Doula Care

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Losing a baby, and then after...
If you have experienced the heartbreaking loss of a pregnancy, you may have powerful memories of the healthcare you received during your time of miscarriage, stillbirth, or termination. While not every mama has a loss experience full of compassionate care, many recall an experience of individual, personalized medical care during their loss journey. Unfortunately, care providers may not always know the "right" thing to say during frightening times of assessment, diagnosis, and treatment, but often, once an issue has been identified during pregnancy, patients recall an increased level of monitoring by their care team, leading to a feeling that their level of care became more intimate. While the experience of pregnancy loss is always difficult, many patients have fond memories of the providers who helped them. Patients remember the names of maternal-fetal medicine specialists who assisted with abortion care, the nurses who lovingly delivered their stillborn babies, or clinic aides who held their hands while they received medication for their miscarriage.

It can be understandable that after such an intimate and closely-monitored loss experience, an expectant mother heading back into prenatal appointments, scans, and tests, can start to feel lost in the shuffle. The fast pace and often crowded atmosphere of obstetrical clinics can create a sense of depersonalization. Sometimes, providers don't read patient charts before heading into appointments, and with so many clients to see, they may even forget about a prior babyloss experience. This can be painful, as babyloss mamas may never forget their doctors, but it can sometimes feel as though their doctors have forgotten them. Furthermore, the rush to "get in and get out" of the clinic can mean that patients aren't able to spend time with their providers talking extensively about their concerns or questions. As a pregnancy progresses, heading into nuchal translucency and anatomy or growth scans can be especially triggering. Even if a subsequent pregnancy is determined to be healthy, expectant rainbow mamas can start to feel extremely anxious preparing for birth. That's where a doula can come in.

What is a doula?

A doula (Greek for "woman's servant") is a trained professional who supports women through pregnancy, birth, and postpartum experiences. Usually a doula has had some obstetrical training, but, in addition, has also been educated about how to support women and their spouses during childbirth from an emotional/psychological standpoint as well. While they do not provide medical care, doulas have extensive knowledge about childbirth and how to support and advocate for expectant parents.

When does a doula become involved in my pregnancy?

Expectant parents usually meet with doulas a few month before their expected due date, though services vary among providers. In fact, some doulas will come work with mothers who are on bedrest or presenting with a high-risk pregnancy. During initial meetings, a doula will get to know the family and ask questions about past pregnancy and birth experiences, as well as major concerns for the pregnancy and childbirth. Doulas can be available by phone to answer questions about medical procedures and prenatal care, and will start to help an expectant mother plan for childbirth. Doulas also explore the type of pain management a patient would like, as well as offering additional resources and suggestions about this, as well as birthing positions and options. They traditionally accompany laboring mothers and serve as an important advocate during this period, mediating between the medical team and parent(s), ensuring that their clients feel comfortable, informed, and empowered. They ensure that their clients' individual needs and preferences are expected, and also support partners who can often feel overwhelmed and confused about the birth process. Following delivery, doulas will spend time helping a mother breastfeed, if she chooses, as well as adjust to bodily and psychological changes that may occur postpartum. Some doulas also offer postpartum services, in which they visit new parents at home, care and cook for the mother, and offer overnight relief with feeding and changing a newborn so that new parents can sleep.

Why is a doula important?

A large review study exploring research from 17 countries with over 15, 858 women indicated that birthing situations including a doula effectively reduced the need for pain medication and Cesarean section, as well as increasing women's reports of having a positive birth experience (Bohren, Hofmeyr, Sakala, Fukuzawa, & Cuthbert, 2017). However, it's also important to know that for women that request or require medical pain management or experience C-sections, doulas can help with feeling more comfortable and knowledgeable about the process, as well, providing physical and emotional support as medical interventions are provided. Doulas provide compassionate, loving care, helping expectant parents deal with and adjust to unexpected complications or changes to their birth plan, too. For rainbow mamas who feel they may have not received as high a level of individual care during this subsequent pregnancy, a doula can fill the gap.

To learn more about what doulas do and don't do, check out their standards of practice and code of ethics here.

Do doulas charge for their services?

Usually, doulas charge a fee for their services, though there are some organizations like The Doula Project that provide free doula care to low-income women, and the The Doula Medicaid Project is an initiative seeking to provide doulas for pregnant women who receive Medicaid. Furthermore, some private insurance plans may provide reimbursement for doulas, and some doulas accept payment plans. A list of volunteer doula programs across the country can be found here. In Pennsylvania, specifically, The Philadelphia Alliance for Labor Support and the North Philadelphia Breastfeeding and Community Doula Program provide options for expectant parents on a budget.

How do I hire a doula?

Doulas certified by DONA International, the lead doula certifying organization, can be found by using the organization's search engine here. Once you've identified a potential provider, here are some good questions to ask:

Why did you decide to become a doula?
How much experience and training have you had?
What services do you offer (prenatal, labor/delivery, postpartum)? Can you direct me to someone who provides the service I want if you don't offer it?
Have you worked with babyloss/rainbow baby mamas before?
How do you feel about medicated/unmedicated childbirth?
How do you feel about C-sections?
What is your availability prior to my due date?
What is your procedure for delivery? What if you are not available?
What is your philosophy about working with medical providers?

You should feel comfortable and empowered talking to your doula, and it can be helpful to ask for references to check out how others have experienced their care. It can be especially helpful to find a doula who is familiar with the special emotional needs of couples who have experienced babyloss, as they may be best able to support and advocate for you during this fragile time.

Summing up

There is no substitute for compassionate, respectful, and personalized medical care. If you have a good relationship with your OB, it is worth asking for some extra time during a new pregnancy to talk about your concerns as well as refresh them on the details of your babyloss experience. Certainly, physicians go into the field because they want to take care of people, and many OB/MFMs that have helped patients through babyloss hold a special place in their hearts for these parents.

However, if you feel you need more care and attention as you approach the middle through the end of your pregnancy, a doula may be right for you. Doulas can provide supportive, empowering, and educational assistance as well as practical support with pain management, relaxation, and advocacy during your birth and postpartum experience. As your heart continues to find space for the baby you lost and the baby that is to come, it is important for you (and your partner) to feel cared for and valued throughout your pregnancy. Doulas can bridge the gap between the medical and personal experience, resulting in a better outcome for all involved.

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