Having a baby much earlier than planned can be traumatic in and of itself. The support of a doula can really help with the process.
Before the birth
If your client is at risk of preterm birth, you can support them through the scary experience by listening, validating, and helping them improve communication with your care provider. I was recently on the labor and delivery floor at a hospital shadowing a nurse and a woman came in for an AFI. She had been dealing with threatening labor for a few weeks, and this was her sixth time coming in for an AFI. Neither her doctor nor any of the staff that did the first 5 tests had realized that she had no idea what an AFI was, what the doctor was looking for, or what might happen if a problematic result came in. The nurse I was shadowing did an excellent job of recognizing this, educating the parents, and looping the doctor in on her fears and need to improve communication. While this example involves a nurse, a doula can help facilitate improved communication. similarly.
It’s important that you stay calm and avoid adding to your client’s fears. Don’t speculate, tell horror stories, or process your fears with your clients. Be a calming influence, and if you need to talk about your own fears or concerns, process with a trusted doula friend.
Your client may or may not want you to accompany her to any concerning tests and procedures. If you’re not in the room with them, do check in before and/or after and see if they need to talk.
Practically speaking, you can encourage your client to be ready a bit sooner. Sometimes this means adjusting their expectations of what it means to be prepared, and helping your client simplify, prioritize and delegate the to do list can help ease their minds. If possible research your client’s condition for your own background, making sure to be looking at only the most recent resources as neonatology (the specialty of caring for premature infants) is a rapidly changing field.
During the birth
Birth doulas, you may or may not know that the baby is coming ahead of time. The little guy pictured on the right is the earliest birth I have been a doula for, and I had no idea anything was happening until I got the call to come to the hospital and things were happening quite rapidly. The baby’s father didn’t even make it to the birth, and this quick photo I took before they intubated was the only time he saw his son’s face without tubes coming out if it for the first few months. He was born just shy of 30 weeks and spent 8 weeks in the hospital and another 6 weeks at home on oxygen. He’s doing well now.
If you think it is sudden and disorienting for you to be called to the birth months before you expected, multiply that by about a hundred and you might get close to what the parents are feeling. Your first task might be to help them cope with the shock. They may or may not want to talk about it. Sometimes you can help them shift to accepting that this is happening and working with their body and their situation. Sometimes that doesn’t work. There is no wrong or right way for parents to cope with a preterm birth. Sometimes all you can do is be there as a witness and reassurance.
As possible, encourage the parents to ask questions and keep what they can from their birth plan. Another family I worked with had chosen not to find out their baby’s sex and the one and only thing they were able to keep from the original birth plan was the plan to have the dad announce the baby’s sex at birth. Everything else had to change because of the emergent concerns about the mother’s health.
You may want to stay much longer after the birth in this situation. Whenever possible, I stay with the birthing parent while the partner accompanies the baby to the NICU, and stay until either the baby is stable, we get a substantial update on the baby’s condition, or the partner/another family member is there to be with my client. This might be hours, especially if your client birthed at a facility without the ability to care for a preemie and the baby and partner have to go to another hospital. The longest I ever stayed after a birth was when the baby had to go by helicopter to another hospital and my client had no one to come immediately. It took 6 hours for her mother to drive to our city.
After the birth
Birth doulas, if you are not providing postpartum doula care, you still have an important role in helping families adapt and process what they’ve experienced. Listening, over and over again as necessary, to your client talking about their birth story. That need can be ongoing. I had a client contact me about a year ago on her daughter’s tenth birthday, to talk about the birth. She just needed to talk it out with someone who wouldn’t dismiss her experience, and as someone who was there, I knew she wasn’t exaggerating the circumstances. Because I listened immediately after the birth, she trusted I could be a safe sounding board again.
If you usually do birth notes, type them up soon after the birth. Keep them strictly factual. But hold off on giving them to the parents until you think they might be ready for them. When you think they might be ready, ask them if they would like them. I have one set of birth notes still undelivered because the parents were not ready and I eventually stopped asking.
Postpartum doulas, you will have to check in with your client to see when they want your help. Many families will have a need for supportive care immediately, but they might need it at the hospital. Many parents with a baby in intensive care try to stay at the hospital (as a hotel stay, not as a patient) or in a nearby hotel to be closer to the baby. You can bring meals, help with pumping, assist with skin to skin, and take fresh clothing to them. You might be more helpful keeping the household running while they are gone.
It’s a good idea to start familiarizing yourself with local resources for families experiencing premature birth. These might include:
- Hospital social workers
- Lactation consultants with experience helping premature babies
- Parent support groups
- Parent mentor or buddy programs
- Mental health services for new parents
A few larger scale resources that might be useful include:
Graham’s Foundation – Parent support network
Caring Bridge – A place to set up a free, private web site to keep family and friends updated on the family’s situation. You can recommend the parents deputize a family member to set it up and keep it updated.
Transitioning Baby to Home Toolkit – These printable handouts cover a bunch of topics. I would recommend just reading these for your own information, and possibly selecting a few applicable ones to share with your clients.
March of Dimes My NICU Baby App – Has information, tracking and other tools to help families learn, connect and stay organized with their baby’s care.