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A Guide to Choosing Doulas and Baby Nurses

California Pacific Medical Center encourages a good working relationship with doulas assisting births in our Family Birthing Center.

With the assistance of staff and local doulas, we've developed our Birth Doula Scope of Practice Guidelines based on positions outlined by the major doula organization, Doulas of North America (DONAOpens new window). If you are planning on using a doula with your birth, please review our guidelines with your doula and medical care provider. You may also find My Birth Day Preferences useful when planning for your birth. For more information on selecting a doula, see the information below:

Some women choose to have extra support during or after their delivery by these individuals. We have included situations in which a birth doula, baby nurse or postpartum doula may be beneficial so that you can assess whether you may need one. You will also find interview questions and details about the services provided and accreditation for doulas and baby nurses.

What is a Birth Doula?
Will I Need a Birth Doula?
What Services Does a Birth Doula Provide?
Where Can I Find a Birth Doula?
Hiring a Birth Doula
What Is a Baby Nurse and Postpartum Doula?
Will I Need a Baby Nurse?
What Services Does A Baby Nurse Provide?
Will I Need a Postpartum Doula?
What Services Does a Postpartum Doula Provide?
Where Can I Find a Baby Nurse or Postpartum Doula?
Hiring a Baby Nurse or a Postpartum Doula
Resources
Authors

Birth Doulas

What is a Birth Doula?

Birth doulas provide physical, emotional and informational support to women and their partners during labor and birth. A birth doula is a woman who is experienced in and has knowledge of childbirth. A birth doula is not medically trained, however, there are several agencies in the United States that certify birth doulas such as the Association of Labor Assistants and Childbirth Educators (ALACE), Doulas of North America (DONA) and Childbirth, and Postpartum Professional Association (CAPPA). The certification processes includes workshops on labor and birth, textbook reading and exams, labor support under the guidance of a certified birth doula, evaluations from clients and/or medical professionals. Once certified, a birth doula may assist during a birth.

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Will I Need a Birth Doula?

If you feel overly anxious about your knowledge and ability to manage the process and pain of childbirth, have specific ideas about the birth process, are uncertain about your ability to think and act when under pressure—and do not have a partner, family or friend who could support you in this way—then hiring a birth doula could provide the reassurance you need to have a safe and satisfying childbirth.

Some considerations for hiring a birth doula include:

I want my partner to have the support needed to assist me during labor and birth;
I have little or no support during labor and birth;
I feel unusually anxious about labor and birth;
I have had a previous difficult labor and birth;
I need extra support to help me make decisions during labor and birth.

What Services Does a Birth Doula Provide?

A birth doula acts as a liaison between parents and the health care team to support the parents in having a safe and satisfying childbirth experience. She is:

Experienced, by attending a high number of births;
Knowledgeable about the various techniques used during the different phases of labor, about her own philosophy of labor and what techniques have been successful for her;
Knowledgeable about the equipment and procedures used in labor and birth.

Where Can I Find a Birth Doula?

To locate a birth doula, first speak with your obstetrician for recommendations. The organization, Doulas of North America (DONA) also maintains a list of doulas for each state.

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Hiring a Birth Doula

Because you and your birth doula will be working together closely, you want to ensure that you share the same philosophies regarding childbirth and that you will have the support you require. When interviewing a birth doula, consider the following questions provided by Doulas of North America:

What training have you had?
Tell me (us) about your experience with birth, personally and as a doula.
What is your philosophy about childbirth and supporting women and their partners through labor?
May we meet with you to discuss our birth plans and the role you will play in supporting me (us) through childbirth?
May we call you with questions or concerns before and after the birth?
What care providers have you worked with? In what hospitals have you attended births?
When do you try to join women in labor? Do you come to our home or meet us at the hospital?
Do you meet with me (us) after the birth to review the labor and answer questions?
Do you work with one or more backup doulas (for times when you are not available)? May we meet them?
What is your fee? Is any part of your fee refundable if you do not attend the birth?
Can you provide references? (Be sure to check the references.)

Birth doula fees vary and include a minimum of two prenatal visits in your home, presence at labor and birth and one postpartum visit. Insurance companies may cover doula fees, so check with your insurance provider. Birth doulas contract with parents up to six months before the due date. They are on-call for one week before to two weeks after the due date.

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Baby Nurses and Postpartum Doulas

What Is a Baby Nurse and Postpartum Doula?

Baby nurses and postpartum doulas provide care to both mother and baby when the baby returns home from the hospital. They are experienced and knowledgeable about the care of infants and provide valuable education, support and guidance to parents for the first weeks of the baby’s life.

There are differences between baby nurses and postpartum doulas in terms of their education, training, focus of care and type of experience they have had with parents and infants.

A baby nurse holds either an LVN (Licensed Vocational Nurse) or an RN (Registered Nurse) degree from an accredited university. An LVN completes one to two years of nursing training and works in the field of obstetrics, including postpartum care and the newborn nursery. An RN completes two to four years of nursing training and works in all areas of obstetrics, including postpartum care, high-risk antepartum care, well-baby nursery, transitional care nursery (TCN) and the Neonatal Intensive Care Unit (NICU). A baby nurse’s work experience has greater importance than the level of her degree.

A postpartum doula refers to those with little or no formal training and those with professional training under the guidelines of organizations such as Doulas of North America (DONA), Childbirth and Postpartum Professional Association (CAPPA) or the National Association of Postpartum Care Services (NAPCS). A certified postpartum doula has successfully completed a training course, reading materials, CPR/First Aid and breastfeeding classes, and has provided postpartum care and received evaluations from both clients and healthcare professionals. A postpartum doula’s work experience has greater importance than her level of formal training and certification.

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Will I Need a Baby Nurse?

Some babies face unusual challenges in the first months of their lives. Prematurity, genetic disorders or other medical conditions can present life-threatening risks to these infants. Discharge from the hospital indicates that your child has overcome the most serious threat to his or her young life, yet many infants require close monitoring and care by a knowledgeable, trained and experienced baby nurse.

A baby nurse can also assist parents of healthy babies. She has a wealth of information and teaching skills, including infant feeding and sleep patterns. A baby nurse helps parents identify potential problems for their newborn and presents options for resolution. A baby nurse facilitates breastfeeding for the new mother, understands the ‘postpartum phase’ of pregnancy and can support a mother in sorting out ‘real’ from ‘imagined’ worries about her baby. A baby nurse provides comfort and reassurance to a first-time parent–allowing the mother to learn about her baby through the important first weeks of her newborn’s life.

If you are carrying a high-risk pregnancy, consult with your obstetrician about the likelihood you would need a baby nurse for assistance when the baby arrives home. If your infant is in the Neonatal Intensive Care Unit (NICU) or Transitional Care Nursery (TCN), consult with your neonatologist, the NICU or TCN nurses. If you are parents of a healthy newborn, you may want an experienced, trained baby nurse to assist you in knowing about your baby and yourself during the first few months of your baby’s life.

Some considerations for hiring a baby nurse include:

My primary concern is teaching and guidance about the care of my newborn.
I am a first-time parent without enough family or friends available for support.
My newborn was born prematurely or with special needs.
I am a parent of multiples.
I have younger children at home.

What Services Does A Baby Nurse Provide?

A baby nurse educates and supports parents, troubleshoots potential issues of concern and offers professional options to resolve them. She:

Understands the “postpartum phase” and supports the mother during this phase;
Promotes a smooth transition from pregnancy to ‘new family’ lifestyle;
Educates and teaches parents to understand their newborn in terms of his or her development and idiosyncrasies;
Understands the newborn’s needs and care routines;
Facilitates newborn breastfeeding and helps resolve breastfeeding problems;
Anticipates issues of concern and poses solutions;
Is attentive, focused and alert in caring for the baby;
Communicates about the baby’s daily routines including feeding, sleep and behavior patterns.

You may want individual assistance from a lactation consultant to better understand your newborn’s breastfeeding patterns and resolve lactation complications that may arise after you have begun breastfeeding. Please contact Newborn Connections at 415-600-BABY for an appointment with one of our lactation consultants.

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Will I Need a Postpartum Doula?

Most parents are surprised at just how difficult parenting a newborn can be! Caring for a baby round-the-clock, with minimal sleep and for weeks at a time puts considerable emotional and physical stress on a parent.

Many women understand little about the ‘post-partum phase’ of their pregnancy and the dramatic hormonal fluctuations that can affect their usual ability to manage stress. Some parents face unusual challenges, such as parents of multiples who must care for two babies at the same time. First-time parents may feel unusually anxious and uncertain about their parenting skills. Parents with young children may find it difficult to tend to these children’s needs during the day after caring for their infant night after night.

A postpartum doula provides infant care and assists with siblings and household activities, allowing you to rest and manage your household and family responsibilities.

If you are a parent of multiples, a first-time parent without family or friends to provide ongoing support, or a parent with young children at home, you may find it helpful to hire a postpartum doula to relieve you for several hours during the day or several nights each week for the first few weeks or months after your baby arrives home.

Some considerations for hiring a postpartum doula include:

My primary concern is getting the rest I need to care for my newborn and manage the household responsibilities.
I am a parent of multiples.
I have young children at home.
I am a first-time parent without enough family or friends available for support.

What Services Does a Postpartum Doula Provide?

A postpartum doula provides infant care, family support and related activities allowing mothers to rest and manage their households. She is:

Attentive, focused, and alert in caring for the baby;
Promotes a smooth transition from pregnancy to ‘new family’ lifestyle changes;
Communicates about the baby’s daily routines: feedings, sleep and behavior patterns;
Washes the baby’s laundry, bottles, and supplies;
Can assist with light housecleaning and light meal preparation, as needed and if possible;
Cares for siblings, as needed.

Where Can I Find a Baby Nurse or Postpartum Doula?

Newborn Connections at California Pacific Medical (415-600-2229) Center has names of agencies that provide baby nurses and/or postpartum doulas, and also has names of private nurses of doulas. While we provide this information, we do not endorse or recommend one individual over another.

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Hiring a Baby Nurse or a Postpartum Doula

Consider the following questions when interviewing prospective baby nurses or postpartum doulas:

What has been your experience caring for newborns?
What kind of training have you had in newborn care?
What do mothers need to know about their babies during the first few weeks of their newborn’s life–how does that change over the next few months?
How do you help the mother and newborn in the first few weeks—and the first few months of their baby’s life? What is a typical day with the mother and her newborn?
Can you tell us about your experience helping mothers breastfeed their newborns? Were their any difficulties and how did you help resolve them?
Can you be flexible if we need extra hours or if we need to change working hours or days?
How do you keep track of feeding and sleep patterns or problems?
What has been your experience caring for multiples? How is this different from caring for single babies? What do I need to know about caring for our twins (triplets) to make the first weeks and months easier for all of us?
What has been your experience caring for medically fragile newborns—premature infants, babies with genetic disorders or other special needs? How is this different from caring for healthy babies? What do I need to know about caring for our medically fragile baby to make the first few weeks and months easier for all of us?

Baby nurses and postpartum doula fees vary with most charging a 4-hour minimum per day. Most work a flexible 4- to 24-hour schedule starting when the baby comes home from the hospital and continuing over a period of time, usually from one week to several months. Some parents schedule their baby nurse or postpartum doula to provide night coverage only while others want a minimum number of hours daily and adjust the hours as needed. Baby nurses and postpartum doulas contract with parents several weeks before the baby is due. Their contract is generally set to start at the baby’s due date, with some flexibility to accommodate an early or late birth.

Please Note: Some nannies have had extensive newborn care experience, either professionally or from raising their own children! You can consider care by an ‘experienced’ nanny as a very good alternative to care by a postpartum doula. Be certain your nanny has attended infant/child CPR/First Aid training within the past year and is current about the recent changes and practices of newborn care.

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Resources

Association of Labor Assistance and Childbirth Educators (ALACE)
P.O. Box 382724
Cambridge, Mass. 02238
Tel: 617-441-2500
Email: ALACEHQ@aol.com

Childbirth and Postpartum Professional Association (CAPPA)
PO Box 491448
Lawrenceville GA 30043
Tel: 888-548-3672
E-mail: info@cappa.net

Doulas of North America (DONA)
Tel: 206-324-5440
Email: AskDONA@aol.com

National Association of Postpartum Care Services (NAPCS)
800 Detroit St.
Denver, CO 80206
Tel: 1-800-45-DOULA
Fax: 303-321-4058
Email: DoulaCare@aol.com

Newborn Connections
California Pacific Medical Center
3698 California Street, 1st Floor
San Francisco, CA 94118
Tel: (415) 600-BABY
Fax: (415) 752-0469
Email: cpmcnewborn@sutterhealth.org

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Authors

The information in this booklet was developed by Alyce Desrosiers, LCSW and Karen Kesti, RN.

Alyce Desrosiers is a licensed clinical social worker with more than 15 years experience working with parents and children. She has been in private practice and has held positions at California Pacific Medical Center, Kaiser Permanente, Ann Martin Children’s Center and UCSF. Since 1998, Alyce has been providing personalized nanny placement services and helping parents through the process of choosing trustworthy nannies and postpartum care for their children. She is a frequent speaker at California Pacific Medical Center, various parenting agencies in San Francisco and Marin County, and author of “Finding a Nanny for Your Child in the San Francisco Bay Area.”

Karen Kesti is a baby nurse with more than 20 years experience. She has worked in postpartum units, newborn nurseries, transitional care nurseries, and the high-risk antepartum units at Brigham and Woman’s Hospital, Stanford University Hospital and California Pacific Medical Center. Karen also provides home care of infants and newborns and, since 1994, has worked exclusively as a baby nurse.

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