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Overview

COVID-19 has caused a lot of changes to birth plans over the past few months and we can expect many of these changes to last for the foreseeable future. In this article, I talk with Heather Delaney, of Maryland State Doulas, about how you can prepare, and what to expect if you are pregnant now. Heather is a wealth of information about how hospitals, birth centers, and home birth midwives are navigating this new environment. Learn what questions you should be asking your doctor or midwife, what to expect when you arrive at your birth venue, and what you may experience in labor and postpartum. Plus, the value a virtual doula can bring to your pregnancy and birth, and the logistics of how virtual support can be a lifesaver.

Thank you to Heather Delaney for sharing so much valuable information in this episode.

Heather Delaney | Owner & CEO | Labor Doula | Postpartum Doula | Childbirth Educator | Maternity Concierge | Placenta Specialist

Heather’s dedication and widespread knowledge of the birth practices within the state of Maryland have made her a sought after resource by both the birthing community and Maryland mothers-to-be. Cross certified with DONA and ProDoula, Heather believes strongly in the informed choices couples should be presented with to create their own birth preferences and baby care options, free of judgment or agenda. Her unconditional support has assisted over 200 families in welcoming their newest family addition in comfort, care, and with confidence. Heather’s passion and expertise have led countless area families to her popular Childbirth Express class, housed at the George Washington University Hospital in D.C.

You can learn more about Heather and Maryland State Doulas by visiting the Maryland State Doulas website or connect on Facebook and Instagram.

Transcript and Resources

Vanessa: I’m pretty much behind a computer and reading a lot of research and news. It’s great to talk to somebody who’s more in the trenches and seeing changes going on with home birth and hospital birth. Do you want to fill us in on your background and your experience as being a doula?

Heather: I was a newcomer to the doula profession about eight years ago. This is not my first career. I, like many labor and postpartum doulas, found the birth world after experiencing pregnancy and giving birth to my first son, Nathan, we just celebrated his eighth birthday. So that kind of led me into examining some options for support for myself, and then expanding that into a bigger community that I wasn’t aware was out there for advocacy and support and options and really providing evidence-based care to families. I became a labor doula myself through going my DONA certification and taking clients as a sole proprietor in the DC Metro area. I live in the state of Maryland, but I’m very conveniently located where I can be in Annapolis, Baltimore, or DC or Northern Virginia, about 15 to 30 minutes in either direction.

Heather: I started serving clients and then found a greater need for creating a larger community and Maryland State Doulas was born about five years ago to serve as a full-service agency with lactation support, labor, and postpartum support, childbirth education, which as a former educator was what I really thrived on and brought me to the table. We’ve been operating and serving lots of families in the area from birth through their babies and beyond, and have continued to do so as the climate has changed recently as you know, we’re all experiencing it full front. So there’s been a lot of little nuances of that type of support and also seeing what families who are expecting are experiencing. And it’s, been a very unique experience to go through it, for sure.

The Balance Between Support and Safety

Vanessa: Unique for sure. I think what’s difficult is that we’re all trying to navigate all of these changes that are going on, and things are changing so rapidly. It’s incredibly difficult to stay on top of all of that. One thing that you and I had talked about before that I really wanted to pick your brain on was this struggle that hospitals and birth centers, and even homebirth midwives, are having to deal with finding a balance between supporting birthing mothers and partners and families, and also ensuring the safety of birthing families, but also support staff, midwives, and OBGYNs. I would love to hear your thoughts on what you’re seeing on the front lines, so to speak and how you’re seeing hospitals and birthing centers navigating that.

Heather: I think when this began back in March, we had a little bit of this is coming. Here’s what we should all be bracing ourselves for and starting to have these realistic conversations and dialogues about logistics and what it’s going to look like. But I remember very clearly how quickly it became a very emotionally charged conversation. As soon as everything here on the East coast locked down, in Maryland on the 13th we got a heads up from schools like, hey, starting tomorrow, tomorrow’s the last day. And then the weekend’s going to hit and everybody’s going to be home. And immediately, I contacted my team, I have 20 labor and postpartum doulas on my team. And we sat down and started to debrief about what changes we were going to see. And immediately started seeing hospitals locked down and saying, all right, we’re going to really pull back the support of having additional visitors coming into the hospital.

It took quite a bit of conversation back and forth to clarify that they also met doulas. That we really needed to be cognizant of the fact that as much as we do know about COVID-19 and the transfer and the spread, especially when people are coming in labor and may be asymptomatic, this was before obviously we had widespread testing. So that was even a bigger shot in the dark. How can we maintain a safe environment? And I think what was difficult for many, including as you can imagine, a lot of panicked moms that called me saying, we were not anticipating this, what is this going to look like? We were really hoping that we were going to be able to have support. Is my husband’s still going to be able to come, can my wife still come?

We were looking at New York and New York, wasn’t even letting them in. What do we do? How do we navigate the situation? How we were all able to take those emotions and put them aside and really talk about the safety aspects of supporting the people that I also care deeply about, which are the nurses who I work alongside every time I did a birth and see regularly and know by on a first name basis, some of whom I know on social media, outside of working next to them in tandem and hospitals and the care providers that, that’s their work environment. They don’t have a choice about who’s coming in and whether they’re positive or negative. And luckily, we have rapid testing here now, so that everybody getting swabbed prior to coming in, but, really making sure that it was a safe place to be.

And what decision making needed to go into place of protocols during birth, that sometimes we would talk to families about their options in terms of things like monitoring or whether or not they wanted to have pain medication preferences like an epidural, and what changes were going to happen if there was no longer safe environment for being intubated during birth, in an emergency cesarean situation. We really had to take a step back and consider, where is the even ground? Where can we provide support and continue to help families when we can’t physically be there because it’s not the safest for us to be continuing to have different contacts within different hospitals. I know you and I were talking about this, Vanessa, I don’t necessarily know that there’s a right answer. Especially now things are starting to relax a little bit in terms of lots of states heading into phase one over here on the East coast. Almost every single hospital that has decided to keep that protocol nice and small in terms of visitor status is staying that way. 

They’re not really opening back up and that kind of led to another emotional discussion. My preference and standpoint is, we still have so many questions and it’s still a situation where we need to keep everybody safe. If we’re continuing to spread contact, myself in question, if I have two clients at two different hospitals and I’m going to support a family, and then four days later, one of my other clients goes into labor at a completely different hospital. I’m taking the environment of one hospital, every single railing I touch, every person I interact with. And I’m taking that to the climate and environment at the other hospital. Ethically to me, that’s just not a chance that any of us should be taking. Luckily, we have other support ways and mechanisms and technology that we’ve been using to make that bridge. During this really unique situation, until it feels safe again to do so, keeping everybody able to perform their jobs and do it to the best of their ability.

The Future of Birth After COVID-19

Vanessa: That’s the hardest thing is there is just so much that we don’t know and it seems like a lot of hospitals had this knee jerk reaction in the beginning. There was some panic going on about how do we keep everybody safe. There was concern about hospitals getting overwhelmed. I’d like to think that they’re going to relax some of those policies. Obviously, we saw in New York, they were saying partners couldn’t be present, and that got a lot of backlash pretty quickly, which I think is good. Birthing mothers should not be doing this alone. They should have a support person there. I’m not sure that I expect when we see phase two, three, whatever it is in these different States roll out, if hospitals are going roll back to business as usual, prior to COVID-19.

Heather: I’ve definitely started to think about what that is going to look like myself for our practice and for our families. Now that we have newly pregnant mothers that are contacting us as we head into the back end of the year, that’s the big question, you know, I really want to have my family there. I really want my sister to be available and at my labor. I would really love to have my doula in person in the hospital or in the birth center, or at my home birth. Do you think that this situation is going to be the same in December? I don’t know, but I honestly, from my conversations with care providers and hospital staff here, I do not see visitor policies changing at least for 2020 and being reexamined heading into 2021.

I had a conversation with a client today and it brought up some opportunities for thinking about our visitor policy and maybe even reexamining it as a whole because one of the things she was really concerned about was what is it going to look like to the climate of my labor? If I am inviting a ton of people there in December and they can come and they need updates and someone needs to communicate with them about how I’m progressing. If I don’t want them in the room the whole time, or I feel uncomfortable asking them to step out. And I said, well, here’s the thing you have this incredible opportunity that has been handed to you that if hospital policy is saying, it’s just you and your partner. Then you get to have that bubble and not have to have what might for you be difficult conversations with family about whether or not they should be. You can have them send you well wishes from afar, but really taking that time to keep it an intimate experience and keep it just between those people that you choose to invite for very specific roles.

And those families that have had to have that mourned, the loss of not having people with them, have in hindsight, kind of enjoyed it and not been so stressed about the immediate postpartum and having six, seven, eight people flooding their tiny room in the mother and baby unit and being like, well, I kind of want to sleep now. So here’s the baby again. And, then when you leave this, baby’s going to be crying and need me, and I’m not going to have the chance to get some rest. So we’ve really been trying to embrace squeezing some lemonade out of these lemons when it comes to some of the policies and where those are headed. For my practice, especially I’ve been telling all of our families, there will definitely be some changes to support and if we can be there and it’s safe to do so in person to have a doula support you in the hospital, of course, we want to be there. But we can’t say for certain what December is going to look like. I don’t think even the best epidemiologists know where things will stand. And I think hospitals are going to continue reevaluating and saying the policies that we put in place for this might be some semblance of what we recreate for the future and, and keep in place. Maybe that will be longer lasting than just a couple of months.

Limiting Time in the Hospital

Vanessa: It’s going to be so interesting to see what happens. And I think hospitals will stay on the conservative end with what they’re doing. Is there any move to get families home sooner after birth, and not holding them in the hospital for 24 hours?

Heather: Yes. There there’s been a lot of that and, comes as a surprise for many families who maybe aren’t expecting it. And it’s something that I’ve been working hard on in my education series from communicating with hospitals here. I always encourage families to do when they’re exploring having their baby in this time of COVID-19 is communicating what their preference is for their postpartum stay. Because we’ve seen everything in terms of families being kept for one overnight and sent home. We’ve seen some hospitals say we would like to send you home after one night, but because your insurance covers a second, you have the option to stay unless we’re totally full. So I’ve seen an instance of either of that, a family that wanted to stay and were told they couldn’t because they needed the room and a family that was told that if they wanted to stay because they wanted a little bit more assistance, a little bit more time to recover and get a handle on breastfeeding, see the lactation consultant in the hospital.

Cesarean Birth

We’ve seen the same, some hospitals that are keeping things normal after a cesarean. One of the things that I’ve been a little concerned about is the rapid discharge for some of our cesarean patients. Usually, it’s three to five days dependent on blood pressure regulation, how the wound is healing, how able to get up and about mom is after delivery. Now what we’re seeing is that those birthing persons are being sent home after two nights. Sometimes it takes much longer just for getting the hang of breastfeeding, making sure that breathing is under control, that blood pressure is stabilized.

I’ve had two instances in our practice, whether it was a, a doula client of mine personally, or one of our other doula’s clients within the practice, a person having to go back to the hospital and be readmitted because they were just sent home to soon after a cesarean. Once they got home, they were feeling fine and then started to experience some of the postpartum warning signs that we keep an eye on in terms of dizziness, pain, swelling, feeling like there were unregulated blood pressure issues, and so on.

Postpartum

The postpartum is really where I am upping our support to make sure that we’re connecting with families and having those conversations. Especially for first-time families going home and not really understanding what to expect. If they’re going home a little bit sooner and discharge is happening much more rapidly, I think the intent behind it is right. Let’s get families out of the hospital and minimize their exposure to anything that could be around. Unfortunately, the follow-up, checking in, especially when it comes to, how are you in terms of the way that you’re feeling, do we need to check your blood pressure? Everybody doesn’t have a blood pressure cuff at home. I’ve had a very big care practice here has been telling their pregnant families to get a blood pressure cuff and a scale for their baby. And to kind of put the responsibility on them at home to be doing a lot of those regulations and checks. I feel like that’s just one more thing to put on an already newly postpartum family, who’s experiencing that new frame of life for the very first time. And now we’re asking them to do all of these things and look for warning signs on their own. It, it definitely adds to the stress and the chaos and the situation.

Having a Virtual Doula

Vanessa: Right. Plus, they’re doing all of this without a lot of other support. Normally you’re going to have family and friends coming by, and bringing you meals, and wanting to come to hold the baby. If you’re not having visitors or people, because you are being cautious about people coming to see you, I can imagine that definitely puts a lot more pressure on you to be taking care of everything on your own. I want to talk about more specifically exactly how your practice is dealing with supporting clients virtually. It sounds like this is a perfect example of where having a doula is going to give you a lifeline for more support postpartum. Can you talk a little bit about how you are navigating all of this and how the virtual support model is working for you?

Heather: Absolutely. We were a little spoiled in that I had already experienced virtual support prior to having to make the jump to that platform. When we were starting to look at options and examining what we’re going to do for all of the clients we already had, sometimes imminently, we had a mom who was going to deliver the very next day and need to put things into place for her as she was starting to look at what her support system was looking like. We needed to make sure that we were going to safely be able to assist them at home if necessary. I would say now that we’ve had two and a half months of virtually supporting clients through labor and through postpartum. A majority of our families have asked us to support them if they’re not being induced safely at home.

That ended up having a lot of moving parts that needed to happen because each individual labor doula has their own comfort level with how many clients they can commit to being with for a certain period of time and not feel like they aren’t providing the best support that they can to each family. It’s a very physical, and sometimes emotionally, intense position to be in when you’re supporting one family after another. Some of our doulas had a variable calendar and some tend to keep their calendar a little lighter. Normally, that wouldn’t be an issue. But when we are considering there is a quarantine period between interactions with people and having to make sure that if there were any asymptomatic, positive COVID-19 tests that our doulas were receiving, that we want to make sure our contract tracing was small.

Immediately we went into lockdown and then had to look at our calendar and say, before I join this person safely in labor at home before they go to the hospital and switch over to virtual support, can I do that safely? Because I’ve had two weeks between the time I was in contact with another family. For some of our families, we did have to spread out and put some support on standby. We always have a backup doula on our team that is really integral and involved in our client’s care. So they already knew that person and knew that if a doula had already been at a birth and it hadn’t been two weeks, that if they wanted in-home support prior to going to the hospital, then we were going to be having that team member tagged as, as the doula who was physically supporting them.

In terms of what things have looked like prior to labor onset, the changes we’ve done are instead of being in homes for prenatal visits, we’re doing virtually, which isn’t that different, except when we’re describing comfort measures. We really had to reinvent the wheel for that and be much more descriptive, have lots of models up on Zoom or Skype, or whatever platform we were using to be able to show and give confidence to support partners so that they knew what they needed to do. And then because most of the hospitals in our area are not allowing doulas in unless we are the primary support person, which for some of the single birthing persons we’ve still been doing, we support families in the home, keep labor moving, help them feel confident about laboring at home for sometimes a longer period of time. Which is being recommended for healthy pregnancies by care providers, that they really want people coming in, kind of ready to go and well advanced, in active labor.

So we get them to that point and then kind of say goodbye and log on to a HIPAA compliant platform, which for us is the RingCentral platform of Zoom, because we are allowed to use that under the hospital HIPAA policy, and also maintain that we’re not recording anything or saving pictures from that platform. Families come in, they bring in either a laptop or an iPad and open it up and there’s their doula. We’re able to see everything. And it really has been enthusiastically embraced, not only by the families who are bringing us in. Especially partners, partners are the number one champion of let’s hop on the Zoom. We’re ready. Let’s go, okay, let me take you here. They usually put the iPad or the computer on the tray table and just move us around.

If they are in the bathroom, we come to the bathroom. If they are next to the bed, we go next to the bed. If the bed gets heightened, so does the tray table. We’ve been able to see really, really well, everything that’s happened. Also, nurses coming in, OBs, and midwives are kind of leaning in the screen and waving and saying, hi, we miss you. And we’ve been able to communicate with them and, and have great conversations if people need support through making decisions. If a partner is providing a great deal of physical support and it looks like time to change positions, we’ve been the ones sitting there guiding them through, hey, sounds like a good time to abandon this position for a while. You’re feeling a lot of pressure right at the front of the top of your pubic bone. Maybe it’s time to start doing some forward-leaning. Getting some rebozo sifting in there. And then again, bringing up pictures and models, doing examples on our end to show. I’m asking a lot of questions to the person laboring, do you feel this? Where does the discomfort feel so that we can make little tweaks on our end? Mentally, it’s definitely made me a little more tired than physically. But it’s amazing how I come out of the other end of a birth experience and I still feel like I was there doing 50 hip squeezes the entire time I was there because there’s just so much of that energy that’s still being transmitted through that medium.

It’s been really fun, I don’t know if that’s the right word, but it’s been a very unique experience that I’m really grateful families have been so happy to have. One of the other things we’re seeing, because minimizing contact coming in and out of rooms, is there is a longer period of time where they’re completely on their own in that room. So they have somebody there that is guiding through how they want to be moving and laboring.

How a Doula Can Support You and Your Partner

I was at a birth two nights ago, where a provider had just checked the person who’s laboring and things were progressing really quickly. She’s a first-time mom. And they said, you know, I know you feel pushy, but it’s really not time to push right now. You’re still only seven centimeters. I really want you to just laboring call us back in an hour or so. And I was watching her and I was seeing how she was laboring and I could hear it the peak of a contract. And she was starting to get a little grunty, and she had progressed very rapidly all day long. And I said you know what? I think you sound like you are starting to push.

And she’s like, all I feel like is I have to poop and it’s constant. It has not stopped. I feel like I’m just going to have this baby. And her partner was a little frazzled because he said, but they said, call us back in an hour. We don’t know what to do. What, what should we do? And I said, go call your nurse, and tell her your instincts and how she’s feeling and she needs to be seen by somebody. He went and he called the nurse and the nurse came in and she said, well, you know, you can’t push right now. You just feel this way because you know, sometimes that of that baby makes a lot of pressure when you feel it constantly call us back and she’s left again. And sure enough, the next contraction happened.

I could tell that things were really going forward. So I told her partner, I said, you go in the hallway and you get that nurse and that doctor and you come right back in and tell them they need to come in now. And sure enough, they came in and that baby was born 10 seconds later. They felt validated because I think they were really lost. They felt like, we were just told that there’s no way I’m going to have a baby in 10 minutes. The resident told me, there’s no way that I could possibly have a baby. I was just seven centimeters. And so sometimes just having someone alongside them to validate the way you’re feeling is absolutely valid and correct. You should insist that somebody see you and, and sure enough, you know, bless her heart, the resident turned to me and said, thank you for being here because we would have missed that. And I’m like, yup.

Birth is unexpected and there’s definitely twists and turns, but having a lot of downtime when families are trying to navigate that and don’t know what to look for, or think that maybe they’re misunderstanding their own instincts, there needs to be validation for that. And it has been great to see that through video. We’ve been able to provide that type of support to families so that they can still experience, having space and safety and information and validation that, yeah, this is painful. Here are your options. Here’s what we can do. Let’s keep working the problem and find a solution so that you have one less thing to worry about with all these other layer cakes of COVID-19 specific things that are now on their plate when they’re certain to navigate that.

Talking to Your Doctor or Midwife

Vanessa: I think a lot of people maybe underestimate it can be very challenging to advocate for yourself, especially in a hospital setting. It’s easy to think when I go into labor, I’m going to ask for this, then I’m going to do that. And I’m going to stand up for what I want. Then getting in there, it’s hard. It’s hard when you have people telling you how you should be feeling and dismissing what you’re telling them. That’s awesome that you can be there virtually to be supportive, give them that nudge to feel like they can stand up for themselves and advocate. Whether it’s to get a nurse back in or what.

Heather: It’s definitely been something that I think honestly, we will probably continue even after this is done because it’s a completely different facet of care. One of the really beautiful things that I’ve seen throughout this entire experience is watching partners really step up and do some incredible things that they may not have been as comfortable to do because they did have support. In a postpartum debrief with that same family, I talked to them this morning, and her partner told me there was no way that I would have felt comfortable doing some of the physical aspects of this labor and also running out in that hallway and being like, get in here, we’re having a baby. If I didn’t have somebody telling me it was okay to do that. The partners that are helping people birth during COVID-19 are incredible and it has been so cool to see.

I think that virtual support definitely was something people were tentative to see how it was going to work. They were grateful. They were still going to have support, but they weren’t quite sure how it was going to translate. And so now, watching that unfold and seeing the success in it and also giving that space to providers to that a lot of times when these things are happening, it’s because they’re trying to keep themselves safe. And I can only imagine how they must be feeling with all of these protocol changes, the constant anxiety of coming into a hospital and getting infected every day, dealing with an influx of patients, the tension and the emotions are so high every day all the time. This is allowing them to have some support too so that they can continue to do the best job.

They know how with all of these obstacles in their way too. And a lot of times we’re seeing those translate into decisions or even sometimes flat affect. I constantly talk to pregnant persons on the phone who were saying, you know, I really thought I’d get more compassion from these questions in my provider checks. And I’m like, they’re just tired, they’re tired and they’re stressed. And sometimes they don’t have the answer for you. And they feel terrible that they don’t because that’s usually a big part of their job and what brought them to the profession is to have the answer. And they just don’t right now. And it’s hard for them to be able to say confidently. Yes, absolutely. You know, here’s what you can anticipate. I think there are a lot less warm fuzzies to go around. And so we’re really trying to step up and provide those and still be excited about virtual baby showers and, you know, make sure that people are still excited about the fun parts of pregnancy when everything else feels kind of like we’re setting it on fire. Yeah. I’m so glad to hear just about the good experiences

Checking into the Hospital and Wearing a Mask

Vanessa: As you mentioned earlier, we are trying to get some lemonade out of the lemons that we’re being given right now. Trying to navigate this changing environment as best as we can. I know you mentioned nurses or care providers coming into rooms less often. Can you talk a little more about what you’re seeing in terms of continuous electronic fetal monitoring or what policies you’re seeing about wearing masks in labor and some of those other changes?

Heather: Absolutely. I think one of the things that I’ve been recommending to anyone who is pregnant today, good questions to bring up to your team is, how are the preferences that you normally would put in place for things like electronic fetal monitoring, going to be changed? What is going to happen when you’re coming into the hospital? Simply coming in and checking into triage is totally different now, because now at the door, when families are arriving, they are, for the most part, having temperature checks for both the partner and the person in labor. And then the person in labor is receiving a COVID-19 swab, the nasal swab to be able to have that rapid test sent off and make sure that by the time they deliver their baby, they can be treated as negative and as asymptomatic.

Those were a couple of anxieties that some of our laboring families have expressed nervousness about, about the nasal swab or getting in. And it’s taking a little bit longer to get into triage and checked into a room. A partner has to wear a mask as long as someone is coming in and out of the room. In the beginning of masks being distributed, which is pretty much only a month old at this point, a lot of people who were going to be birthing were panicked going, I’m not going to wear a mask when I’m pushing. That just sounds terrible. I’m going to be really hot and sweaty and uncomfortable. I’m worried I’m going to hyperventilate. Those are all valid things.

Luckily, what we’ve seen is a mask is being given to the person laboring and that’s staying on through triage. Then as soon as someone is in the room, that’s coming off for the person birthing. If you’re scared about seeing a mask, when you’re coming in, definitely have that conversation with the nurse and the care provider. For the most part, they’re compassionate. They don’t want you to be uncomfortable with one more physical sensation. So keeping that mask on and triaged is simply because you’re interacting with so many more people, nurses, the on-call that are going to be sharing air and breathing space with you and navigating and making a plan for when you’re coming into the hospital can also help you to cope with that period of time having a mask on. So you’re not coming in ready to have a feeling like that’s going to be completely unimaginable for you at that moment.

Partners usually are wearing masks when nurses are coming in. The partner wears a mask when the nurses are in there, as soon as the nurse leaves partner can take the mask back off. I’ve had some partners that just brought a cloth mask and hospitals are okay with those being used. I have been recommending to birthing people to bring cloth masks because they’re more comfortable postpartum because on mother, baby, same thing. When you have your care providers coming in and out to check baby nurses coming in and out, you’re still going to have to wear a mask during those periods of time and that’ll make it more comfortable for you.

Continuous Electronic Fetal Monitoring

The big piece that a lot of people are putting on plans and normally do put on plans for, for normally progressing labor is to be able to use intermittent monitoring and not have to be connected to the monitors the entire time. If they get a reassuring heart rate reading on baby, a good strip for 20 minutes, being able to take the monitors off and move around freely. Since there has been concern about staffing, all hospitals are short-staffed on their nurses right now, making sure that the baby is being traced and contractions and heart rate are continued to be charted. Many hospitals are asking people to come in and labor to be continuously monitored, even when there’s no evidence that they need to be on a monitor continuously. A couple of ways to get around that or to talk with your care team about whether or not they have wireless or Monica monitors. Some hospitals are lucky and they have many and are able to get those on and use them. Sometimes that’s not an option. If it’s not an option, how can we keep monitors on you and still have you moving around freely and able to get comfortable in labor, getting out of the shower without having to be unplugged constantly, or come to some compromise. Like putting a shower into your plan after doing three or four different position changes for about an hour and a half. Then getting the shower for 40 minutes, having that interaction with the nurse and then being hooked back up can we put belly bands over those monitors so that when you are forward-leaning and changing positions frequently, that you’re not, you know, losing the tracing of baby and picking up your heart rate.

And instead, luckily a lot of providers are being really patient with that and saying, yep. Let’s if we have to be continuously hooked up to monitors that are plugged in, we can do a lot to make that more comfortable. And make sure that the people in labor who didn’t necessarily want that to be a big part of their plan are still able to maintain the other aspects of their comfort measures that they were looking forward to and going forward.

Epidurals

In that kind of management style, some other things that we saw and are continuing to see with some practices is a recommendation that families receive an epidural if that’s a part of their pain management preference, particularly early on in their labor. The thinking behind that, and it was really unfolded and described well to me by a close colleague who is a labor and delivery nurse, was that there is an effort to minimize the exposure of someone who would have to be put under general anesthesia in an emergency cesarean, or if their blood platelet count came back and their body did not support an epidural, and they had to be put under general, the amount of water droplets that would be exposed to everyone in the OR would put everyone at a great amount of risk. Especially since that person, even being swabbed and being considered COVID-19 negative. Sometimes those swabs are faulty. Sometimes we have someone who is asymptomatic or maybe the test didn’t come back, or it was a false negative. Protecting them is the big reasoning behind wanting to make sure that pain management and those options if surgery is put on the table is present. But if someone doesn’t want an epidural, that is definitely something that would make for a big conversation with the care provider to make sure that those plans are known. I have yet to see a care provider force that on someone saying, no, we really want everyone to receive an epidural so that it is in place. We know that that’s ready to go in case of emergency surgery.

VBAC

Even with some of our VBAC clients who, you know, may have been on the fence about that. The ball’s still been in their court, but I’ve definitely heard stories from other places around the country from other doula colleagues, other nursing friends, where some practices have decided that’s the safest for their team is to maintain that pain management scale with an epidural, for everyone that’s birthing. Unless they come in and they stop and drop, they’re ready to have a baby. And the second thing they get there, and it’s something that families should have continuous voice for that if that is not a plan of yours, and you do not want that to be a part of your plan, examine those options, discuss with your care team, why it’s important for you to not have that epidural, unless you request it and continue to have that option available for, for that support. 

Those were kind of the big three that we’ve been seeing the mask-wearing the administration policies with monitoring, coming in and being continuously monitored, and then epidural usage. And then overall just seeing care providers, less seeing doctors and nurses coming in far less frequently than usual and having to, you know, definitely navigate that situation and, and see kind of where the physical support is coming into play with those interactions with those people.

Talking to Your Care Provider Before You are in Labor

Vanessa: So much of this comes down to, you have to have communication with your doctor or midwife way before you go into labor, right? These are not conversations that you want to have in the hospital when you’re in labor. You want to have good communication with your doctor or midwife about how these policies are going to affect you. I imagine it can be terribly challenging when these policies are changing all the time. If you’re due in a week or two, definitely you want to be having these conversations with your doctor or midwife. If you just found out you’re pregnant, we don’t know what these policies are going to be like by the time your baby is arriving. What are you recommending as far as any specific talking points or questions that people should be asking their doctor or midwife, within a few weeks when they’re expecting their baby?

Heather: That’s definitely a great thing to bring up at any stage of the pregnancy. Maintaining that relationship of communication with the care provider is the forefront. I have always been a huge proponent of that and writing down questions and having a place to discuss that, whether you have a labor doula that can have to give you a heads up on tests and procedures. Whether you don’t and you want to keep informed of what things are changing.

Questions to Ask

A great question to ask at any stage of pregnancy is, currently what are your office’s practices surrounding comfort and support in labor? Can I move? Where are you anticipating families wanting to deliver? Some offices are asking families to allow there to be time to set up a table and put on the traditional masking gown for the care provider to, you know, not be exposed to anything. Some are like I’ll catch your baby wherever. Kind of maintaining how that practice is marrying their normal philosophy of care to COVID-19 is going to give a very clear picture of how things may unfold in labor. Asking about current hospital practices and how they’re finding those are being navigated by their team. And whether they’re big proponents of using masks in labor for partners and family. How they feel about people having to be continuously monitored when they want you to come into the hospital.

If you have a healthy pregnancy and labor seems to be progressing normally on its own, do they want you to stay home for a longer period of time? We’ve had a lot of care practitioners recommending that to families saying, if your goal is not to be monitored and to freely move, and you have a labor doula, and you would like to have unmedicated labor you’re, you don’t have any preexisting conditions. We’ve been monitoring the baby and your well visits, and everything’s been great, stay home until you’re ready to come in and have a baby. A lot of our OBs and midwives have been saying that to families and I’m really encouraging them to be in an environment that helps them labor and it feels more conducive. So that’s definitely a huge question to ask, what are you going to want me to do? If that happens? What would be your recommendations for induction? Are you doing more inductions because you are concerned about beds and you’re concerned about staffing? Is there room to flex on induction? If you are having me come in for an induction and maybe it’s not medically necessary yet, and we can still do some tests of fetal wellbeing to maintain that it’s okay to continue being pregnant. 

Big questions for VBAC candidates are when do you expect me to have to go into labor? What are those policies going to do to impact my goal of achieving a successful vaginal birth after cesarean? Really getting a temperature on your provider is a good place to shoot off from. It can bring up some uncomfortable conversations. I would say, you know, and I am a person who is a huge fan and supporter of care providers. I have enjoyed having great relationships with them over the years. I know all of the stress they’re under. I empathize with the situation they’re in. However, what I’ve been telling families is if you’re having these conversations, regardless of when you’re due and those conversations are kind of being brushed to the side or you’re being told, well, when we get closer, we’ll talk about it.

Well, when we schedule an induction, we’ll talk about what we’re going to do. That’s probably a sign that you should insist upon having that conversation right now. Or if you’re early enough in your pregnancy where you’re starting to feel that maybe the decisions that might be made in those moments, won’t support the type of birth that you’re looking to achieve. And, and your support network is not necessarily going to be conducive to that, then you might want to consider changing practices. We’ve seen a lot of families decide simply to abandon the hospital setting and go to home birth. If there’s a home birth midwife locally, that can take them and they feel confident and comfortable in that situation or simply switching offices because of the communication and, and bedside care and, and how that’s been unfolding for each subsequent prenatal visits. 

Some families have decided that they need to have that compassion and support and patience and time to go through all their decision making. As transparently as providers can be about what they’re going to encounter when they’re developing with that practice. Continuing to have those conversations and say, no, I want to have it right now. And I don’t want to have it in four months when I’m having a baby and obviously things might change. But if I was going to have a baby today, how do you feel about me moving in labor? How do you feel about me birthing in the bathroom, standing instead of prone with my legs and stirrups with a big drape underneath me and you with your hazmat suit on having to stop pushing so that you can get set up? There are definitely ways to gauge that support from your care provider. And, and it’s definitely a lot more in terms of questioning right now. And I think that that’s definitely stressful for families. Finding a good support professional, finding somebody who has a good list of questions you can ask is a good offshoot point from any stage to really start to anticipate and paint a picture of what you might encounter when you’re birthing.

Vanessa: Those are all great things that you should be bringing up. If you’re going to have a conversation that’s uncomfortable with your doctor or midwife, you don’t want to do that and labor. Now is the time that out of the way. 

Heather: Absolutely. And I think especially women in labor, we are people pleasers, by nature. Having that resolve, going in and saying, I’m going to have this uncomfortable conversation and how I feel about the way that that conversation leaves me matters. And if I have an intrinsic just gut feeling that that conversation should have gone differently, or I didn’t feel great after it, then it’s valid. It’s a valid thing to then go forward. And either debrief that conversation with a doula, if you have one or with your partner or come back to your practice the next week and say, you know, I didn’t really love how that conversation went. And I just want to clarify where I am putting wishes. I want to feel confident that you’ll support me as safely and best as possible to do these things that I want to do in labor.

Hiring a Doula

Vanessa: When are you getting involved with clients generally, if you pick up a doula client. 

Heather: We see clients all across the board. I would say the most common time that I interact with families is either right in the middle of their pregnancy, right after they found out if they’re finding out the sex of baby and anatomy scan has gone well or kind of close to a month out at the tail end. I’m fortunate that I teach a lot of childbirth classes in the area. And so a lot of times we find our clients after they take a class late in their second trimester, early in their third, and then they realize, wow, there was a lot more to this process than I thought I would be interested in, you know, putting my wishes forth. And I think having a support system for that would be really helpful. That being said, I talked to a first time expecting person today who just found out that she’s pregnant and knows that having a support system and a guide through pregnancy going to be really integral.

I think a lot of times people forget that doulas aren’t just for birth were, were for prenatal and pregnancy support too. And, and more so than ever. We’ve really checked in with our, our clients sometimes daily as they go through being pregnant at the time of COVID and, you know, updating them on hospital Polly’s SI’s and updating them on, Hey, heads up. Here’s what they’re saying about masks. Here’s what your mom’s group is saying. This is what we’ve been told, bring it up in your next visit. It’s not going to be something that you should be overly scared about because here’s exactly what’s happening. So, you know, I think a lot of the good that’s being spread by pregnant in September groups, those groups are great, but unfortunately when we’re dealing with high intensity, high stress, emotionally charged situations and conversations, they’re huge spreaders of misinformation.

What we’ve really tried to do is to really bring it back to evidence-based and fact-based care based on our relationships with providers and how we can help families molds and navigate the changing situation day by day. It’s never too late to hire a doula unless you’re about to have a baby as in pushing the baby out, that probably isn’t the first thing that you would think as you’re pushing the baby out. Having that type of support can definitely be benefited from at any stage of pregnancy. We’ve definitely seen families seek out support a lot sooner now that people are finding out that they’re pregnant. We’re encountering a lot more of those inquiries, as well as a lot of people who, maybe held off on making that decision, found out through talking to their care team. They were a little less confident in the ability to have that support together. Maybe a family member was going to come in and be there for moral or emotional support. And now can’t, and they’re finding late in the stages of their pregnancy that they need that support system.

Vanessa: I see so much value and getting connected with somebody early on that you can periodically check in with, that’s a good sounding board for these message boards are saying this, my doctor is saying that. Trying to reconcile all these different opinions and fears and figure out exactly what you should be preparing for expecting. Have you had clients outside of the DC area?

Virtual Support

Heather: I have. What brought me to virtual support when we were creating this for COVID-19 was I had a family who I was their doula for their first baby and they moved to Michigan and they really wanted me to be there. Obviously, I couldn’t jump on a plane and fly to Michigan and be there for three weeks on either of her due date. So they said, well, how do you feel about having me be your doula on, on a Zoom call? And I said, well, I’ve never done it before, but sure. We had the privilege and benefit that we’d already had a relationship, I’d been there for her previous birth. I knew her, but you know, a lot of our clients that we’re meeting right now, we’ve never met before. Sometimes we’ve never even had more than Zoom interaction. Especially in my childbirth education series, I’ve had clients who are joining those classes and those topics seminars from all over the country, which has been very fun and very cool to see.

I think one of the really beautiful things about finding knowledgeable birth support professional now, especially those of us who are game to continue this beyond COVID-19 is that it opens up a lot of options too. If you really enjoy somebody and you want to have that support system for you, and you may not live within the radius where that person can get to you quickly and your labor, that is an option for you. So those are exciting things that we’re seeing.

Vanessa: Very exciting. Why don’t you, can you tell us where we can find more information. I will link to your website. What about potential virtual doula services or your childbirth education classes?

Heather: I am on social media as well as our website. I know you’re going to link that but it’s marylandstatedoulas.com. Maryland State Doulas is on Facebook. We’re on Instagram as well. And we constantly are doing live series and a couple of Tuesday talks and linking our classes there so that they’re easy to sign up for just on the spot to be able to get in. We actually have a comfort measures for partners series that is a quick little Friday night class we’re doing this week that has had a lot of success in the past, especially over a virtual platform for partners to maybe if you are not having a doula. And you want to get some insight on how you can get some support measures, especially during COVID-19. Some of the doulas on our team get together and they go forward and show a lot of the different things that we have in our bags, how we can use tools to support physical maneuvers when to use them positioning techniques and, and why we do those things. There are definitely lots of ways that I would love to connect with anybody and really kind of give some insight. I’m blessed that I know a lot of doulas that are physically in many different locations, so it’s not uncommon for someone to contact me and say, do you know anybody local to me in Indianapolis? Can I get a recommendation of who I can start reaching out to? And, and I’m happy to kind of guide in any scenario to help people find what they need during this time.

Vanessa: Perfect. I cannot thank you enough for taking the time to conversations with me and really give us great insight into what’s going on in the hospitals. All of the awesome things that you’re doing to do virtual support and all of the lemonade that you’re making out of the lemons of this current situation. Thank you so much, Heather. Let’s definitely keep in touch. Maybe we’ll bring you back on and the near future and talk about where changes and what we’re seeing and give some people some more tips on how they can be prepared.

Heather: Oh, thank you, Vanessa. I would absolutely love that. I love the dialogue and discussion and it’s been fun to talk about these things and hopefully it’ll provide some more insight. I know myself as a first time birthing person, how nervous I was about the things that I didn’t know. And I think the most common thing I hear from families is I don’t know what I don’t know. And so hopefully this clears the air a little bit about some what to expect, especially in a time that may feel a little more nerve-wracking than normal,

Vanessa: Just having that heads up of, when you get to the hospital, they are going to test you. You are going to get your temperature taken, and they may hand you a mask. Just knowing that that’s coming, takes some of the anxiety out of it. Thank you, Heather.

 

 

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