File photo: Postpartum doulas are different from birth doulas, who support a mother during labour and delivery, and have different training than night nurses, who typically watch and feed a baby while parents sleep.

Washington - There were many things about being a new mom that Courtney Lee-Ashley didn't know: How often she'd need to pump, how hard infant poop stains would be to get out, and how many times she must sterilize baby bottles. 

But there was one thing she did know: She and her husband, Matt, would be primarily on their own, with limited family help after baby Everett arrived in April.

So Courtney did what her planning instincts told her to do: Before Everett was born, she sat down and interviewed Betsy Quilligan, a postpartum doula. For $3 600 (about R47 000), Courtney and Matt purchased 100 hours of Betsy's time, to come to their home two to three times each week for the first three months of their son's life to help the Lee-Ashley family adjust to their new arrival.

"Matt and I both have nieces and nephews, but we have never spent the night with a baby by ourselves," Courtney said. Courtney knew that new mothers were at risk of postpartum mood disorders, including anxiety and depression; she wanted to be sure that she had support ready, should she have any symptoms. And while both Courtney and Matt have doting parents willing to visit from out of town, Courtney's dad is undergoing treatment for cancer and her mother would have limited ability to visit from North Carolina. "I didn't know if she would have the flexibility to come if we needed her," Courtney said. I thought [hiring Quilligan] would relieve the anxiety that she was having, too," Courtney said.

Postpartum doulas are different from birth doulas, who support a mother during labour and delivery, and have different training than night nurses, who typically watch and feed a baby while parents sleep.

Neither of the Lee-Ashleys knew much about postpartum doulas before they met Quilligan, but both are emphatic that Quilligan dramatically shaped their newborn experience. Courtney credits Quilligan with helping her establish a successful breastfeeding routine, something she struggled with initially, giving her confidence, and facilitating better communication between her and Matt. 

Even as the Lee-Ashleys prepare to return to work, they say Quilligan's advice and presence eased their transition: Courtney now has a pumping routine, and during several of Quilligan's visits, they've left Everett with her to do brief errands. For Courtney, symptoms of postpartum mood disorders never materialized.

"It's nice to have a woman here, a woman who has been through it, who understands the changes your body is going through and can regularly monitor your moods," Courtney said.

The results of such visits can be significant; countries with routine home visits after birth, such as the Netherlands, where professionals check in on the mom and baby at home and investigate any problems before they escalate, have lower rates of postpartum mood disorders, higher breastfeeding rates, and better maternal and infant health.