There are many aspects to the job description of the postpartum doula.
One of the greatest of these is the confidence and education we can give to a family. As you step through the door for the first time post birth, your job is to listen and observe. How are the parents coping with their new role? Where are they facing the greatest challenges? What issues need to be addressed immediately? How can I best support them? Whether it be with breastfeeding issues, postpartum mood disorder indicators, a seemly disinterested dad, a needy sibling, an overbearing in-law, demands of multiple babies, or just the average exhausted new parent, we jump right in and get to work.
As a postpartum doula, we offer support to the new family. We model loving behavior. We listen to their concerns and questions. We interpret their needs; we share in their joy. Hopefully, we alleviate their fears and build their confidence. But, most importantly we educate!
Our time with these families is usually short- lived, however, and often they are overwhelmed with all the information that is presented to them.
I would like to stress a simple activity that can be easily overlooked by inexperienced parents: “Tummy Time.”
While it is recommended that you place your baby on his or her back to sleep to reduce the risk of SIDS (Sudden Infant Death Syndrome), constantly lying in this supine position can cause problems. One is plagiocephaly, which is a condition characterized by an asymmetrical distortion (flattening on one side) of the skull. I have seen this more often in a baby who was born prematurely. A baby’s skull is soft and made up of several movable plates. If an infant’s head is left in the same position for long periods of time, the skull plates may move in a certain way that creates a flat spot. If this is not corrected the child could develop ear and jaw problems. The ear canal may form very narrow which can increase the risk for ear infections and the jaw may grow out of alignment causing uneven bite and TMJ (Temporomandibular Joint ) disorder symptoms.
We must demonstrate to new parents how to do tummy time with their infant and stress the importance of doing it daily.
Start small. Aim for a few minutes at a time when the baby is in a quiet alert state and do it several times a day. The younger the infant the more readily he will adjust. I usually suggest starting once the umbilical stump has fallen off. With a newborn, we should show positions with the adult reclining and placing the baby chest to chest. Another might be to carry the baby face down with your arm supporting his or her neck and torso. This will help them get used to that sensation. A third would be to lay the infant on your lap using your hand for support. Although you are varying the activity, tummy time should be done for at least 10 – 15 minutes a day for the newborn to one month old.
As the infant gets a little older, place them on a mat and get down to their eye level. You may want to roll up a small towel or receiving blanket and place it under the baby’s chest and arms. Adjust his or hers arms over the wedge for added support. A nursing pillow also works well. Engage the child and make it an interesting and happy time. Again, doing this several times a day will insure proper development.
As they mature and their upper body muscles strengthen, play games with the adult moving side to side and in front the baby or place a favorite toy in varying positions. This will cause the infant to turn their head accordingly and strengthen their neck and shoulder muscles even more. Lengthen the duration to 20 to 30 minutes twice a day for babies who are over two months. With consistency, the baby will enjoy this time and gain greater mobility.
Remind parents that at no time should the infant be left unattended while on his or her tummy.
Research has shown that infants who do “Tummy Time” will generally roll over and crawl earlier and sit without support sooner. It strengthens all their upper body muscles and even contributes to their ability of reaching for object and bringing them to their mouth.
With this simple exercise, the baby will be meeting the milestones of infant development.
Another thing that we as doulas should look for is torticollis. Torticollis is a condition that causes the baby’s head and neck to tilt to one side. Torticollis often results from the shortening of the Stemocleidomastoid muscle (SCM) which causes the head to tip toward the shortened muscle and the chin to rotate in the opposite direction. Over time this can limit the baby’s ability to achieve milestones like sitting, crawling and walking.” And may also lead to the fore mentioned plagiocephaly.
I may have seen more than the average amount of torticollis since I deal with a great many multiples. It can occur when there is overcrowding in the womb. If you notice that a baby is constantly turning his or her head to the same side or always sleeping with his or her head in one direction, just mention to the parent that they should call this to the attention to their pediatrician at the next visit. With early detection it can easily be corrected with simple physical therapy exercises.
As CAPPA healthcare professionals, we strive for excellence in all aspects of our career. We care deeply for the families that we serve and we hope that our presence in their lives will have long lasting benefits. Leaving them with tools to do their job is just one aspect of our job.
By Margee Hanford, CPD
Copyright CAPPA 2015