As doulas, we provide non-medical support to clients. We do not diagnose, perform any clinical tasks, and we do not give any medical advice. However, we do hold space, educate, and help clients find evidence-based information so they can make informed decisions. For those reasons, it’s important we be aware of common pregnancy complications.
For many clients, the first person they think to chat with is their doula. They may be wondering if a headache is typical in the third trimester or if they should be worried about struggling to keep water down. Knowing potential complications helps us be aware of the importance of directing our clients to their healthcare providers.
Being aware also helps us support them in making evidenced-based decisions with their medical provider.
It is important to note that while there are common pregnancy complications, many clients will have low risk pregnancies without complications.
Increased Risk of UTIs and Yeast Infections
The hormonal changes during pregnancy can alter a person’s pH balance. This can increase the risk of developing a UTI or yeast infection. Pregnancy alters the immune system. An altered immune system is less effective at fighting germs.
Many also struggle to hydrate well or may skip the frequent urges to pee which can contribute to the risk of a UTI.
As a doula, you will not diagnose or treat these things. However, if a client mentions bladder discomfort, pain or itching you can remind them it’s important to reach out to their midwife or ob/gyn. You can also reassure clients who have been diagnosed that it is a common ailment, and they did not do anything wrong to contract an infection.
Feeling Dizzy or Faint
Early changes in blood pressure, blood sugar levels, and the ease of becoming dehydrated can make dizziness and feeling faint a common pregnancy complication. Remind your clients of the benefits of staying dehydrated when possible and eating small frequent meals.
It is important that they report any symptoms to their healthcare providers, however, to ensure there aren’t underlying major complications. Fluctuations in blood pressure with standing quickly and such can be common, but so can hypertensive disorders in pregnancy.
Bleeding, Spotting, Subchorionic Hemorrhage, Vanishing Twin, Threatened Miscarriage, and More
Approximately 50% of pregnancies have some bleeding or spotting. Of those, about 50% will go on to have a live birth. If a client contacts you with concern about bleeding or spotting, hold space and remind them of the importance of contacting their provider.
Spotting within the first trimester is common. However, as one gets into the second and third trimesters, any bleeding and spotting often warrants an immediate visit with a qualified provider. In some cases, cervical irritation causes bleeding. In other cases, a subchorionic hemorrhage is the problem.
Unfortunately, in other cases there’s an impending loss, premature labor, or other major complications. We should never add to a client’s fears, neither should we dismiss symptoms. We should calmly assure them that we are there for them and their provider can provide further instructions.
Cervical Insufficiency and Cerclage Treatment
For clients who are a high risk, have had a previous second trimester loss, or who are otherwise being checked, cervical insufficiency can be a concern. This is where the cervix is shortening or even opening without any contractions or early labor.
When found before 23+5, an emergency cerclage can be placed as indicated. In other cases, if they know early in pregnancy, a preventative cerclage can be placed at 13-15 weeks.
Progesterone can help in some situations. Doctors may also prescribe hospital bedrest as indicated.
Perinatal Mood and Anxiety Disorders (PMAD)
Perinatal Mood and Anxiety Disorders impact around 20% of pregnant people. Numbers vary depending on the source. People may also underreport PMADs. As a doula, it is important to be aware of qualified therapists, psychiatrists, etc., who are familiar with PMADs.
While all therapists can legally treat PMADs, many benefit from those who have training specific to the perinatal period.
Gestational Diabetes
Some mistakenly assume lifestyle causes gestational diabetes. While lifestyle and diet can contribute, it is not at all the only factor for gestational diabetes. Many who are in excellent shape and who have a great diet can still suffer from gestational diabetes.
The placenta impacts blood sugar levels and can trigger gestational diabetes. If your client experiences GD, you can reassure them it is a common condition. GD leads to complications when blood sugar levels are regularly elevated. Well controlled GD rarely causes issues.
Remind clients to follow their provider recommendations and meet with a diabetes educator as needed.
Hypertensive Disorders of Pregnancy, Preeclampsia, Eclampsia
Hypertensive disorders during pregnancy can be common. When left untreated, however, they can cause severe mortality and morbidity. As a doula, being aware to remind clients to report headaches, swelling, etc., to their providers is important.
As doulas, we do not need to scare clients. However, we can provide basic education about red flags they should report to their providers.
There are many pregnancies and births which unfold with no complications. As doulas, it is important we understand some of the risks, however, so we can provide the best support. During your training with the International Doula Institute, you will learn about these as well as other possible complications. You will also learn how to support clients in all risk levels of pregnancy from low-risk homebirth to scheduled high risk c-section, and everything in between!
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...