care, Alicia felt deeply supported and empowered to navigate her postpartum journey with confidence.
María’s Story: Embracing Mexican Postpartum Practices
María, originally from Mexico, followed the tradition of “cuarentena,” a 40-day period focused on rest, bonding with her baby, and eating warm, healing foods. María’s mother was a strong advocate for traditional postpartum practices, including:
Drinking chamomile tea to support digestion and relaxation.
Using abdominal binding techniques to aid recovery.
Resting while family members helped with household chores.
María’s doula seamlessly integrated into this family-centered care. She respected the family’s use of herbal remedies and traditional methods while offering evidence-based guidance on breastfeeding and newborn care. María appreciated how the doula honored her cultural traditions while supporting her modern needs, helping her transition into motherhood with grace.