The Fourth Trimester and the Postpartum Doula

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You might not have heard of either before. I’m pleased to shed some light on the two.

The real last trimester

Women enter what is called the fourth trimester, after the birth of their new baby. The first three months postpartum are an extension of life in the womb for your newborn. Remember that during all of those weeks inside of you, your baby had her every need met: she was fed when hungry, soothed when you walked about, and fell peacefully asleep to your beating heart each day. The postpartum period is a sensitive and tender time: you are recovering from the hormonal and bodily changes during your pregnancy and the immense effort that you put forth in labor. It’s an equally important time for your baby to adjust to her new environment and new ways of receiving nourishment. Thankfully you and your baby have nothing else to do but get acquainted and get taken care of mutually.

Erica Shane and Twins

Postpartum healing for a new mom usually takes a minimum of 6 weeks to occur, yet it is more than likely that you will experience a slower recovery of 3 months or more. This is normal. In many cultures around the world, the fourth trimester is recognized as a special time—a time in which a mother is acknowledged as being born too. Baby and mom are enveloped in the warmth of home, and nurtured in a myriad of ways so that the process of adjustment and healing can be all the easier. There are many holistic practices and customs worth investigating that allow for women to be revered for the new journey they are beginning.

In the modern world, women are lucky to be able to take bits and pieces from traditional models of postpartum wellness. It is encouraged by doctors and midwives alike that women take at least a couple of weeks just to focus on learning and caring for their little one, while allowing the body to recuperate. For some women, this may seem more than challenging. Family may be far away, friends are busy or they just may have a different style. The dad may also need time to adapt to the new situation and may not be experienced at caring for others while juggling the demands of a new baby. A new mom might learn that she needs a steady, neutral presence as she learns to breastfeed, understand her baby’s cues, and heal physically from her birth.

With a non-judgmental ear beside her, a woman can feel less vulnerable as her hormones work hard to support every cell and organ in her body, returning it to it’s pre-pregnancy state. A tired mom will do very well sleeping while her baby sleeps, giving mundane tasks to a helper, and seeking support even with small concerns before they may become bigger. She will thrive on encouragement and reminders of the normalcy of her process.

The postpartum doula

On a deep level, the postpartum doula is a caregiver skilled in protecting the delicate nervous systems of both mother and infant. She is conscious of the family as a whole, hearing both the mother and father’s concerns. A new family might have many questions about their baby’s growth and development, reading baby’s cues, learning ways to soothe her to sleep or ways to stimulate her during a feeding. Other questions about newborn care involve positioning for burping, ways to swaddle, how to soothe a colicky baby, and umbilical cord care, bathing, diapering, circumcision healing, or bottle feeding advice.

Many people view the postpartum doula as the one who “mothers the mother.” The idea here is that the better cared for the mother, the easier her task in adjusting to her new role and caring for her newborn on her own.

A postpartum doula moves with grace and stealth in the home. Her duties range from assisting with latching and positioning in a breastfeeding session to brewing the postpartum tea that her client has asked her to prepare in order to soothe her nerves and promote milk flow. If the mom is engorged on day 4 when her milk comes in, her doula will teach her breast massage and other tips for easing the discomfort and passing the milk more comfortably to her baby. On another day, a mom might have many questions about her birth, seeking insight into what happened and how to celebrate and move forward. A mother might have a perineal tear, hemorrhoids, or cracked nipples that call for daily attention and her doula will be glad to develop a healing protocol that the mother is comfortable with. Your doula might love to cook, and will offer you a menu of dishes rich in nutrients especially important for your postpartum recovery, including nutrients to build blood and to promote healing.

If you have a cesarean birth, additional time is needed for muscular healing and you are encouraged to be on bed rest as you learn to care for your child. Your doula will hold and soothe your baby while you rest. She will prepare foods and/or share recipes to build your iron levels. She will listen to you and offer insight on your healing. She will remind you what is normal.

Your postpartum doula will definitely share information on appropriate postpartum exercises according to the week, and will provide education on signs of postpartum blues and depression. She will cross every bridge with you and make sure you get across safely. She will usually have a partnership with an IBCLC (international board certified lactation consultant) so that if there are tongue tie problems, poor milk flow, an impending mastitis issue, or complications with pumping she will have an expert to call right away.

Your postpartum doula will offer practical support for your baby and your own wellness in the first days home, tips for navigating through sleepless nights, baby care while you rest, and she might even offer overnight care! Many doulas are trained in healing modalities in the case that a mom might need a 20 minute foot rub, or a moment of guided relaxation. This can be so valuable for a mom needing a bit of tender loving care, the kind she has been pouring out continuously herself since she met her newborn for the first time.

A postpartum doula is there to nurture the couple, to offer them non-judgmental emotional support and advice, and to help unearth the confidence they need in their new role and life. Parents are encouraged to develop their own parenting style and to practice self-care while maintaining a healthy rhythm with newborn care.

Your doula might visit you in the hospital after the birth of your baby to help with initial bonding, seeing that you feel calm, confident and well informed. Or she may come over around the first day or two that you arrive home. She is always only a phone call and words of advice away.

A postpartum doula works with couples adopting and/or using surrogacy to adopt a baby (or two!). She will help you find donor milk or will seek out the best newborn formula, depending on your preference. She will mold her packages to fit your needs. For example you might need your doula to take care of your baby while you do passport paperwork, or get a much needed massage and dinner with your partner. You may need half of the session to chat and learn about newborn care, and the other half to go for a much needed swim. Your doula knows that all couples need to nurture themselves too during an adoption process. She will remain emotionally present with you the whole way through.

Supporting couples in the postpartum period is as vital as your prenatal care and attention. The same ideas about being present and hearing your own intuition in pregnancy/labor are the keys to living with a new baby. No matter if it is your first baby or not you deserve support in the postpartum period.

If you know that you can use in-home doula support after the birth of your baby, first consider what type of support you might need. Do you know you will need breastfeeding support and sibling care? Will you also appreciate a chef and someone trained in healing modalities? Would you like a visitor 3x a week? Ask the doula about her postpartum experience. Will she understand where you are coming from and walk the path with you even if she wouldn’t make those decisions for her own family? Has she worked with same sex couples before? Has she worked with surrogacy cases? Does she make you smile? When you speak over the phone or meet with potential caregivers, express your needs, learn about their offerings, and you will know if it’s a good fit. It’s about connecting with that caregiver more than anything, feeling supported from the very start.

Where does the term ‘Doula’ come from?

The original Greek word “doula” has changed in scope since its introduction in Dana Raphael’s book, The Tender Gift: Breastfeeding, published in 1973. Raphael had written about the lack of breastfeeding support in the US maternity care system and it’s comparatively low success rates compared to Europe. Through her research of birth and caregivers around the world, she coined the term “doula” which is a Greek term originally meaning servant. She found that in ancient Greek households, a doula was a woman in the highest level of servitude to women in the home, basically a female slave. Doulas were an integral part of the home who assisted women during childbirth and child-rearing. The term “doula” was used initially outside of Greece to describe a postpartum doula: a woman who visits the home, teaching and reassuring new mothers about breastfeeding and postpartum recovery. The term “doula” has now expanded to encompass a woman dedicated to providing physical, emotional, informational, and advocacy support to women during the pre-, peri-, and postnatal periods. The use of doulas is gaining popularity throughout North America and around the globe.

Photo Credit: Mitya Ku via Compfight cc

Erica Shane
Erica Shane is a seasoned labor and postpartum doula, originally based in NYC. She has spent the last seven months in Asia supporting women and their partners in the tender and exciting moments of childbirth and new parenthood. With a passion for holistic care giving and bringing birth back to the family, Erica is dedicated to each and every family she serves, understanding the distinct needs and wishes each one brings. For information on her 2014 work schedule, and other links to practitioners in the birth world of Bangkok, contact her at and do not forget to peruse the valuable resources on her website:


  1. Juliet  /  August 12, 2015, 9:40 am Reply

    Hi, I found your website online and wanted to make an enquiry whether any of your doulas can perform the following:

    Postnatal massage with hot compress
    Tummy binding (such as bengkung)
    Herbal baths for stitches etc
    Cooking confinement food etc.

    These are more traditional practices and I wanted to know if anyone could do a variation of these things, either typical Thai style or orher.
    We have a lot of help with the baby so this is what’s most important to us.
    Thanks for getting back to me! All the best,

  2. admin  /  August 13, 2015, 2:23 pm Reply

    Thank you for your interest in our medical services.

    We support the use of a doula and are glad to answer any and all questions you may have. If you require more information from the author of this article, you can contact her regarding her services at the following website:

    In terms of pain management, our hospital has many pain management programs to explore before childbirth.

    These programs can take place inside the waiting room/labor room. After childbirth, the hospital guides women through the breastfeeding process and provides advice should breastfeeding be difficult for the mother or child.

    It is important to us to make this transition as seamless as possible so that mother and child can continue the feeding process at home. Should the process continue to prove difficult, we have a specialist at the lactation clinic inside the hospital to consult further.

    Your comfort is important to us, and we believe that all mothers should breastfeed their children and are glad to guide you.

    Explore our new birth unit at

    Thank you.

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