As a doula, you are NOT a medical provider. However, being aware of a variety of medical complications can help you support your clients. Why? Because people rarely discuss some important postpartum complications. Parents don’t know to seek support for certain ailments.
When you’re aware of common red flags for complications, you can let your clients know about resources. You can also remind them to check in with their providers.
It’s important to note that you never diagnose or tell a client what they are or aren’t suffering from.
However, you can use language such as, “Some people experience pelvic pain after pregnancy due to pelvic floor dysfunction, injuries and more. If you’re experiencing discomfort or pain, you can ask your doctor or midwife about pelvic therapy or seeing a pelvic specialist. You can also check out www.pelvicpain.org to learn more.”
Here are some rarely discussed postpartum complications doulas need to know:
#1: Postpartum Complication – Pelvic Floor Dysfunction
“Pelvic floor dysfunction (PFD) refers to a broad constellation of symptoms and anatomic changes related to abnormal function of the pelvic floor musculature. The disordered function corresponds to either increase activity (hypertonicity) or diminished activity (hypotonicity) or inappropriate coordination of the pelvic floor muscles.”
This can occur outside of pregnancy, but it can also be exacerbated or caused by pregnancy. Again, as a doula you are not equipped to diagnose or even recommend this condition. However, you can let clients know that this condition occurs and any significant discomfort lasting beyond six weeks postpartum, and especially six months postpartum, should be evaluated.
Some symptoms of PFD include:
- Urine and fecal incontinence (while leaking is common, it is not normal outside the immediate healing time)
- Pain with sex, arousal, etc.
- Difficulty emptying bladder
- Pain or heaviness with standing
- Pelvic muscle spasms
- General aches and pain in pelvic area, hips, etc.
As a birth professional, you can suggest meeting with a pelvic therapist or women’s health physical therapist for a postpartum evaluation for all clients. Some practices offer free mini evaluations, some are direct therapy, so no prescription is needed, and others require a referral from their doctor or midwife. Even without PFD, pelvic therapy can be a great part of overall postpartum healing.
#2: Perinatal Mood and Anxiety Disorders (PMADs)
While many have heard of postpartum depression (PPD), that is one of many potential diagnoses in the perinatal period (during and after pregnancy).
A perinatal mood and anxiety disorder can be PPD, but it can also be an anxiety disorder, obsessive compulsive disorder, panic disorder, and more.
While upwards of 80% of new parents experience anxious thoughts, and 80-90% of birthers experience baby blues in the two weeks after birth, PMADs are different. These disorders greatly impact one’s ability to function and have a big impact on mental and physiological health.
As a doula, remind parents that mental health conditions are common in the postpartum period. Some doulas recommend their clients take the Edinburgh Postnatal Depression Scale (EPDS) as a self-evaluation weekly or so and reach out to their doctor with concerns.
Normalizing and discussing postpartum mental health before client’s ever have concerns can make it easier for them to ask for help.
#3: Vulvar Dermatological Conditions
It is quite common to have some irritation in the vulva and perineal area after having a baby. It is especially common due to using feminine products.
Some conditions which extend beyond typical irritation include:
- Vulvodynia/vestibulodynia
- Yeast
- Contact Dermatitis
- Psoriasis and eczema
- Generalized allergic reaction and inflammation
Again, as a doula you are NOT equipped to diagnose or treat anything. However, simply letting clients know these conditions exist if they are experiencing vulvar or perineal discomfort can help them know they should advocate for care. It isn’t uncommon for providers to dismiss new parents in the healing phase rather than given proper care for ailments. Yes, parents should expect some minor complications after birth. However, one shouldn’t suffer or have prolonged issues.
#4: Postpartum Complication – Fissures, Muscle Damage, Etc.
While many experience mild to moderate tears to the perineal area, a few will experience a severe third- or fourth-degree tear. Despite this, even the severe tears tend to heal well. Occasionally, however, a severe tear can lead to fissure, muscles damage, nerve damage, and more.
For parents experiencing pain beyond 6-weeks, and absolutely beyond 6 months, like pelvic floor dysfunction, they should request a thorough evaluation. Many doctors tell patients having a baby requires time to heal. This is absolutely true. However, assistance during healing, and treatment as needed, ensures there isn’t unnecessary pain or improper healing.
#5: Painful Sex After Giving Birth
While this is a symptom of both #4 and #1, it can occur for other reasons. Most notably, if there is no damage to the vaginal canal or perineum, some pain is simply due to low estrogen. While breastfeeding, many experience lower estrogen levels.
As a doula, you cannot diagnose or treat anything, nor can you tell them it is “only related to low estrogen.” However, you can tell a client that discomfort during sex after birth is something some people experience. You can share that some find breastfeeding can lead to vaginal dryness and that use of lubrication can help some. Then, it’s important to direct them to their doctor or pelvic health specialist for any ongoing concerns.
There are many changes and potential complication in the postpartum period. Due to stigmas as well as providers not taking complaints seriously, some parents suffer unnecessarily. As a non-medical support, you can help validate concerns clients have and direct them to appropriate resources.
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...