Pregnant tired exhausted woman with stomach and head issues at home on a couch, being sick.

Labor Support Redefined: Updates to our Best Practices for Doulas

If you haven’t taken or finished the COVID-19: Best Practices for Lactation Consultants, Perinatal Educators and Doulas, please know that this blog and the ones that follow are ADDENDUMS and SUPPLEMENTS to the course.   They will refer to the essential information in that program.

 As we developed a communication plan for our students, we have a weekly briefing newsletter (which you are welcome to sign up for, even if you’ve yet to take the course), and these supplements.  We decided to post some of these publicly.  If you’re new to WisdomWay Institute, we hope this information may be of benefit to you. 

But please don’t stop there to learn what you need to know in order to keep your communities healthy.  We must work together to mitigate the spread of coronavirus and meet the needs for reproductive health services.   For the sake of time and the urgency to get out new information, you will see places where we refer to the course.

On March 16th, we launched the COVID-Best Practices Course for Lactation Consultants, Doulas and Perinatal Educators.  It brought together providers around the country and it has since cultivated some meaningful conversations and collaborations.  So thank you, dear birthkeepers, and let’s keep it going.

We’ve created a format for Community Conversations, and just had our first discussion last night. While we laid the ground to address practical and pressing issues affecting our practices, the group most needed to share our grief, overwhelm, and to explore coping.  We’ll be announcing Mindfulness support calls shortly. But sign up for our next Community Conversation here.

Community Response

Last week, many of us hoped that the spread could be contained in ways that were similar to the H1N1 pandemic and that the response from the doula community could be similar.

I think everyone can relate to each day presenting a new reality check….

In the nationwide doula community, doulas organized to put a bid in to be allowed access – challenging the 1 visitor policy.  AHWONN  and DONA put out statements describing the importance of continuous labor support. The community discussed having Personal Protective Equipment, disinfecting our birth bags, and we established some practices that were shared in our course.

At this point, as so many hospitals hit surge levels, this all seems painfully unrealistic.  I think it’s important to realize how we’re all navigating unfamiliar, extraordinary, unthinkable circumstances.

In the Best Practices Course, we included protocols for providing care in the hospital setting, home setting, and other practice-specific situations.

We’re keeping those practices in the course because there will be a post-pandemic world where hopefully, we doulas and those providers who are non-medical but an integral part of the care of expectant and new families can be aligned with best practices for universal, standard, and transmission-specific precautions.  And someday, personal protective equipment will again be available.

But for now, providers around the country and the world are redefining their models of care. As families await their first contractions, a day that they had so looked forward to and planned for, doulas are putting creative solutions in place to support them.

Some highlights from the Course and updates:

  1. Do what you can virtually.

We’re all putting technologies in place to meet the needs of the clients we have.  Use virtual and phone but don’t, please, text instead of talking to someone during labor itself.  I believe it’s important to hear the tone of a laboring person’s voice, to hear the sounds they make through the contraction, to know if there’s a catch in their voice.   Now more than ever, our skillful reassurance is important.

  1. If you do attend someone….

Some providers are still able to attend their clients in labor at home or even in the hospitals, either as the ‘one support person’ or even with a partner.  I realize at this writing that by the time I finish making sure this blog has no hanging sentences and I’m publishing, even those few areas in the country that are not in shelter in place, and medical centers that have not hit surge capacity, are likely to be so.

Maybe you’re going to help your client stay home as long as possible. Maybe you’re going to be there for the duration.  We’ve highlighted some of the Best Practices but this is in no way comprehensive. For a full summary refer to the COVID-19: Best Practice Course.

    • Fully implement the transition and threshold practices (sanitizer, clothing change, handwash) as you arrive at the home, leave the home, arrive at the hospital center, leave the hospital, and arrive
    • Sanitize your shoes and keep any outerwear separate from your family’s outerwear. (We’re using a sealed Rubbermaid container outside our door.)
    • Bring your own protective equipment – DO NOT under any circumstances TAKE SUPPLIES from the labor/delivery rooms. If you think a glove or two won’t matter, please stop and learn more (take our course, or something).
    • Plan to reduce your birth bag to essential items that are each sanitized and not reusable from client to client
    • Plan to be there for the duration – once you arrive, coming and going is not allowed.
    • Bring snacks, clothing changes, water for hydration, cell phone chargers and your own disinfecting wipes, hand sanitizer, and a modification of PPE.
  1. PPE for doulas

We include the Making Do options in our Course.  If you’re not a student or want to research on your own, go to the WHO and follow their recommendations for PPE in emergencies.  All of our information assumes you are caring for someone who is not symptomatic or a PUI.

As we proceed through the weeks ahead, we’ll address more of your questions about caring for pregnant persons or new parents who are in quarantine or isolation.

  1. DO NOT be tempted to replace a trained birth attendant

Lots of families are afraid.  They don’t want to go to the hospital.  They’re asking about home birth.  How should you respond?   In our next newsletter, we cover the issues facing families who are fearful of their planned hospital deliveries and share resources, the power questions you can use to support them in their informed decision-making, and other best practices within the scope of care.

But before we can get all of this information to you, please direct any clients interested in exploring out of hospital birth to the trained and experienced home birth providers or birth centers in your community.

Haven’t signed up yet?  Know colleagues that still need it?  Enrolling in the course will also give you access to our newsletters, and invitations to our Community Conversations.

"Let’s do this work together to bring the kind of caring presence that heals "

Karen Laing