When Kimberly learned she was expecting her second child, her first reaction was terror. "I had a really hard time pulling out of postpartum anxiety and depression after the birth of my first child," Kimberly reported. "It was like I fell into a deep, dark hole I couldn't get out of."

So when Kimberly gave birth to her second child, she took preventive measures. Acting on the advice of her therapist, she hired a postpartum doula. Her doula, Heidi Koss-Nobel, explained that her job was not to solely assist with the new baby, but more importantly, to support the new baby's mother.

Mood disorders: A combination of nature and nurture

The causes of perinatal mood disorders can be complex, but it's generally related to a combination of nature and nurture: we do know that fluctuations in estrogen across a woman's reproductive life (such as in pregnancy, birth, and the postpartum period) may disrupt the balance of the neurotransmitters and affect a woman's mood . However, we also know that environmental stressors such as lack of social support can contribute to the onset of a perinatal mood disorder . Research has shown that particular aspects of social support in the home such as offering supportive listening can ameliorate the symptoms of postpartum depression . Another study relevant to social support benefits showed that mothers with Postpartum Depression (PPD) receiving home visits interacted more responsively with other mothers and their babies than control groups. Also, their infants faired better in emotional regulation/response to stimuli, language development, and mental development .

In her role as a postpartum doula, as well as a survivor of perinatal mood disorders herself, Koss-Nobel offers empathy, support and reassurance for her clients whenever they have questions or just need to talk to someone "who's been there." By caring for their baby and older siblings, doulas enable their clients to catch up on serotonin-replenishing REM sleep, which is critical for mental health stabilization. In addition to household support such as meal preparation and light housekeeping, doulas also offer parent education and mentoring as well as important referrals to health care providers that specialize in proper diagnosis and treatment of perinatal mood disorders.

The word doula (pronounced doo-la) is Greek in origin and roughly translates as "woman's servant." Supporting fellow women during birth and in the postpartum period is an ancient tradition that has been diminished in Western modern society. In response to this void in support, the profession of doula was born. Until recently, most doulas could be found soothing women in labor and delivery rooms. But with so many new mothers living far from their parents and other family members in Western cultures, an increasing number of doulas now specialize in easing women through the postpartum period.

Doulas as key team members

A small but growing number of doctors and other health professionals are now recommending postpartum doula care to women who are at high risk for, or have previously suffered, perinatal mood disorders as part of their preventive treatment plan. Doula care can be "as powerful as medication and talk therapy," said Margie Bone, a psychiatrist and a founder of the Community Birth & Family Center in Seattle. If called in early, doulas can ease or, in some cases, prevent depression, Bone said.

The handful of providers in the Seattle area who were willing to recommend postpartum services since Koss-Nobel began in 1996 has grown to more than 100 today. Today the doctors, nurses, lactation consultants and therapists with whom they often work treat doulas as key team members.

By helping families get off to a good start, Koss-Nobel believes doulas reduce the impact perinatal mood disorders can have on the exposed child, enabling parents to forge healthier bonds with their children and become better parents.

In addition to being a postpartum doula, Koss-Nobel is the former Executive Director of Postpartum Support International of Washington, a nonprofit organization offering support and education to families and health care providers about perinatal mood disorders.