In one of our assignment in the main doula course, we ask our students to take into consideration the medical diagnosis of their patient while developing a personalized birth plan. What follows is the response that we got from one of our students:
I actually do have first hand experience with gestational diabetes and cesareans — four of them to be exact. I taught myself how to escape the genetic grips of gestational diabetes. It took a few tries, but I succeeded. However, that being said, this was a harder assignment for me!
Prenatally, much can be talked about with the client to help ensure a greater outcome of her labor and birth. These include discussing how to better control her gestational diabetes not only through diet but also with weekly exercise and medication, such as insulin if prescribed by her provider. Also, talk with her about her water intake to help with her urinary tract infections during her pregnancy. This may not completely stop her from getting them, but hydration will surely help with alleviating some discomfort during one. Help her create a pro and con list for the hospitals that are in question for delivery since she has not yet decided. Call all local hospitals and question them on their cesarean protocols especially as they relate to women with gestational diabetes. This will allow a greater peace towards controlling her birthplace.
Prenatally, I would also inform her of a gentle cesarean and ask her if that would be of interest of her. If so, have her contact the chosen hospital and find out if that would be a possibility for this birth. This would allow the baby to be placed on her chest right after birth if no issues such as RDS are present. It would also allow nursing as soon as possible and at least before she gets sent to recovery and the baby goes to the nursery. This can also help with the baby and the potential threat of low blood sugar right after birth. Being the doula in the actual surgical room with her during delivery, you can help ensure that the baby gets a good latch if breastfeeding is permitted and that they are as comfortable as the situation allows.
Knowing about her anxiety and panic attacks and anticipating them during her birth, we can talk about ways to help alleviate the symptoms including different relaxation techniques such as visual aides, breathing practices, and exercise. These should be practiced daily during the rest of her pregnancy to help her if and when the true attack comes on.
Shortly before surgical interventions, be sure that any pains that can be controlled using relaxation and any hot packs or cold packs are used.
Ask that a sign be placed on baby’s bassinet and placed in the chart that baby is not to have any artificial nipple including bottles and pacifiers — that mom’s breast alone is to be used for pacifying and nourishment. Also, as far as baby is concerned, make sure that it’s noted that baby is with mom as much as allowed so as to ensure bonding and good breastfeeding habits.
As soon as delivery is over and knowing that there will be side effects from the epidural, request on the birth plan the use of warm blankets, warmed IV fluid, and also anti-itch medications.
Make sure that she knows her personal control management plan and that her pain is dealt with promptly so as to not get out of control. (This is actually a personal one for me. After my very own second cesarean delivery, my nurses were trying to get me out of bed saying it’s time but I knew something was not right. I had incredible pain and when moving almost went into a shocked state from the pain. Come to find out, my med schedule was messed up. It was never discussed with me how often I could ask for pain meds. So I assumed, and I assumed wrong. Instead of the every 15 minutes that I could have asked for, I was asking every 4-6 hours, and my nurse didn’t catch on. Needless to say, it was unnecessary pain and trauma that if only made known to me, could have been avoided.)
After delivery and recovery, be ready to aid her in pain control including the gas pain that she is anticipating. Getting up and moving as soon as possible after delivery will help with the return of normal organ function. Having hot packs ready for her to use may also be brought up.
Have liquids available in her room, and remind her to drink since she will no longer be NPO. Ask for a clear liquids plate to be brought to her room for when she is ready to try and eat. Once clear liquids are tolerated, ask if she can be moved to a normal diet.
Once the baby is ready and the mother has a room, try to establish good breastfeeding techniques as soon as possible. Encourage skin-to-skin and bonding to help with the breastfeeding process. Show her the different holds and what a proper latch looks like. Give her realistic expectations on pain and how much a newborn actually eats. Be there to answer any questions that she may have and any physical needs that may need to be met. Also ask that a lactation consultant visit her room and find out if home visits are possible for help. Also ask for info on the closest La leche league to help even more often once the patient leaves the hospital.