Certified Postpartum Doula (CPD)


Introduction

CAPPA is an international certification organization for Doulas, Childbirth Educators and Lactation Educators. Since our foundation in 1998, we have certified thousands of perinatal professionals. As one of the first and most comprehensive perinatal organizations in the world, CAPPA is respected for its longevity and its commitment to excellence in both education and unsurpassed student and member support. Choosing an organization for your education is an important decision. CAPPA offers stability that you can be confident in as you invest in your education and career.

POSTPARTUM DOULA SCOPE OF PRACTICE


The CAPPA Certified Postpartum Doula


CAPPA Postpartum Doulas fill an important role in providing emotional, physical, and evidence-based informational support to the new family after the birth of their baby.


How CAPPA Postpartum Doulas work with families


The Postpartum Doula works with families in the postpartum period; offering support, information, instruction, comfort, and referrals as needed. Postpartum Doulas support the mother’s recovery, give instruction on infant care and feeding, and assist with household organization. Postpartum Doulas can be found working in the community in private practice, in cooperatives, as part of groups or agencies, as well as serving in various community programs.


How CAPPA Postpartum Doulas work within the healthcare system


Postpartum Doulas are skilled support persons who act as consultants and resources, not clinicians. They therefore work with the healthcare system by encouraging and promoting excellent communication between the new family and the health care team, encouraging informed decision making and self-advocacy, supporting the choices of the new family, providing non-clinical care, and offering appropriate referrals when their observance or counseling uncovers situations that require healthcare attention or support.


Clinical Limitations of CAPPA Postpartum Doulas


CAPPA Postpartum Doulas are non-clinical professionals. CAPPA Postpartum Doula courses do not qualify a professional to act as a medical care provider. CAPPA Postpartum Doulas do not dispense medical advice, diagnose medical conditions, interpret medical diagnoses or clinical results, perform clinical procedures, or prescribe/administer medications or treatments of any kind.


CAPPA Standards


CAPPA Postpartum Doulas work within the CAPPA’s standards of practice to uphold the following (available to read as individual documents): code of conduct, a grievance policy, mission statement, vision statement, organization philosophy, and social media policy. CAPPA Postpartum Doulas use current evidence based information in their practice. They maintain their knowledge and skills through continuing education. They work within the legal framework of their individual community and region.


CAPPA Postpartum Doulas:



  • Provide non-biased emotional, physical, and informational support during the postpartum period

  • Encourage the family to seek care that reflects their values and needs

  • Models and teaches effective communication

  • Encourage informed decision making

  • Support the physical and emotional healing of the mother

  • Provide information on care options and resources for the mother and newborn

  • Support and assists with infant feeding

  • Educate the family on newborn care and characteristics

  • Provide support to the new mother’s partner and/or family

  • Assist with household organization

  • Refer to healthcare professionals when support requires clinical assessment, a need for prescription, or medical diagnosis


 CAPPA Postpartum Doulas do not:



  • Diagnose medical conditions

  • Interpret medical diagnoses or clinical results

  • Prescribe or administer treatment of medical conditions

  • Perform clinical procedures, including: taking infant’s temperature or administrating medications to infant or mother

  • Take over complete care of the infant, including: buckling infant into car or car seat and cutting infant’s nails

  • Transport any family members

  • Stay alone with babies or other children

  • “Sleep train” babies

  • Act as a housekeeper or nanny


POSITION PAPER


Evidence-based Postpartum Doula Care


Introduction


Many birth professionals feel the postpartum adjustment period lasts well into the first year, making the fourth trimester the longest. In her book Mothering the New Mother, Sally Placksin states “It seems more accurate and more realistic to offer women a broad timetable of postpartum cushioning that covers the first twelve months of new motherhood. Some women will feel that they have settled in a shorter period of time; others will find it might take longer, depending in what kind of support they have to help them.”


When considering birth in industrialized societies, birth is relegated to three trimesters. Rarely is the final and most life altering time period, the postpartum period or fourth trimester considered. By medical definition, the postpartum period is the six weeks following the birth of a baby or completion of pregnancy. This is the period where the woman’s body returns to its pre-pregnant state. Many birthing professionals recognize that this adjustment period is not only physical but also emotional, intellectual and relational.


The impact of rituals on the physical, emotional, intellectual and relational aspects of the postpartum period is undeniable. Research indicates that the lack of effective rituals of reintegration may be a cause of postpartum disorders. The transitional adjustment period between birth and parenthood should include rituals such as baby care basics, the role of the new family, emotional support, breastfeeding or bottlefeeding support, and maternal mentoring. These rituals, when present in sufficient quantity, empowers society by empowering the family unit by increasing the confidence level and increasing the incidence of positive parenting experiences.


In many cultures, women and their families are cared for and nurtured by the community around them for weeks, and sometimes months after the birth of a new family member. Women living in kinbased communities adhere to customary postpartum rituals and typically do not experience postpartum disorders. They also tend to breastfeed their babies for a longer period of time and feel closer to their infants than women who have had no support. Strong social support is vital.


In today’s mobile society, extended families do not live close and may be unable to provide care for the new family. New parents may expect medical professionals to provide not only informational support but also educational and physical/emotional support outside of the hospital setting. When this support from family or professionals is lacking, mentoring is then lost. This is where the postpartum doula can be an invaluable resource, by bridging the gap and providing the missing mentoring opportunity.


From Marshall H. Klaus, John H. Kennell and Phyllis H. Klaus in Mothering the Mother, “Most studies show that a person’s previous history or a family history of psychiatric problems increases the chances of postpartum depression. In most cases, however, psychosocial factors are important. The woman may be experiencing bereavement, the effects of unemployment or inadequate income, unsatisfactory housing, or unsupportive relationships. The experience of childbirth may have aroused memories of a past stillbirth or miscarriage, abortion or death of her mother. When a woman has had a poor relationship to her own mother or was separated from one or both parents before the age of eleven, she is more likely to be depressed and anxious. Another factor may be the woman’s inability to confide in her partner or a friend. Women are often embarrassed to tell another how badly she feels. Loneliness, isolation and lack of support are serious contributors to postpartum depression. Some mothers may find it difficult to reconcile the realities of mothering with their prenatal fantasies.”


The Role of the Doula


Although some families have all the support they need from their extended families and community, this type of care can be rare. When family members are not able to provide the support during the postpartum period, the Postpartum doula is a viable option. Postpartum doulas are knowledgeable professionals who assist families during the critical period immediately after the birth of their baby. They “mother the mother” and offer physical, emotional and informational support to the family as well as practical help. The doula’s expertise in mother and baby care enables her to assist with postpartum comfort measures, breastfeeding support, non-judgmental guidance in infant care techniques, information on normal postpartum restoration, and family emotional assistance through this major transition.


Postpartum doulas are trained to know when things are not progressing normally and how to utilize available resources plus suggest referrals for help when appropriate. Doulas have a deep respect for the family structure and know how to balance information and help in a way which empowers the new parents to care for their own baby while at the same time offering guidance and support.. In turn, this gives the parents a sense of accomplishment and success in their parenting skills. While fulfilling this role, the doula may also perform light household chores, provide meal preparation, sibling care and parent education, all while nurturing the family in a nonjudgmental, objective way.


The postpartum doula does not provide medical care for the mother or baby, however she may provide extensive information regarding maternal/child health during the normal postpartum period. The postpartum doula should be well acquainted with the professionals in her community who can help the postpartum family, such as physicians and midwives, lactation consultants and educators, pediatricians, counselors and support groups. Her vast knowledge of the birth and postpartum process makes the postpartum doula a valued member of the birth team.


CAPPA Training and Certification Process


Critical to a comprehensive training and certification program is the quality of the evidence-based standard of care and scope of practice. Persons interested in pursuing a career in postpartum care should investigate certifying organizations for philosophy, inclusiveness, perspectives, researchbased curriculum, efficacy of trainers, and follow-up during the certification process and postcertification. Training for postpartum doula care should include but not be limited to newborn care and feeding methods, comprehensive care of the postpartum woman, infant development, postpartum depression, support of the postpartum family, coping skills, developing resources, working within the birthing community, and business development skills.


Conclusion


With changes taking place in the family structure over many years, and new families not having the resources available to them as in the past, the postpartum doula is making a significant impact on the process that takes place in the postpartum period. All the research seems to indicate this to be a very positive impact. The fourth trimester can be a very turbulent time for some families in that they have limited resources for support. The postpartum doula fills a void left by families not being close enough or able to offer help, and reassurance while parents adjust to their new role and responsibilities. New families deserve the support and encouragement a postpartum doula can give.


References



  • Bernazzani O, Saucier JF, David H, Borgeat F. Psychosocial predictors of depressive symptomatology level in postpartum women. Journal of Affect Disorders 1997 Oct;46(1):39-49

  • Brugha TS, Sharp HM, Cooper SA, Weisender C, Britto D, Shinkwin R, Sherrif T, Kirwan PH. The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey. Psychol Med 1998 Jan;28(1):63-79

  • Carty, Elaine & Bradley, Christine. A Randomized Controlled Evaluation of Early Postpartum Hospital Discharge. BIRTH 17:4, 199-204. December 1990.

  • Davis Floyd, Robbie. Birth As An American Rite of Passage. University of California Press. 1992.

  • Deshpande, Anjali D. & Gazmararian, Julie A. (2000). Breastfeeding Education and Support: Association with the Descision to Breastfeed. Effective Clinical Practice. Dorland’s Medical Dictionary, 24th Edition, Saunders.

  • Fisher JR, Feekery CJ, Rowe-Murray HJ. Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. J Paediatr Child Health 2002 Apr;38(2):140-5

  • Hodnett, Ray KL (2002). Caregiver support for postpartum depression. Cochran Review.

  • Holopainen D. The experience of seeking help for postnatal depression. Aust J Adv Nurs 2002 MarMay;19(3):39-44

  • Klaus, M., & kennell, J. (1985). Bonding. Reading, MA. Addison-Wesley.

  • Klaus, M.H., Kennell, J.H., & Klaus, P.H. (1997). Mothering the Mother. Reading, MA: AddisonWesley.

  • Klaus, M.H., Kennell, J.H., & Klaus, P.H. (1995) Bonding: Building the Foundations of Secure Attachment and Independence. NY. AddisonWesley.

  • Kleiman, K. (1994). This Isn’t What I Expected. USA. Bantam.

  • Kennell-Tackett, Kathleen (1996). When a new mother is depressed. Leaven. 32 (3), 35-37.

  • Lim, Robin After the baby’s birth: A woman’s way to wellness. Celestial Arts. 1991.

  • Logsdon MC. Helping hands. Exploring the cultural implications of social support during pregnancy AWHONN Lifelines 2000 Dec-2001 Jan;4(6):29-32

  • Meyer BA, Arnold JA, Pascali-Bonaro D. Social support by doulas during labor and the early postpartum period. Hospital Physician September 2001.

  • McArthur, Christine. (2002). Women’s psychological wellbeing could be significantly improved, and depression reduced at 4 months after birth in women who had redesigned care. Lancet. 359 (9304) 370-371 & 385-87.

  • McCarty, E. Early postpartum nursing care of mother and infant in the home care setting. Nurs Clin North America 1980: 15:361-372.

  • McIntosh, J. (1993). Postpartum depression: Women’s help-seeking behavior and perceptions of cause. Journal of Advanced Nursing, 18, 178-84.

  • McVeigh C. Motherhood experiences from the perspective of first-time mothers. Clinical Nursing Research. 1997 ;6:335-348.

  • Middleton, W. et al. Postpartum Doula Office: Essential Documents for the Postpartum Doula. 2001. Perinatal Education Associates.

  • Miller, MD, Laura. (1996). An update on postpartum mood disorders.

  • Montagu, A. (1986). Touching: The Human Significance of the Skin. New York. Perennial Library.

  • Panzarine S, Slater E, Sharps P. Coping, social support, and depressive symptoms in adolescent mothers. Adolesc Health 1995 Aug;17(2):113-9

  • Placksin, Sally. (1994, 2000). Mothering the New Mother. 1st and 2nd editions. NY. Newmarket Press. Raphael, D (1973). Breastfeeding: The Tender Gift. NY: Schocken Books.

  • Ryan, Alan S. (1997). The resurgence of breastfeeding in the United States. Pediatrics. 99 (4).

  • Sears, W., & Sears, M. (1993). The Baby Book. USA. Little-Brown. Seguin L, Bouchard C, St-Denis M, Loiselle J, Potvin L. Social support network evolution after the birth of their first baby: comparison between lower and middle class mothers. Can J Public Health 1995 Nov-Dec;86(6):392-6

  • Stephen Matthey, BSc (Hons), MPsych, PhD, Mary Morgan, BAppSc, OT, Loretta Healey, Bsw, Bryanne Barnett, MD, David J. Kavanagh, PhD and Pauline Howie, PhD Postpartum Issues for Expectant Mothers and Fathers JOGNN, 31, 428-435; 2002

  • Tarkka MT, Paunonen M. Social support provided by nurses to recent mothers on a maternity ward. J Adv Nurs 1996 Jun;23(6):1202-6

  • Viinamaki H, Niskanen L, Pesonen P, Saarikoski S. Evolution of postpartum mental health. Department of Psychiatry, Kuopio University Hospital, Finland. J Psychosom Obstet Gynaecol 1997 Sep;18(3):213-9

  • Wolman WL, Chalmers B, Hofmeyr GJ, Nikodem VC. Postpartum depression and companionship in the clinical birth environment: a randomized, controlled study. Am J Obstet Gynecol 1993; 168: 1388-93.


 


This Position Paper was written by CAPPA Director of Postpartum Doula Programs, Crystal Sada and approved by the CAPPA Board of Directors. Copyright remains with CAPPA, PO Box. 491448, Lawrenceville, GA 30043. 1888-548-3672, www.cappa.net.


Copyright CAPPA 2002. CAPPA hereby grants permission for reprint with complete attribution.


TRADITIONAL (IN-PERSON) COURSE


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TRADITIONAL (IN-PERSON) COURSE


This course is designed for students who choose to take the in-person training class.



Course Requirements



  • 2 years to complete your course from the date of your CAPPA in-person training class.

  • CAPPA certification candidates must be at least 18 years of age. No person under 18 years of age may attend CAPPA training classes.

  • Be a member of CAPPA.

  • Enroll in the Postpartum Doula Traditional Course in CAPPA Academy.

  • Attend a CAPPA Postpartum Doula training class.

  • Read the CAPPA Postpartum Doula training manual and the required books from the CAPPA required reading list.

  • Complete Part I of the HUG Your Baby Training.

  • Order, read, and watch the video clips from the Mother and Baby Care booklet available in the CAPPA shop. Details/forms are provided within CAPPA Academy.

  • Proof of current infant and child CPR certification through the American Heart Association or the Red Cross.  In-person class WITH mannequin practice required.

  • Submit three evaluations from postpartum doula clients. Details/forms are provided within CAPPA Academy.

  • Two letters of recommendation from professionals. Details are provided within CAPPA Academy.

  • Order, read, and complete all online content, including videos, from the Understanding Breastfeeding Book, available in the CAPPA shop. Details/forms are provided within CAPPA Academy.

  • Create a resource list with information on local support for parents. A guide for creating this list is included within CAPPA Academy.

  • In order for candidates to be eligible for CAPPA certification they must sign and agree to the following forms: Code of Conduct and Social Media Policy, Grievance Policy, Mission Statement, CAPPA Approach / Philosophy Statement, Vision Statement, and Scope of Practice.

  • Pass the multiple choice exam and essays in CAPPA Academy. An 85% passing grade is required.

  • Please view all of CAPPA’s Policies and Procedures.


ONLINE DISTANCE LEARNING COURSE


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ONLINE DISTANCE LEARNING COURSE


This course is designed for students who are unable to take the in-person training class.



Course Requirements



  • 2 years to complete your course once you enroll.

  • CAPPA certification candidates must be at least 18 years of age.

  • Be a member of CAPPA.

  • Enroll in the Online Distance Learning Course.

  • Read the CAPPA Postpartum Doula training manual, the required books from the CAPPA required reading list, and watch the required DVDs.

  • Complete Part I of the HUG Your Baby Training.

  • Proof of current infant and child CPR certification through the American Heart Association or the Red Cross.  In-person class WITH mannequin practice required.

  • Submit three evaluations from postpartum doula clients.

  • Two letters of recommendation from professionals. Details are provided within CAPPA Academy.

  • Order, read, and complete all online content, including videos, from the Understanding Breastfeeding Book, available in the CAPPA shop. Details/forms are provided within CAPPA Academy.

  • Create a resource list with information on local support for parents.

  • In order for candidates to be eligible for CAPPA certification they must sign and agree to the following forms: Code of Conduct and Social Media Policy, Grievance Policy, Mission Statement, CAPPA Approach, Vision Statement, and Scope of Practice.

  • Pass the multiple choice exam and essays. An 85% passing grade is required.

  • Please view all of CAPPA’s Policies and Procedures.


DUAL/TRANSFER COURSE


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DUAL/TRANSFER COURSE


This course is designed for students who have already been certified or have trained with DONA. (Documentation required.)



Course Requirements



  • 1 year to complete your course once you enroll.

  • CAPPA certification candidates must be at least 18 years of age.

  • Be a member of CAPPA.

  • Enroll in Postpartum Doula Dual/Transfer Course in CAPPA Academy.

  • Read the CAPPA Postpartum Doula training manual and the required books from the CAPPA required reading list.

  • Complete Part I of the HUG Your Baby Training.

  • Order, read, and watch the video clips from the Mother and Baby Care booklet available in the CAPPA shop. Details/forms are provided within CAPPA Academy.

  • Proof of current infant and child CPR certification through the American Heart Association or the Red Cross.  In-person class WITH mannequin practice required.

  • Submit three evaluations from postpartum doula clients. Details/forms are provided within CAPPA Academy.

  • Two letters of recommendation from professionals. Details are provided within CAPPA Academy.

  • Submit a 300-500 word essay on CAPPA’s Postpartum Doula Scope of Practice.

  • In order for candidates to be eligible for CAPPA certification they must sign and agree to the following forms: Code of Conduct and Social Media Policy, Grievance Policy, Mission Statement, CAPPA Approach / Philosophy Statement, Vision Statement, and Scope of Practice.

  • Pass the multiple choice exam and essays. An 85% passing grade is required.

  • Please view all of CAPPA’s Policies and Procedures.


The Executive Director for the Postpartum Doula Program is Laura Nance (cpddirector@cappa.net).

PHONE: 770-965-9777
EMAIL: INFO@CAPPA.NET

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