Worried woman

Ask A Doula: Unexpected Outcomes

Q My postpartum doula client just called and said their son was born with medical problems they didn’t know about. (Can I be vague to avoid identifying my client?) So instead of starting to work with them in a few days, they want me to start with them when he has had surgery and comes home from the NICU. I’m fine with this, though not knowing when that will be makes it hard to book future clients. I’ll make it work. What I’m not sure about is how often I should stay in touch with them while their son is in the hospital, what I will need to do differently when we do this work, and how I should handle it if the baby does not make it. What advice do you have for me?

A What a hard situation! I hope that their baby is able to overcome the problems he is currently facing, and that the parents have a good community of support for however long it takes. I’m glad they have you! If you haven’t already, spend some time brushing up on your resource list for families with a baby in the NICU and learn about local resources to help them. You don’t necessarily want to send everything over there all at once, but bringing them to the front of your mind can be helpful.

I would recommend that you find out if the family has set up a way to keep family and friends updated. Some people set up a site on a place like Caring Bridge, others use social media like a Facebook group or IG account. If they have something like this, ask if you can follow to keep up with what’s happening with their son. If this is an option, I advise following this regularly and reach out when they start posting about preparing to go home. I would recommend a text every 2-3 weeks if you’re not able to follow something like that. Just a quick “How is Jonah?”

When you are able to go into their home and serve them, there is a lot that will be the same. You’ll do less with helping the parents with physical recovery from birth, and you should be ready for them to want to talk about their birth and NICU experiences. Practice active listening, validate their emotions and hear their story as many times as they need to tell it. If needed, refer them to someone to help them through any trauma from the experience.

With the baby, you will need to be careful of scope and avoid doing anything that would cross into medical territory. You can absolutely still educate about routines, encouraging safe sleep, etc, keeping in mind any adaptations that might be needed because of the baby’s medical care and needs.

If the baby should die from this, refer to your contract to see how you should handle it. If you contract doesn’t currently address unexpected outcomes or loss, this is a good time to think about that and create a policy. I’ve answered a previous question about stillbirth that you may find helpful as well. Even though the family is going through a hard time, you do still deserve to be paid for your work. Sure, you could give a discount or do some work for free, but you don’t need to feel obligated to work for free or give a discount in this situation. It’s your call.

I wish you, this little boy and his family all the best!

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