"Most people I know who don't hire a postpartum doula (myself included) aren't doing so for lack of reasons, but for lack of funds. Those who can afford a postpartum doula could also afford a housekeeper and/or a nanny, so for the target market it's a little redundant. And for the rest of us it's completely out of reach."

It is true that the majority of women who need and want a postpartum doula do not have access to them because of financial reasons.  I believe the awareness of doulas in general is starting to become more known and considered a necessity by parents and practitioners alike (if a mom wants one) and not a luxury. There were birth doulas before they were popular on reality television and before Hollywood celebrities deemed them as a necessity. There are many hospital programs being formed, non-profit organizations for low income families and even incarcerated mothers to be. 

This progress did not happen overnight.

Families are not as close in proximity like they were a few decades ago. Most of my postpartum clients are considered “transplants”. Neither one is originally from the area nor are they covered in regards to physical support when it comes time to bring baby home. To be fair, they aren't all well off. Some are walking away from jobs to be home (mom or partner) and they are losing an income. Some cannot afford the services at all and their family (who cannot be there in the flesh for various reasons) pull money together to get help. 

Every family is different and not everyone desires or needs the same services. Assisting a first time mom at home may look different than assisting a mother who already has other children at home. We are not only supporting the mother, but we are helping everyone in the household adjust to the new changes and new baby. A mother who had an uncomplicated vaginal delivery may need less help physically than a mother who had a cesarean birth- but she still will need help in other areas that are just as valid. There are mothers with preemies, multiples, single mothers and those with deployed partners who could benefit from postpartum help.

The need for postpartum support for *every* mom is very real. 

We (the birth community) are trying to make postpartum care just as available as labor support.  We all believe that every mom who wants support should have access to it. It has taken research, lobbying, and advocating for labor support to be available to every mom. We are doing the same with postpartum care and you can help make it available for yourself and to all moms as well.

• Start planning early for your postpartum time. If you have an FSA/HSA account you can start putting money there if it makes sense for you and if your insurance covers it. I have had clients pay for birth doula services and childbirth education services with these accounts. Some insurance companies will cover a postpartum doula support is there is a “prescription” from your provider. The more expectant mothers and families are calling and asking about postpartum support the more it will start to be something they will need to pay attention to.
  


• Since you are planning ahead are there things you can sell, cut back on or eliminate to help make the postpartum time less stressful?
  


• Ask your insurance company if doula services are covered. While every insurance policy is different and changes every year it is still worth it to inquire and find out what is required if the coverage is available. In this situation you would have to pay for the services and submit the required paperwork for reimbursement. Check with your insurance provider for more details.
  


• Speak with your care provider about postpartum support, what the studies show and how much of a difference it helps, especially mothers who are at risk for postpartum depression. I have heard of some providers prescribing postpartum support for some moms- so it is definitely worth bringing up. Plus, the more they hear mothers inquire about it the more they will realize that is something that should apart of the childbearing experience.
  


• Having a baby shower? Ask for contributions to doula services with a “cash gift” fund registry. People want to help and they want to make sure that they get you something that is of value. If you do not mention it you will get a ton of really cute 3 month old summer outfits or duplicate baby ducky tubs. I’m joking, but seriously, put it on your registry! 
  


• You have already considered what you may need postpartum, right? If you do not feel comfortable having that request on a gift registry you can make your needs be known to those closest to you. Are the grandparents ”snow birding” and can’t come to help right away or at all? Does your sister want to help but she is on the other side of the country or even city but has her hands full? Co-workers, best friends, mom and prayer groups love to come together to help each other out. When someone is not sure of what to give gift certificates (or cash) are always well received. Most doulas have can create gift certificates for their services so if you've already interviewed with a postpartum doula and know you want her services let those closest to you know.  
  


• Have you found a postpartum doula you’d love to work with? Ask her if she has payment plans. Most have no problem accommodating payment plan requests. Be prepared to pay a deposit or retainer. When we have an agreement to work with a family we are saying no to others. This will help the doula confidently block off your EDD time-frame.
  


• Do you have a service that may be of value to the doula and her family? Bartering is an older custom but still used today-especially among small business owners. The item/service proposed has to be of value to the doula and/or her family and you two have to agree on the monitory value and include it in the contract. The doulas who are willing to barter usually will not barter the entire cost of service. Be honest about your situation. If you value the service most doulas will help you come up with a plan that everyone can feel good about.
  

When I was pregnant with our third child I spent most of the pregnancy on bed-rest, he came early and the delivery turned out to be an unplanned cesarean. Based on our life with me on bed-rest I knew that the postpartum period would be rough and it was. I remember still recovering at the hospital and my husband asking me to please find out if anyone could come to help. We’d already lost months of my income and he’d already missed an equivalent of 2 months of work to take care of me while I was on bed-rest and our other children. I’d experienced postpartum depression with our previous child, he would need to return to work sooner than we both would like and this combination caused us both a great amount of anxiety.

We were blessed with meals for weeks which helped tremendously. However, I wasn't surprised when I could not find consistent help during my recovery and postpartum period. My own mother had passed a few years prior and my mother-in law was willing but could only help so much. Most of my family lives out of state and like my local friends and family had obligations of their own that they couldn't step away from. There were and are no hard feelings. I know many of you can share similar needs and difficult postpartum periods. It is the state of our culture right now and why the access to postpartum help for everyone is so vital to women and their families. 

So I would encourage every expectant mother to sit down with your partner (or someone close to you) and figure out what will help you the most during the postpartum period. As a birth doula I do this during a prenatal visit and with postpartum clients as a part of the initial services. Most of us either wait until the last minute or we assume we have everything covered. Being in the middle of a rough postpartum period makes it challenging to coordinate the help that most of us need. Planning ahead for this time is as important as what kind crib the baby will sleep in or what color paint their nursery/room will be. I promise!