Doulas—Always Adapting

Doulas—Always Adapting

By Kelly Kolb

There never really is a “normal” day as a birth and postpartum doula. One day, I may be at a birth, squeezing hips, massaging tight muscles, creating a peaceful environment, relieving a birth partner, and advocating for the family’s birth preferences. Another day I’m sitting with a client breastfeeding her newborn, discussing feeding and sleep, encouraging her to enjoy a healthy snack and some tea, to rest, and to trust her developing parent instincts. Still another, I may be teaching a parent to swaddle, reading new research, stretching with a pregnant client, or answering a panicky text with reassurance. The constants are really relationships and connection, being the steady handhold for families as they navigate new experiences.

So now, in a time when many are physically isolated, what is the experience of connecting with families, and what is the experience for new and growing families when their village is out of reach? In short, it’s harder and more challenging for them and for me. But it’s possible. Here’s how we’re adapting.

Since so much of my work is about developing relationships so families feel comfortable and I can better understand their needs, I’ve spent some time working on ways to do that when we can’t be together in person. Like many today, I am relying on video conferencing tools like FaceTime and Zoom on a daily basis. These tools have been a great support as the next-best-thing to face to face when meeting with clients. Getting the opportunity to catch expressions, gestures, posture, movements, and tone of voice is invaluable in tuning in to what’s really going on behind the words. Frequent text messages are great for quick questions and updates, but they can’t replace a more personal conversation. In particular, I’ve found that tools like Zoom can be really helpful since I can easily share pictures and video clips to illustrate positions, techniques, stretches, exercises, etc. when I would normally be doing something with them hands-on. 

Preparing for birth has been more stressful for clients. Keeping up with changing policies and safety recommendations has added a layer of worry and uncertainty to their plates. Many providers and birthplaces have been recommending more interventions than usual, challenging birth preferences. So we’ve been having more frequent conversations about options, often in advance of prenatal appointments so parents feel more prepared to make their decisions during appointments and during the birth itself. The risks of pregnancy complications, health of their baby, or potential separation of parents and baby have been additional stressors for expecting families and we’re navigating with lots of information and communication among all the members of the birth team.

For birthing time, I always tell parents that much of my (physical) support comes through the birth partner’s hands. Birth is so much about the hormone flow. Giving the birthing person as much comfort, ease, and love as possible, and eliminating as much stress as possible, supports having a more comfortable, positive birth experience. A partner’s touch and voice are some of the most helpful support tools available. As a doula, helping the partner know how best to support the laboring person in the moment is some of the most effective work I can do. In this time when those birthing at a hospital can only have one support person present with them, guidance and support of the partner is essential. A combination of calls, texts, and/or video that best fits the family’s needs helps me stay in touch, support, and guide as the birth progresses. These days I get more texts from the partner updating so I can share new positions or comfort techniques appropriate to how the birthing person is feeling, and calls or video chats with the birthing person and partner together when they want to talk through options available to them.

At the time of this writing, those choosing to birth at home or at our local Philadelphia-area birth center have both their birth partner and their doula present at their births. All present in the room are wearing masks and practicing careful handwashing and hygiene. Masks muffle voices, hide smiles, reduce our ability to communicate non-verbally, and make our presence feel less personal. I’m finding myself doing more nodding and verbal affirmation when I am wearing a mask to add context and create connection where a change in expression would normally have done so. 

In our area, so many people are changing their plans from a hospital birth to a home birth that home birth midwives are working closely together to coordinate care, availability, and resources to meet the needs of as many birthing people as possible. They are gathering up supplies donated by local midwives, doulas, and families to help families who are switching to home birth late in their pregnancies. A petition is circulating asking Pennsylvania lawmakers for emergency measures to immediately license Certified Professional Midwives (CPMs). Pennsylvania is one of only 16 states not currently offering CPMs licensure, which limits patient access to care as well as to insurance coverage for home birth. For those who are good candidates for home birth and can afford the option, home birth can provide a more comforting setting for their birth and the ability to choose the people they would like to have present.

I’ve switched in-person support for the postpartum period to virtual support these days as well. Instead of visits of several hours for conversation, support during feedings, help around the house, and a chance for parents to nap or shower, visits now are conversations from a few minutes to an hour or so. We review what’s working well, what’s challenging, what to expect, how they and the baby are changing and how to incorporate that into their lives. I help them find additional resources if they need, teach skills via Zoom, or even recommend products. I’ve found that many parents are now doing without baby showers, so are sometimes scrambling in the last days of pregnancy to get all the supplies they want to have on hand for the early days home with baby. I have found an increased interest in cloth diapering. Some clients are concerned about the availability of disposable diapers in light of distribution problems and shoppers buying out supplies, so some are seeing cloth diapers as an option they wouldn’t have previously considered.

For the long-term, those in the birth community are preparing to help families with the anticipated increase in birth trauma and perinatal and postpartum mood disorders. There’s renewed focus on trauma-informed care and a wide variety of support resources to reach people in the ways they need it most, which varies from family to family. New research is underway to better understand the changes to birth choices, outcomes, and experiences over time.

One of the biggest changes for new parents these days is not having friends and family visiting. Some have had a challenging time emotionally with this, when they had imagined or expected to welcome baby with visits from their own parents, siblings, friends, and extended families. The meal trains, extra hands, and close support they had envisioned never materialized and they find themselves navigating the early days in isolation. However, some families I have supported have found themselves really enjoying the opportunity to nest in together without having to entertain visitors or be out and about in public with a new baby. They’ve found they are able to get more rest and bonding time than they expected and are having a more peaceful start.

Separation has definitely sparked creativity all around in finding new ways of navigating new parenthood. I’ve started new online support meetings for expecting families and for postpartum families that have provided great opportunities for sharing and connection. Couples have introduced their babies to family members through windows and through video chats. Delivery and curbside pickup have replaced the casseroles or bags of groceries dropped off by friends and neighbors. And we all seem to be savoring what peace, calm, and connection we can find so much more than ever before.

Kelly Kolb, CD/PCD(DONA), ICCE, SBD, HCHD owns Joyful Start Family Support and provides caring, professional, non-judgmental doula support and childbirth education for families of all kinds and birth of all kinds. She lives in Glenside, PA, with her husband, daughter, and two cats. She can be reached at joyfulstartfamilysupport.com.