As doulas, we are frequently on-call from approximately 37-42 weeks. We may not be contractually obligated to provide support during preterm birth, but many of us will do our best to support early clients. Given that about 1 in 10 births in the US are preterm, knowledge about supporting preterm birth is important.
While comfort techniques, understanding of physiological labor, etc., can be like term birth, the emotions, interventions, and immediate postpartum can vary. Understanding preterm birth is important so you can help your client understand what to expect.
Whether you can provide typical, in-person doula support, or only virtual support, your role as a doula can be vital during preterm birth.
Should Doulas Be Supporting Preterm Birth?
Should doulas support preterm birth? Absolutely! It is a myth that birth doulas are reserved for unmedicated, low intervention births only. In fact, those facing higher risk births are almost in higher need of support. This can be especially true of those who had initially hoped for a low intervention birth.
As a doula, it can be helpful to encourage clients to keep you up to date following prenatal appointments. If they know they are at risk of preterm birth, it might be beneficial to discuss the terms of your contract with them. Ideally, you will be able to provide them with support regardless of when they go into labor.
While we cannot be on-call for every client from hire to birth, we can do our best to meet unexpected needs. If a client is at risk for preterm birth and you know you cannot provide support before a specific date, it might be helpful to work with a backup.
It is vital, however, that clients fully understand your services, contracts, etc., so they know when you can provide support.
What Can Doulas Do During a Preterm Birth?
It is important to recognize that preterm birth, just like term birth, can vary greatly. The earlier the gestation, the less birth options are available to a client.
For example, when one gives birth before 35 weeks gestation, they are often given magnesium. While this drug provides important neuroprotection for the infant, it can create a fall risk for the birther. Magnesium can impact muscle function and balance. In these cases, the birther is often restricted to the bed for safety, so they do not fall and injure themselves or the baby.
Preterm birth also typically requires continuous fetal monitoring. The earlier the gestation, the higher the risk of true fetal distress.
However, as a doula, you should be well versed in how to support clients who are restricted to the bed. You would continue to provide the same support you would for any client in bed. In addition to that, you would want to provide extra emotional support and reassurance. Holding space is vital as they are likely worrying about the wellbeing of their preterm baby.
Helping clients understand what to expect after birth is also important. For preterm babies, the NICU team is present at the time of birth. They may also have additional L&D nurses, respiratory therapists, and additional personal in the room. Helping them stay focused on birthing and not additional people can be important.
Providing Supporting Preterm Birth and NICU Separation
While not all preterm infants require NICU stays, those born prior to 35 weeks are almost always admitted to the NICU. Some 35-week infants do not need the NICU, but most infants born prior to 36-37 weeks will spend some time in the NICU.
Many hospitals do aim to allow some skin-to-skin before the cord is cut, whenever safe to do so. However, after 1-2 minutes, or whenever baby is stable, they are often quickly whisked to the NICU. If baby requires immediate resuscitation, it is done in the room. This can be overwhelming for parents. Calm reassurance and support are vital.
It is also helpful to educate clients about active management of the third stage (placenta delivery). In the absence of skin-to-skin and latching, many facilities will routinely administer Pitocin and possibly Cytotec to reduce the risk of hemorrhage. When there is no ongoing skin-to-skin or latching, there is a risk of less oxytocin to trigger uterine contractions.
Your client may not notice these medications, but it is important to help clients be aware of what they might expect.
You can also provide support by encouraging an early lactation visit (within an hour of birth) to begin expressing milk. Remind them they should not expect much and that it is more about stimulation and not output yet.
You will use all the tools you learn during your doula training to support clients during a preterm birth. However, you can also provide additional education, support, and reassurance during an often-unexpected birth.