Postpartum Doula, Home Visiting Program or Pediatrician: Who Does What After Birth

Day four, and three kinds of questions

It is day four. The baby fed for an hour and still seems hungry. Your stitches ache more than yesterday. The kitchen is full of dishes, your partner is asleep on the couch, and you have just cried in the shower for no reason you can name. Each of those is a real question, and each one belongs to a different person.

After birth, families suddenly have a team, even if no one introduced its members. Your own doctor or midwife. The baby's pediatrician. Perhaps a home visiting program. Perhaps a postpartum doula. Knowing what each one is for saves you from waiting on the wrong person while the right call goes unmade. For the wider picture of the first days home, our post on taking your baby home for the first time is a gentle place to start.

Your OB-GYN or midwife: care that is about you

Postpartum care for your body and mood belongs to the provider who cared for you in pregnancy. The American College of Obstetricians and Gynecologists (ACOG) says postpartum care should be an ongoing process rather than a single visit, and recommends that all women have contact with their obstetric care provider within the first 3 weeks postpartum, followed by ongoing care as needed and a comprehensive postpartum visit no later than 12 weeks after birth.

ACOG lists what that comprehensive visit should cover, including mood and emotional well-being, infant care and feeding, sleep and fatigue, and physical recovery from birth. Bleeding, incision or stitch pain, fever and mood are all questions for this provider, not the pediatrician. If one of the warning signs in the "When to call" panel shows up, you do not wait for a scheduled visit.

The pediatrician: the first visit comes fast

Your baby's doctor sees your baby sooner than many parents expect. The American Academy of Pediatrics (AAP) schedule of well-child care says newborns should have an evaluation within 3 to 5 days of birth and within 48 to 72 hours after discharge from the hospital, including an evaluation for feeding and jaundice, and that breastfeeding newborns should receive a formal breastfeeding evaluation.

After that come visits by 1 month and at 2, 4 and 6 months, and the same AAP schedule includes screening the mother for depression at those early visits. If a questionnaire about your own mood appears at the baby's checkup, that is why. The pediatrician also tracks weight on a growth chart, which the AAP calls one way to tell whether your baby is getting enough to eat.

Between visits, the pediatrician's office, including its after-hours line, is the call for anything about the baby's health: fever, breathing, feeding, diapers, color, sleepiness.

That first visit goes better with notes. Write down when the baby fed, for how long or how much, and how many wet and dirty diapers there were each day, plus any questions that came up at 3 a.m. The AAP calls a newborn's diaper a good indicator of whether they are getting enough to eat, so a simple log gives the pediatrician something real to look at.

Home visiting programs in Arizona

Many parents have never heard of home visiting, and it is worth knowing about. The Arizona Department of Health Services (ADHS) describes it this way: home visiting connects expecting parents and parents of young children with a trained support person; participation is free and voluntary; and families receive regular support and coaching in their own home. ADHS says a visit might include child development information, building positive parent-child relationships, tools for managing stress, and referrals to other resources.

One state program is Health Start, which ADHS says uses community health workers to provide education, support and advocacy to pregnant and postpartum women and their families in targeted communities. Families receive home visits and case management with oversight by nurses and social workers through the enrolled child's second year, and mothers are screened for postpartum depression.

Programs differ by community and not every family will qualify, so ask. ADHS lists the Strong Families AZ Helpline by phone or text at 602-345-0471. If you are hoping for a nurse to visit you at home, ask your hospital, provider or health plan before discharge whether that is offered to you.

Where a postpartum doula fits

A postpartum doula is the non-medical member of the team, and the one who stays for hours. CAPPA, one of the national doula training organizations, says its postpartum doula is not a clinician and does not diagnose medical conditions, interpret medical diagnoses or clinical results, or perform clinical procedures, including taking an infant's temperature. What she does is practical and continuous:

• Hands-on help with feeding routines, positioning, and bottle or combination feeding.
• Newborn care teaching: bathing, soothing, swaddling and safe sleep set-up.
• Protected rest: she settles the baby while you sleep or shower.
• Meals, errands and light housekeeping tied to the baby and your recovery.
• Time with an older sibling.
• Listening, and encouraging you to call your provider when something seems off.
• Help getting to appointments with your questions written down and the diaper and feeding log in hand.

Building your team, and when a doula is not the answer

The roles stack rather than compete. A family might see the pediatrician on day four, hear from the OB's office in week two, enroll in a home visiting program for the longer haul, and have a postpartum doula in the house during the hardest early weeks. Put every number on the fridge before the birth, including the pediatrician's after-hours line.

Doulas of the Valley offers postpartum doula care, daytime and overnight, across Scottsdale, Paradise Valley, Phoenix, Chandler and Maricopa County; our postpartum doula page says we are trained to recognize signs of postpartum adjustment issues, and that recognizing is never diagnosing: the call to your provider is still yours. For what the visits look like in practice, read what to expect from your first postpartum doula visits and what a postpartum doula does.

A doula is the wrong choice if you need someone to check your baby's weight, jaundice or breathing; that is the pediatrician. She is also not a substitute for a free home visiting program if what you want is long-term parenting coaching through the toddler years. And if your mood is the main worry, start with your provider and read the signs of postpartum depression and anxiety.