International Doula Institute | Doula Blog

What Is Hyperemesis Gravidarum?

November 2, 2021

As a doula, you are a non-medical support for pregnant, birthing, and postpartum families. While you are not a clinical provider, it is important you are familiar with common medical issues which impact the people you work with. Understanding hyperemesis gravidarum (HG) is important so you can provide evidenced based support to clients suffering from HG.

If you are familiar with medical terminology, hyperemesis simply means excessive vomiting. Gravidarum refers to pregnancy. However, HG is more than just vomiting.

While morning sickness impacts 50-90% of pregnancies, HG impacts just 0.5-2% of pregnancies. Morning sickness is considered a typical symptom of pregnancy. Medically, morning sickness is referred to as nausea and vomiting of pregnancy or NVP. HG is not a typical pregnancy ailment and always requires professional medical support.

As a doula, being familiar with symptoms of HG can help you in providing your clients with support, resources, and the information to self-advocate for adequate treatment.

What is Hyperemesis Gravidarum?

The HER Foundation is a leading expert in hyperemesis gravidarum. They explain it as unrelenting nausea and/or vomiting which leads to a loss greater than 5% of pre-pregnancy weight, symptoms which interfere with daily activities, and dehydration leading to the production of ketones.

However, if you ask someone who has experienced HG, they will describe it in a way which paints a greater picture of what it truly is. HG is truly life altering. It takes good things, gives bad things, and ultimately changes families.

The simple ability to stay hydrated, a basic need for physical and even mental wellbeing, is quite nearly impossible with HG. Many with HG cannot even eat, and if they can, the food immediately comes right back up. It can ruin teeth, steal time from children, ruin careers and finances, and in severe cases it can even lead to the loss of the pregnancy.

As a doula, if your client mentions any of the following symptoms, you should strongly encourage her to speak to her provider and be insistent about treatment:

Inability to drink enough
Frequent vomiting
More than 24 hours without keeping food down
Dark, foul-smelling urine
Severe nausea impacting her ability to care for herself (e.g., unable to shower)
Ongoing dizziness, especially if it leads to fainting (should seek help immediately)
Feeling of ongoing vertigo
Overall inability to function most of the day

Is HG That Much Worse Than Morning Sickness?

Morning sickness is highly inconvenient and uncomfortable. Some might lose a couple pounds and occasionally struggling with staying well hydrated. However, with typical morning sickness, there’s an ability to function decently, just at a slower pace.

With HG, there’s an inability to function well, if at all. One woman who experienced both NVP and HG as morning sickness being getting sick, washing your face, and then going about your day, but HG as getting sick and never being able to function without feeling as if you’re about to collapse.

While some call HG severe morning sickness, it is truly far beyond morning sickness.

Things such as ginger, crackers, eating before getting out of bed, none of those things work for HG. It is not a normal pregnancy side effect; it is a medical condition in need of treatment. As a doula, the best thing you can do is encourage a client to seek medical care and never push NVP remedies.

What Are The Effects Of HG?

Untreated or undertreated hyperemesis can lead to miscarriage, and in 10% of HG pregnancies even termination for medical reasons as not everyone receives proper treatment.

HG also often impacts future family plans as parents cannot fathom repeating such a difficult ordeal no matter how much they desire more children.

HG can lead to:

Suffering strong phantom odors
Weight loss with ongoing metabolic issues
Depression and anxiety
PTSD
Side effects from needed medications
Ongoing gastric issues and damage
Dental problems
Food issues
Painful treatments with risks such as PICC lines
Relationship difficulties

And that is only a partial list. When treated properly, some cases of HG respond well to treatment. Often, women are undertreated or not taken seriously. In rare cases, there is no relief with treatment, only basic management.

Where Can One Get Help With Hyperemesis Gravidarum?

As a doula, you are non-medical and cannot give medical advice. However, you can provide resources, especially if a client is undertreated.

Some are never prescribed medication even after losing over 10% of their body weight, some fight for necessary fluids and some are erroneously told termination is their only choice. If you have a client in that situation, refer them to these websites:

Baby Registry – How Doulas Help Plan

October 31, 2021

As a doula, you can provide more than simply labor support. Many clients will see you as an expert of everything related to pregnancy, birth, and babies. When a client is getting ready to make their baby registry, they may ask you for help.

Sure, you can hand them a list like the big box stores have. There’s certainly nothing wrong with that. However, you can also provide them with out-of-box ideas to truly assist in the transition into parenthood.

Many big box store lists have more gadgets than parents truly need. Some items are even detrimental to evidenced based feeding guidelines, contribute to developmental concerns, and are even dangerous for safe sleep.

Here are some baby registry ideas for your clients to add to their list:

Easy To Dress Baby Clothing

Baby clothing is absolutely adorable. Buying mini suits and fashion items are great. However, in the early weeks, babies go through 8-12 diapers per day. Babies also benefit from frequent skin-to-skin sessions and may enjoy being swaddled. This makes these adorable outfits a bit less practical.

Suggest easy snap or zipper items which needn’t go over baby’s head. Items which are easy to get on and off so they can easily be changed and set up for skin-to-skin.

Zipper, snap, and even magnetic one-piece sleepers are ideal. Kimono style onesies are great. Some brands are even designed specifically for easy skin-to-skin.

Encourage parents to register for the practical clothes knowing plenty of people will still purchase the fun outfits.

Sleep sacks and light muslin blankets are also beneficial on the registry.

Comfortable Clothing For The Postpartum Period

Encourage parents to add items on the list for themselves. If they’re not comfortable adding that to the registry, remind them to share if people ask what they need.

The immediate postpartum period is a time of rapid bodily change, healing, discomfort, all combined with joy and the comfort of snuggling a little one. Having a comfortable robe to provide a sense of security while giving easy access for breastfeeding can make things a little easier.

Soft items can provide positive sensory input while her body is healing from birth. Convenient and soft nursing tanks, nightgowns, and robes can make the early days and weeks a bit more enjoyable.

Gift Cards For Coffee, Food, And Convenience – A Baby Registry Must

Certainly, babies need items. However, when parents are cared for they can better care for their babies. Gift cards allowing for parents to grab some extra coffee without thinking of their budget can help them feel cared about.

Gift cards for convenient take-out or delivery allows parents to use at their convenience and need. It’s also easier for families with specific dietary needs, allergies, etc.

Contributions Towards Doula Care

The ultimate gift is support during and after birth. When new parents are supported through the birth process, they are gifted a lifelong memory of being cared for. No, a doula cannot guarantee any specific type of birth. However, a doula can guarantee continuity of support regardless of how birth unfolds.

Contribution towards postpartum care allows parents to adjust with guidance and extra rest. Many parents have plenty of onesies, but little hands-on professional support.

Baby Registry Items To Promote Healing

Anyone who has given birth knows they weren’t quite prepared for how much healing they would need to do. Encourage parents to consider items which aid in postpartum healing. The more focus on healing, the faster the healing can occur.

Being prepared before baby’s arrival can save a late-night run to the pharmacy. Best of all, many baby shower guests have been there before. Adding an item or two to the registry lets other guests know the parents are open to these types of gifts. They may end up buying some of their favorite healing items remembering just how uncomfortable the early days can be.

Items such as witch hazel, peri bottles, nursing pads, nipple creams and ointments, herbal sitz baths, and more, can make excellent registry items.

Go Easy On Baby Gear

Babies need a safe space to sleep, a safe car seat, and often a safe space to be set down. However, many big box stores tell parents they need every and all types of baby gear. Yet overuse of baby gear is tied to plagiocephaly and even delayed milestones.

Encourage parents to get the safety items they need. Beyond that, play mats, little toys, and baby carriers are all excellent developmentally appropriate items.

As a doula, you can help parents get the items they really need as they prepare their baby registry.

“It Takes A Village!” – Parent Support

October 28, 2021

As a doula, you may have heard the saying, “work yourself out of a job,” in terms of how to truly help parents. The underlying goal of doula support is to educate, support, and empower families. Helping families find their “village” is an important part of helping your clients navigate parenthood. Parent support is vital.

Being aware of local support, resources, and social opportunities for new parents is an important part of your job. Doulas have the unique opportunity to support parents during a time of drastic change. While our role is to provide immense support, we are unable to provide all the support a family needs.

Here are ways to help support clients in finding parent support:

Educate Clients About The Importance of Healthcare Provider Choice

While their midwife or obstetrician, and their child’s pediatrician or family physician will only have a certain role in their life, it is the first step in creating a supportive village. The decisions clients make about healthcare providers can impact the level of support they have during these transitions.

Does their prenatal care include plenty of time to ask questions? Do they feel respected and cared about? Will their pediatrician provide evidenced based support along with empathetic care?

As a doula, you have the unique opportunity to help families understand the important role of their providers.

When parents feel supported during pregnancy, the transition to parenthood is smoother. Compassionate, evidenced based, and empowering support during birth can impact the transition both short and long term. After birth, support is a vital part of building confidence as a new parent.

Childbirth And Parenthood Preparation For Parent Support

As a doula, you might also provide childbirth classes. Group childbirth and parenting classes are excellent for finding parent support. Parents have the unique opportunity to connect with others in the same season of life.

If you do not provide childbirth classes, you might consider offering birth preparation support groups. Otherwise, you can connect with other birth workers in the area who provide those services. When new parents can connect with others navigating the third trimester, birth, and early parenthood it normalizes the challenges while providing support.

New Parent And Feeding Support Groups

In addition to connecting with parents through prenatal classes, new parent support groups are a wonderful place to build a village. Many people notice a shift in their friendships and relationships when they become parents.

If your typical social circles enjoy going out often, you may feel isolated in the early weeks and months when you cannot get out. Connecting with other new parents to meet for coffee, at a playground, or to hang out at home can be a wonderful way to still socialize

For parents choosing to breastfeed, breastfeeding support groups can be a wonderful way to meet other parents. There are also baby playgroups, music classes, and more.

As a doula, learning about the different parent groups available in your area is a great way to support your clients. By connecting your clients with other support, you’re providing continuing parent support long after they’re your clients.

Providing ongoing support by helping parents is an important part of your role. Take time to learn about providers in your area, ongoing support, and more.

Postpartum Plan – Help Clients Enjoy The Newborn Days

October 26, 2021

As doulas, we often help our clients prepare and plan for their birth experience. New parents spend time taking birth classes, researching birth positioning, and even write up birth plans. Logically, parents know there will be an adjustment, but they may not take the time to write a postpartum plan.

As a doula, helping clients create a postpartum plan is an important part of providing professional support. A postpartum plan can aid in having a more positive and empowering start to parenthood.

Here are 5 ways to help clients prepare for the early days:

#1: Plan Ahead – What Does Your Postpartum Plan Look Like?

Take time to help your clients think about their postpartum options. What types of parent leave do they have? Do they have paid or unpaid maternity leave? Paternity leave?

Will one parent transition to being a stay-at-home parent? When does one or both return to work? How early must they plan for that transition?

Do you provide postpartum doula services? Will they be in need of or desiring professional postpartum support or do they have other support lined up?

Help them consider how much sleep they typically need per night to function. Then, help them figure out how they can get that much sleep but over twenty-four hours as they aren’t likely to sleep straight through for a while.

What is their plan for meals? Getting to doctor appointments? Are they comfortable with the basics of newborn care or would a class help?

There are many things to plan for in the postpartum period. While becoming a parent is a natural experience, and many of us wing it, a bit of planning can make the transition a bit smoother. As a professional doula, you have the knowledge to aid in creating realistic expectations of the early days and weeks of parenthood.

#2: Remind Parents To Ask For Help

Can parents survive the early days without assistance? Likely, many do. However, can parents properly rest, heal, and adjust without help and still have a positive experience? That is much less likely.

Remind parents to think about their support systems. Do they have neighbors, friends, perhaps help from their religious organization, that will cover some meals? Do they have the resources to hire any help?

Who can they ask for help with infant care and sleep support? Do they have a parent or else someone they can hire to aid in household organization?

Do they know area therapy practices to reach out to should they need additional support? Are they familiar with any new parent support groups?

As a doula, reminding parents that no one should transition to life with a new baby alone is an important part of supporting them. So many assume if they’re ready to have a baby they should be able to do alone. However, parenthood is not meant to be done alone.

#3: Create Realistic Expectations

I often think about how fortunate I was to have my first children long before Instagram, Pinterest, and other social media platforms were huge. I did not see the stage photos in someone’s pristine living room with a three-day old baby.

As a professional, you can make a world of difference by educating parents about realistic expectations. Babies need a lot of hands-on care and attention. The house isn’t likely to be spotless. Calls may be missed. Getting out the door may take longer than they ever imagined.

When you have realistic expectations, the adjustment is easier. When you expect things to be as easy as they seem on Instagram, well, you’re likely to feel as if you’re not doing as well as you should. The reality is social media is far from reality.

#4: Have A Feeding Plan

Breastfeeding is the biological norm. Unfortunately, that doesn’t mean it will always be a smooth and easy transition. For parents planning to breastfeed, ensure they have up-to-date evidenced based information about the early days of breastfeeding.

You can also help ensure they have the contact information for Certified Breastfeeding Counselors and IBCLC lactation consultants. A prenatal breastfeeding class can be wonderful. And knowing who to call should problems arise often means a little less stress.

If one plans to pump, bottle feed, combo feed, etc., help them plan for extra parts, cleaning process, and how to make things go smoothly. There are many new products to aid in quick sanitizing, organization and more.

#5: If Nothing Else, Remind Parents To Rest, Rest, Rest!

One of the biggest mistakes new parents make is to be too active. Many try to keep up with guests, they may want to get out and about, they may feel obligated to do things. However, in the early days and weeks, rest is imperative to physical and mental health.

Reminding parents to take it easy, to prioritize rest, and to know that rest is vital is such an important part of postpartum planning.

You can help parents have a smooth adjustment by incorporating postpartum planning into your services.

Why Birth Position Matters

October 18, 2021

As doulas, parents hire us in hopes we can help them have a positive and supported birth experience. One thing we learn as doulas is how important the birth position can be. The position one labors and births in can have a big impact on how their birth unfolds.

Why? Well as you’ve learned or are learning in training, the supine position (laying on back) with legs far apart can close the pelvis by 30% compared to other positions.

When you’re trying to give birth to a whole human, 30% is quite a bit of space you’d want to take advantage of.

How do we help parents understand that birth position matters? Here are some reasons it matters:

Few Birthers Naturally Choose Supine or Lithotomy Positions

As a doula, you value evidenced-based information. An older French obstetrician, Michel Odent, spent much of his carrier observing and documenting behaviors in labor and birth. He also observed how the environment impacted choices.

When left to their own freedom of movement, especially without a bed central to the birthing space, few women naturally chose supine or lithotomy positions. When we give one the space to move and listen to their body, it seems few bodies find comfort in supine positions during labor.

Even when one chooses pharmaceutical pain relief, there is pressure and sensations which are often relieved with alternative positions.

The Use of Gravity – The Birth Position Matters

We would all be a bit uncomfortable if it were suggested we start using the bathroom while lying down. Sure, we could absolutely do so. Yes, people with limited mobility, post-op situations, and sometimes our little ones, all go to the bathroom lying down.

However, it is neither the most natural position nor the most comfortable. Gravity and the ability to relax the pelvic floor are both important.

Benefits of being upright and active during labor and birth include:

Reduced length of the first stage of labor
Less need for pharmacological pain relief
Reduced risk of tearing and pelvic floor damage
A shorter second stage of labor, some sources citing 40% shorter

A shorter birth with less reported pain is often enough to encourage parents to get upright and moving. It is also helpful to provide education prenatally so they understand this isn’t new information or a trend. Even modern obstetrics was aware as early as the 1930s that the lithotomy position reduces pelvic space.

Unfortunately for many, the convenience and ability for providers to see has made the lithotomy position common.

Help Clients Break The Idea of “Normal” Birth Positions

For clients who have only seen birth on TV or in movies, there’s a strong likelihood that they natural association lying down with giving birth. During prenatal education, you can help clients explore different positions. Help them find positive birth stories showing different positions.

Whether they plan an unmedicated birth or desire an epidural, there are many positions one can labor and birth in.

For those planning an unmedicated birth, the position options are nearly endless. For those with an epidural, magnesium, or other fall risk concerns, there are still many things they can try including:

Leaning over a birth ball on the bed
Using a peanut ball between knees and under legs, rotating sides every so often
Adjusting the L&D bed to be upright
Making use of the squat bar on the laboring bed

Showing pictures, videos, and having discussions about these alternative positions during the prenatal period will help them be more comfortable exploring options during labor.

Birth Positioning Is a Matter of Empowerment

Helping your clients understand their rights of autonomy and choosing what works best for them can be extremely empowering. Supporting clients in making informed decisions is a big part of your role as a doula.

There is not one right way to give birth, neither are there guarantees about how birth will unfold. However, when clients get to be active participants in the birth planning process, as well as during the birth, they’re more likely to report an empowering birth experience.

On a final note, a wonderful quote from Active Birth by Janet Balaskas, “By deciding to have an active birth you will be reclaiming your fundamental power as a birth-giver, a mother, and a woman. You will be giving your baby the best possible start in life and a safe transition from the womb to the world. Should any unusual difficulty or complication arise, you will be free to make use of the safety net of modern obstetric care, knowing that you have done your very best and also knowing that this is your choice and that intervention was really necessary. In this way, even the most difficult birth can be a positive experience.”

What Does Doula Support Really Look Like?

October 16, 2021

There are many myths about what doula support really looks like. It isn’t uncommon for people, even new doulas, to assume support is limited to unmedicated birth or even only out of hospital birth. In reality, doulas provide a wide range of services and support.

Whether a client is planning an unmedicated, out of hospital birth with plans to breastfeed, or they’re scheduled for a medically necessary c-section with plans to bottle feed, doulas can provide immeasurable support. Many clients will fall in between those two scenarios.

Regardless of how one plans to or ends up giving birth, here are ways you an provide doulas support:

On-Call Doula Support For Continuity of Care

As a doula, you will provide on-call support for your clients. For birth doulas, this means being available within a reasonable time frame from approximately 37 to 42 weeks gestation. The knowledge that someone will be available shortly after you call is an amazing benefit of doula support.

While midwives, nurses, and obstetricians remain on-call for their clients, they are there to provide clinical care. As a doula, you can provide support before, during, and after the need for medical and clinical monitoring or care. The continuity of care is an amazing benefit for doula clients.

Practical Assistance

In addition to the obvious birth support, doulas are available to provide practical assistance. Forgotten items, needing water, remaining bedside while a partner runs to grab a snack – all basic practical assistance.

For postpartum doulas, this can look like making sure the parents eat, running an errand, or helping organize baby items.

Provide Reminders of Normalcy

Every birth is unique. However, as a doula you are well educated about normal physiological birth, interventions, etc. You have the knowledge to help reassure parents about the different things they are experiencing during labor.

Reassurance during labor, birth, and the postpartum period can be invaluable. Your doula support in helping provide reminders of normalcy can take an otherwise scary experience and help it be positive.

Support In Processing The Birth Experience

As doulas, we are not counselors, psychotherapists, or psychiatrists. We cannot provide any mental health diagnosis or treatment. However, we do have the skills to be an ear as clients process their birth experience.

We are able to provide non-judgmental support as parents process their birthing experience. We often bear witness to how their birth unfolded. While we shouldn’t color their experience, we can provide insight as the process simply by having been there.

We can reassure parents that they did amazing. We can provide an understanding ear knowing the complexities of birth.

Support For Unexpected NICU Stays, Medical Complications, Etc.

Birth often unfolds well. However, sometimes unexpected complications occur including extra medical needs and NICU stays. As a birth worker, you possess the skills, understanding, and resources to provide additional support when the unexpected occurs.

Helping clients process the unexpected and connect them with resources is an important way to provide holistic doula support. You can also provide the no strings attached check ins and reminders you’re thinking of them in a way which friends and family aren’t always able to do.

Nutrition And Food Support

As a mother myself, I often think how I wish someone would just feed me. When I’m responsible for growing a human, breastfeeding a newborn, healing, etc., it’s easy to forget to prioritize my own health and nutrition.

As doulas, we have the unique opportunity to “mother” new parents during a time of transitions. Many doulas provide meal support. Whether you’re simply reheating their meals so they remember to eat, or holding baby so parents can enjoy a meal together, making sure parents eat is an important part of doula support.

Sibling Support

When parents welcome a younger sibling, it can be a transition for everyone. As doulas, we can provide sibling support as we provide whole family support. Sometimes sibling support looks like providing infant care so parents can spend time with their older children. Other times it may look like reading a book and playing with a sibling.

Different doulas provide different services. However, many doulas find providing sibling support to be a valuable and needed service.

A Truly Helpful Visitor

When parents welcome a new baby, everyone wants to visit. While it can be exciting to show off your new little one, it is definitely exhausting. As a doula, you visit to provide true doula support and assistance. You are one visitor parents can truly look forward to.

Yes, doulas provide ongoing support for birth. Doulas are certainly skilled and trained to help parents with unmedicated, physiological birth. However, doulas also provide additional services to help support families in unique ways.