From Doula Work to Feminist Theory, and Back

SELF DISCOVERY IN THE POSTPARTUM PHASE:

From doula work to feminist theory, and back

Part II

By Binda Colebrook, LCSW

Note

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This is part II of an article based on my Master’s in social work thesis exploring new mother’s experience of the postpartum phase and the role played by their postpartum doulas. My findings, garnered from a series of interviews, are reported here.

In part I, self-in-relation theory was described. Instead of stressing independence, this theory emphasizes relationship differentiation, or connection without dependence – which tallies well with the doula belief system. Also touched upon was the higher incidence in Westernized societies of postpartum depression during matrescence (new motherhood) as compared with more traditional societies. Reasons for this discrepancy include the lack of instrumental assistance to new mothers and the lack of social recognition or a role transition for this phase of a woman’s life.

Thesis findings

To deepen my understanding of the postpartum phase, I interviewed mothers and postpartum doulas. My sample consisted of three postpartum doulas and nine first time mothers who had had a postpartum doula. One mother had twins. All the others had singletons. All the mothers were educated at the Master’s degree level. The doulas had had ten or more clients and had worked with a broad socioeconomic client base.

My questions touched on how these mothers had experienced the postpartum phase, whether their doula had affected that experience and whether my theory that they did better when they were consistently in-relation to a doula or other support person during that time was valid.

The interviews gave some insight into the range of experience a mother can have in the postpartum phase. Two of the women reported that the postpartum phase was an empowering and healing experience. These mothers were amazed that they coped so well but added that they had “easy, good babies.”

Five other mothers felt that the postpartum phase was intense, but positive, and added that the doula made the difference because she "made life do-able." For these women, it was hard to be calm, and the doula modeled that for them. All the women in this group felt in control, but still needed practical help and emotional support. Some of the mothers in this group felt they had to keep up the house cleaning and appearances and apologized when they could not. For the mother of twins, the postpartum period was challenging, and her doula was instrumental in making it a positive phase of life.

For the remaining two mothers, the postpartum phase was very hard and they felt "slammed" by it. The doulas did help, but they were not with the mothers enough. The mothers felt set up by their own expectations. One mother said, "Who is in charge of the deception?...You’re supposed to be all happy and joyful, you know, ooh, this wonderful maternal feeling. It was not like that for me. It brought a lot of resentment and I just felt alone." The other said, "When I actually gave birth, I felt incredibly unprepared, as if all of my preparation and mental exercises had been devoted toward pregnancy and the process of birthing." She added that when she imagined motherhood, she skipped the baby phase, and had no idea what it meant to be a mother. For her, it was a huge life change. In her case, the doula acted like a "social worker" who helped her accept her new identity.

The theme of isolation and loneliness came up for quite a few of the mothers, as did the feeling of vulnerability. One mother stated, "no one talks about this – the resentment, the loneliness." For many mothers this isolation was accompanied by feeling "brain dead" and "overwhelmed" as well as "unsure" and "nervous". One mother said, "There is no empathy for new mothers. It does seem like everyone around the new mom has forgotten how overwhelming it is" to become a new mother. This same mother felt as if all the attention given to her while pregnant disappeared and the focus shifted from her to the baby. Additionally, she felt that the attention given to her was the wrong kind because it required her to be a hostess. For this mother, the doula kept the attention on her by providing for her and not making demands, and in so doing, gave her the energy and calm space to focus on her baby.

A majority of women in this sample found the postpartum phase to be difficult. Many of them expected that they would need practical help in this phase of life, but they did not know that they would need emotional support. They did not know how vulnerable they would feel inside. A lot of them disliked the feeling of not being in control or not having command of what they needed, and found it hard to allow others to take care of them.

The doulas concurred with the mothers that the overarching goal of the doula is to mother the mother so that she can mother her baby. The doulas stated that the kind and amount of support given to the mothers varied from mother to mother, but that it encompassed three categories also identified by the mothers as follows: emotional, educational and physical support.

A Cultural Set-up

The doulas commented that the problems of the postpartum phase are a cultural issue and that there needs to be more acknowledgement of what actually happens to a woman in this phase. They added that the mainstream individualistic culture of the United States leaves women thinking that they cannot ask for help and that there is no empathy for new mothers. One doula stated that "it is a set up for them to feel like they are failing." She continued, "Mothers don't know that this is a time when they can stop being the hostess, house cleaner and cook." They will sacrifice bonding and nursing for keeping the house going and guests happy. One doula stated that women, even those with financial means, ask, "Do I deserve this doula care?” She added that she often hears new mothers say that they "hate to ask for help." According to the doulas, this leads women to think that they should be able to “do it all” in the postpartum period. As a result, an educational part of what doulas do is to let mothers know that it is OK to ask for what they need. They support the mother emotionally in understanding this and then model it in physical ways.

New Mothers Need to Be In-relation

The number of mothers in this study who mentioned feelings of isolation during the postpartum phase speaks to the idea that new mothers do best when they are in-relation in the postpartum phase. The doulas interviewed had observed similar reactions in their work across socioeconomic lines.

Yet the majority of mothers in this study also found it hard to accept the doula's physical support. One mother exemplified this when she spoke about her doula bringing her a meal in bed:

"There was some awkwardness for me maybe around being taken care of and…served. I certainly didn't think of her as a servant at all… I felt sort of privileged…I remember she and I talking about that, it made me feel like this is the most powerful intervention any one could have."

Because of the mothers’ awkwardness at being taken care of, the doulas often found themselves re-contextualizing the postpartum phase through a self-in-relation modality, allowing the mother to reframe for herself what it means to be dependent at this time and to realize that it is not a negative.

It is interesting to note that a lot of the women in this study were strongly identified with being independent and disliked needing to rely on others in the postpartum phase. While Jordan et. al. (1991, 1997) saw women as being in-relation, the mothers in this study still seemed to be strongly identified with being independent. On the other hand, their postpartum doula's support brought them tremendous relief. In effect, the new mothers in this study seemed to be caught between the need to be in-relation and the need to be independent and self-reliant. This tension was amplified by the fact that they were coming to terms with their baby's reliance on them. These new mothers seemed to be discovering and adjusting to their newfound identity as mothers, leaving behind their independent adult identity and facing their newfound status as being in-relation to their child, to other women, and to themselves.

The mothers in this study were also surprised to find such a strong need for emotional support at this time. Most of them were very grateful to receive this kind of support from their doula. Most came to understand that they do not have to become mothers in isolation. Accompanying this was the recognition by some of the mothers that they felt comfortable with being in relation. As such, the postpartum phase can be an opportunity for women to experience healthy dependency.

Women Thrive on Connection

Women should not be expected to mother their newborns alone. Instead of beginning life as a mother in a state of isolation and anxiety, new motherhood can begin in a state of connection. A postpartum doula can be the catalyst for a shift in a woman’s experience of this phase of life. The doula does this by helping a woman come into contact with an important facet of her womanhood, one that is about fostering connections to others. It is these connections that give the mother the emotional room to discover her baby and herself in a new way.Thus she is given the tools to work toward a smooth transition into matrescence.

References

Jordan, J.V., Kaplan, A. G., Miller, J. B., Stiver, I. P. & Surrey, J. L. (1991). Women's growth in connection, writings from the Stone Center. New York: Guilford.

Jordan, J. V. (1997). Clarity in Connection: Empathic knowing, desire and sexuality. In Women’s Growth in Diversity: More Writings from the Stone Center. J. V. Jordan (Ed.) New York, Guilford Press.

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