Case Study: How Doulas Can Adapt for Successful Remote Birth Support

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Louise Johnson was preparing to assist as a doula when the COVID-19 pandemic dramatically shifted hospital requirements for childbirth. New limits were placed that allowed only one (1) support person in the room with the birth mother. This happend just two (2) days before her client’s due date. Learn how Louise was able to adapt to the evolving requirements and how she worked with the birth family to prepare them for a remotely supported birth experience.

Below are excerpts from Louise’s birth packet, reproduced here with permission from her and her clients.


Excerpts from a Birth Packet for Remotely Supported Hospital Birth

DOULA GOALS

Based on the assessment, birth care plan, and Mother and Father’s goals [not included here], my goals for this birth are:

  • Physical, emotional, and informational support for Mother and Father’s birth plan
  • Provide information on relaxation techniques, trauma healing, and practical tools to help anxiety.
  • Utilize techniques and skills that may help influence Mother’s comfort, Father’s support role, and birth team communication as much as possible during labor
  • Encourage and affirm Mother and Father’s decisions during labor and postpartum healing

AMENDED DOULA GOALS DUE TO COVID-19 RESTRICTIONS

(Added when we found out that the hospital tightened restrictions and they are no longer allowing an extra birth support person.)

  • Help prepare Father to serve as the main support person through sharing resources on e-mail, text, and one in-person session prior to their due date. Provide printed resources on labor support for them to bring to the hospital and use during labor.
  • Continue to listen well and allow Mother to process her fears and stress in a safe and supportive way. Continue to encourage relaxation, mindful prayer, etc.
  • Support Mother in-person through her early labor at home, if needed.
  • Support Mother and Father as needed through phone, text, and video chat while they are in the hospital and for the first week postpartum.

EVALUATION

The hospital that Mother chose to deliver at amended their visitor restrictions to only allow one support person in labor and delivery, just two days before her due date. With that new restriction, we amended her birth plan to make Father the primary in-person support and me a virtual support person through texting and video calling.

In order to prepare Father for taking the lead support role, we chose to do an in-person “crash course” in their home the day before her due date. In that meeting, we reviewed and practiced acupressure for pain management, basic foot and hand massage techniques, relaxation and focusing practices, and a few of ways to utilize a rebozo. I answered questions, shared printed resources with information on everything that we practiced, and gave a lot of encouragement to both Mother and Father. After our crash course, they both said they were nervous but felt better prepared with the new tools and amended plan.

Labor started several days after Mother’s due date. We connected via text at the on-set of labor and she requested that I maintain contact every 15 to 20 minutes even if she wasn’t able to write back immediately. She labored at home for a few hours, showering and practicing relaxation techniques. She and Father then went to the hospital and were admitted.

As the labor progressed, I maintained contact with Mother and Father by answering any questions that she sent over text, sending encouragement with birth affirmations and Scriptures that she said were powerful for her, and linking songs off of her labor playlist every 15 minutes. Within a few hours, Mother soon delivered a beautiful baby! We maintained contact through text until she and the baby were ready to try to get some sleep.

PHYSIOLOGIC ACTIONS

Mother shared that she found position changes, showering, and acupressure very helpful in helping “take the edge off” the pain of contractions. She used warm compresses at home to help with back pain.

SAFETY ACTIONS

Mother expressed that this birth was the most calm and safe that she has ever felt. Factors that she mentioned contributed to her feeling positive about this birth were: use of relaxation techniques that we had practiced throughout her pregnancy, positive affirmations from her whole support team throughout the labor using scripture and her birth songs, and (for the first time) having a L&D nurse that was a fellow woman of color that she did not feel intimidated talking to and asking for help. She also was very pleased that she had a clear birth plan and the L&D team followed it exactly as she hoped.

SOCIAL ACTIONS

Mother was very nervous about communicating with the hospital team as she has had negative experiences in the past. She was also concerned that as a woman of color she would be stereotyped or discriminated against. We worked together on questions for her prenatal appointments and on making a clear birth dream sheet so that if she was having a hard time communicating, she could refer to those things. After delivery, she said that they used the sheet throughout the labor and she was thrilled when the nurses referred to it and reminded each other what it said even when she didn’t prompt them.

When she went to the hospital during a panic attack earlier in her pregnancy, she was sent to labor and delivery and had a very positive experience being cared for by their staff which also helped alleviate some of her fears about communicating during labor. Father stepped out of his comfort zone a few times during this labor to ask for help from a nurse with comfort measures. He said it was easier to try things when he and Mother were alone since he didn’t feel self conscious, but it was a good step for him to talk to the staff and make requests when Mother needed assistance.

ESTEEM ACTIONS

Mother had lots of opportunities to make decisions through the last few weeks of her pregnancy. With all of the COVID-19 restrictions rolling out, going past her due date, and dealing with some other non-pregnancy issues, Mother showed a strong and flexible spirit. She often needed to process her options and thoughts out loud, so we had regular phone calls during the last couple of weeks of her pregnancy.

There were many times she wrestled with doubt of her own strength in handling all of the stress from the unexpected changes, but Mother was very responsive to verbal affirmations and reminders of spiritual truths and we usually ended the calls with her self-talk in a more positive place. Mother requested information to help make decisions a few times in late pregnancy. She asked for data on inductions based on due dates, and natural induction methods. Evidence Based Birth had wonderful information that I was able to send her and she said that it helped her and Father in the decision process.

Follow Brent Leavitt:

Dad, Granddad, Co-owner at New Beginnings Childbirth Services, and a Social Entrepreneur.

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