International Doula Institute | Doula Blog

FET Pregnancies and High Blood Pressure – What Doulas Need to Know

October 19, 2022

As doulas, we are non-clinical pregnancy, birth, and postpartum support providers. However, with 1.5% of babies being conceived via IVF, it is important to be aware of how IVF can impact pregnancy. Upwards of 40% of IVF cycles result in frozen embryos, it is important to be aware that frozen embryo transfers (FET) have risks. Research shows FET pregnancies and high blood pressure may be related.

As doulas, we do not need to be aware of all medical scenarios. In fact, most pregnancies unfold quite well. However, it is important we have the necessary information to support our clients. In some metro areas, upwards of 5% of babies are conceived via IVF. In states where IVF is mandated to be covered by insurance, the numbers could be higher.

Given the frequency of IVF, most doulas will eventually support clients who have conceived via IVF. As a professional doula, it is important you have the information to provide adequate support.

New research shows a potential connection between FET pregnancies and high blood pressure. As doulas, knowing this can help us educate our clients and encourage them to discuss these risks with their midwives or doctors.

FET Pregnancies and High Blood Pressure

An increase in blood pressure can be a common side effect of pregnancy due to hormone shifts. However, when it reaches a certain point, it becomes hypertension – or high blood pressure. This increases pregnancy and birth complications for both mother and baby.

Given that cardiovascular events are a leading cause of complications, all pregnant people are screened and monitored. However, those with specific risk factors might have additional monitoring.

Currently, approximately 1 in 25 US pregnancies are complicated with hypertension. The research published in Hypertension, an American Heart Association journal, found FET may be associated with a 74% increased risk of hypertensive disorders.

Surprisingly, the study found fresh embryo transfers shared a similar risk of hypertensive disorders as naturally conceived pregnancies.

Frozen embryo transfers are done in a different cycle than a full IVF cycle where eggs are retrieved. With a fresh transfer, the embryos are transferred three or five days after egg retrieval rather than a separate cycle.

What Are The Risks of Hypertensive Disorders During Pregnancy?

Hypertensive disorders increase risks for both the birthing person and the baby. While they are often managed well, the risks exist and can cause problems such as:

Complications from high blood pressure for the mother and infant can include the following:

For the birthing person: preeclampsia, eclampsia, stroke, medically necessary induction, early c-section, placental abruption (which increases risk of hemorrhage).
For the baby: birth before 37 weeks, low birth weight, IUGR, and complications associated with preterm birth and low birth weight – hypertension can impact blood flow to the placenta and thus the baby

As doulas, we will not be diagnosing or treating clients for hypertensive disorders. Neither should we give them worst case scenario and scare them about risk factors. However, we can use our information to encourage adequate prenatal care. Also, discussing concerns with their medical provider, and encourage them to be self-advocates when they have concerns.

We can also support them with stress management, nutrition, and problem-solving ways to get adequate rest.

What Did The Study Find?

Researchers took a unique sibling comparison approach to differentiate whether the risk factor was the parents or the type of conception. Those included in the study have a previous naturally conceived birth, as well as either an FET or fresh IVF transfer.

Sindre H. Petersen, M.D., the study’s lead author and a Ph.D. fellow at the Norwegian University of Science and Technology in Trondheim, Norway, and her colleagues, examined national data from medical birth registries from Denmark, Norway, and Sweden. They looked at nearly 2.4 million women who were ages 20 to 44 years old who had single deliveries and gave birth during the study period from 1988 through 2015.

They found:

Of those analyzed, women with a pregnancy resulting from an FET were 74% more likely to develop a hypertensive disorder during pregnancy compared to those who conceived naturally.
Of those who had both a natural conception and an FET, the risk of hypertensive disorders in pregnancy after FET was twice as high compared to their naturally conceived pregnancies.
Pregnancies from a fresh IVF cycle did not have a higher risk of developing hypertensive disorders compared to a natural conception.

“Our sibling comparisons indicate that the higher risk is not caused by factors related to the parents, rather, however, that some IVF treatment factors may be involved,” Petersen said. “Future research should investigate which parts of the frozen embryo transfer process may impact risk of hypertension during pregnancy.”

What does this mean for doulas? In short, if you have a client who shares they are pregnant via an FET your knowledge helps. It is important to help encourage they keep all prenatal appointments. You can encourage them to follow provider recommendations. Also, share general education regarding lifestyle and diet options which might aid in reducing their risks.

Is Covid-19 Responsible For Pregnancy Complications?

October 18, 2022

is covid-19 responsible for pregnancy complications We are all aware of the drastic global impact of Covid-19. We all lived during a major global pandemic which cost millions of lives, altered how we worked and learned, and impacted healthcare. Researchers, doctors, midwives, and global health organizations are scrambling to grasp if Covid-19 responsible for pregnancy complications.

During the initial and ongoing pandemic, statistics shows a noticeable jump in pregnancy complications. Multiple initial theories existed, but now science is not so sure of the impact of Covid-19 on pregnancy.

Is Covid-19 Responsible For Pregnancy Complications?

Ilhem Messaoudi, a professor of immunology at the University of Kentucky, said she and many of her colleagues have been surprised by the extent the pandemic has had on pregnancy complications. Being that Covid-19 was thought to be primarily a respiratory infection, the healthcare field did not expect reproductive organs and the placenta to be impacted.

However, pregnancy experts spent the last few years trying to understand the spikes in maternal complications. Initially, these complications were reported anecdotally, however they have since been verified in several large studies. There’s an extremely small, but still alarming, group of unusual stillbirths.

“I was naive,” Messaoudi reflected. “Now I wonder, ‘What else have we been missing?’”

The difficult part, it will take nearly a decade or more to truly be able to study and understand what impact Covid-19 truly had and may continue to have on pregnancy outcomes.

Initial Theories

There are some who felt immediate shifts in outcomes could be related to changes in care. Some routine tests were delayed in the beginning of the pandemic. Long hospital waits, staffing issues, etc., could have led to delays in care which otherwise would not have occurred.

However, with several studies complete, it appears there is an actual physiological impact of Covid-19. Yet it will still take time to know for sure.

Covid-19 is not the first viral threat to pregnancy. During the 1918 flu, there was also an increase in pregnancy complications and stillbirth. In 2015, Brazil and several other countries experienced complications from the Zika virus which increased the risk of stillbirth and congenital birth defects.

There are some encouraging findings, such as no evidenced of impact on male or female fertility. Neither the infection nor the vaccine is associated with any changes in fertility. While there may be a shift in one menstrual cycle, there are no ongoing fertility complications.

Covid-19 Pregnancy Complications

While the fertility news is great. Unfortunately, there is still a concern with pregnancy itself. While most people infected experience no complications, there are documented increased risks of:

Preeclampsia
Very small risk of stillbirth
Hypertension
Other complications.

Research remains unclear, but they believe the risks likely begin with changes in the blood and immune system of pregnancy people. While pregnancy can be magical, it is also a time of brutal physiological changes. There is an increased risk of stress on the heart and circulatory system. In fact, pregnancy people have a blood volume increase of 30-50%.

It turns out that Covid-19 can have a drastic impact on the immune system and cardiovascular systems. Covid-10 attaches to ACE2 receptors which are involved in regulating inflammation and blood pressure. Doctors found in some patients, the virus can lead to hundreds of microclots which can impact a pregnant person and growing baby.

Amy Heerema McKenney, a Cleveland Clinic pathologist, seemed to study the placentas of stillborn babies in rapid succession during the pandemic. While she had seen only 20 placentas in six months of studying them, it still marked a notable increase.

What was most concerning is the obvious differences between typical healthy placentas and those of the stillborn babies during the pandemic. McKenney noted they looked like nothing she had ever seen before: firm, scarred and more of a shade of tan.

“The degree of devastation was unique,” she said. She noted most of the women were in their second trimester, unvaccinated or only partially vaccinated, and infected with the coronavirus within a two-week window before their pregnancies ending.

Other Specialists Saw Similar Complications

Other researchers also noted similar complications.

A report from the Centers for Disease Control and Prevention involving 1,249,634 deliveries from March 2020 to September 2021 saw a similar link “Although stillbirth was a rare outcome overall, a covid-19 diagnosis documented during the delivery hospitalization was associated with an increased risk for stillbirth in the United States, with a stronger association during the period of delta variant predominance,” researchers wrote.

Researchers suspect Covid-19 impacted blood flow to the placenta in some way. It may also trigger clots, impact hypertension, and thus impact stillbirth and preeclampsia rates.

Unfortunately, it will take years to fully understand the impact. While current research does not suggest delaying pregnancy, like we saw with Zika recommendations, it is likely most recommend taking precautions to reduce the risk of contracting Covid-19 during pregnancy.

As doulas, it is important we provide evidenced-based information, share current recommendations, and do our best to help our clients get adequate care during pregnancy.

Doula Support For Teen Parents

October 17, 2022

As a doula, you are a professional resource in the birth community. As doulas, we serve parents from all demographics. Doula support for teen parents is something all doulas should be familiar with. While teen pregnancy rates have dropped in recent years, the rate is not zero.

As doulas, we know every birthing person deserves adequate support, respect and autonomy during pregnancy and birth. However, we also know that disparities in care exist for a variety of reasons, sometimes including disparities in teen care.

When providing doula support for teen parents, it is important to be aware of certain things to help provide them with adequate and respectful support.

Doula Support For Teen Parents

The most important thing to remember when working with teen parents is that they are individuals just like all your clients. It is helpful to use questionnaires, open conversations, etc., to avoid making assumptions or generalizations.

Just as each thirty-year-old client you serve is unique, so is each teen parent you serve.

There will be somethings which are unique to teen parents such as:

Increased risk of certain complications due to their physiological development
Potential challenges with balancing pregnancy, birth, postpartum, and pre-college level schooling
In rare circumstances, social services may be involved if the teen is younger than the age of consent in your state

Build Confidence and Open Communication

As a doula, one of the most important parts of our work is building our clients’ confidence in giving birth. We also build their confidence in trusting their body, trusting instincts, and knowing the right of autonomy during pregnancy and birth.

It is not uncommon for teen parents to report feeling talked down to, ignored, or not respected during prenatal and birth care. While this sadly occurs with many pregnant people, teens are more likely to be treated poorly during pregnancy. Whether by community, health professionals, or family, there are times people attach morals to pregnancy and consciously or subconsciously treat pregnant teens poorly.

As doulas, we must never be part of putting down any client. In fact, professionally it is our role to build up our clients. We are to encourage them to speak up for themselves.

It is also important for us to help clients develop open communication with their providers. One great thing is to teach and remind them of the BRAIN acronym.

Benefit – what is the benefit for me? For baby?
Risk – What is the risk to me? To baby?
Alternatives – what alternatives do we have?
Intuition – What’s my gut feeling?
Nothing – What happens if we do nothing?

This simple acronym is a great way to encourage open communication.

Pregnant Teens May Experience More Complications Than Fully Developed Adults

While teens have given birth for millennia, that does not lessen the known risks of birthing before full development. Certainly, teen is a wide age-range, from thirteen to nineteen. A thirteen-year old’s risk is very different than a fully developed 17-, 18- or 19-year-old. However, depending on some factors, even older teens can face risks due to social determinants of health.

“Adolescents are at increased risk for low-birth-weight babies, high blood pressure in pregnancy, preeclampsia, higher complications from sexually transmitted diseases, and increased rate of infant death,” said Dr. Anne Waldrop, a maternal-fetal medicine fellow at Stanford University.

As a doula, we remain non-clinical. However, we can provide general education and encourage clients to remain in contact with their providers. We can discuss optimal nutrition, stress management, and refer as needed for resources.

We can also provide information about the signs and symptoms of high blood pressure, pre-eclampsia, and preterm labor. The sooner one is in contact with their health provider when complications arise, often the more options they have for managing such conditions.

We should be offering education on these topics for all our clients, regardless of their age. However, as a doula it can be helpful to know which of our clients may be at increased risk for certain complications so we can tailor additional education to meet their needs.

Birth Doula Support For Teen Parents

Physiological birth is a process which often unfolds quite well. This is even the case among teen parents. However, for young teens who are not yet fully developed, there can be some risks during birth. It is a balance to provide appropriate support, encouraging understanding of normal physiological birth, alongside encouraging clients to have open communication with their providers.

There may be situations, just like with all clients, where a doctor may jump to interventions “just in case” based on potential risk factors versus specific circumstances. However, we must remember we are not medical providers.

As birth doulas we can:

Encourage clients to choose care providers they truly trust
Help clients become educated about their birth options
Support them in developing birthing plans and preferences, while providing evidenced-based information
Educate them about birth interventions and how to make informed decisions
Provide non-judgmental support
Give support which helps them to have a positive birth experience by feeling heard, cared about, and safe, regardless of how birth unfolds.

We can also help prepare our clients for a healthy postpartum experience and safe newborn care experience. As with all clients, the prental period can include evidenced-based information and resources about breastfeeding, infant feeding and care, and safe infant sleep.

IDI Recognized By The Minnesota Department of Health

October 16, 2022

IDI recognized Great news, IDI doulas! The International Doula Institute has been recognized by the Minnesota Department of Health as a designated Doula Certification Organization (DCO). We’re officially official in Minnesota!

It is extremely important to note that doulas are NOT regulated, do not require licensure, and are not medical providers. Nonetheless, this is an important and exciting development in IDI’s growth. Why? It means more hospitals, more states, more global organizations will recognize IDI on your certificate.

Being that all doulas are non-medical and can provide support without being overseen by a government agency, you do not need to worry if your state does not have an official stance. In fact, very few states do.

The reason IDI worked with the Minnesota Department of Health is to help the public. The department of health created their statewide doula registry to aid the public in finding professional doulas. It takes just a bit of leg work away from parents searching for a doula.

In short, Minnesota is simply showing the community it values doula work.

What is the Doula Registry in Minnesota?

It is important to note, again, that there is no licensure required for professional doulas. This registry is simply a public service to Minnesota residents looking for a doula.

“The Minnesota legislature enacted a law effective July 1, 2007, creating the Doula Registry within the Minnesota Department of Health (MDH). The department verifies that an applicant is certified by one of eight private certifying organizations listed in statute and identifies whether the doula has a criminal history as shown on the web site of the Minnesota Bureau of Criminal Apprehension.”

In short, the registry simply helps residents find a certified doula who does not have a criminal history. That said, it is not a requirement for doulas to be certified to work. Nor are doulas required to have no criminal history to serve their community. Every family can make an informed decision about the doula they feel most comfortable working with, regardless of their certification or history.

I’m Not in Minnesota, Does It Matter IDI Recognized?

Yes! Why? During the pandemic, many doulas found themselves struggling to be able to support their clients. By being recognized by a state department of health, it is easier for IDI certified doulas to gain the ability to support clients birthing in hospitals with restricted birthing support policies.

To be added to the registry, IDI needed to provide the department of health with information regarding our training and certification process. Again, there is no overseeing body in doula work, however, by being recognized it shows systems used to overseeing bodies that our process and training is up to par.

Does IDI Believe Doulas Must Certify, Register, Etc.?

At IDI, we strongly believe in professionalism, evidenced-based training, and ongoing education. That said, we also recognize that birth support has existed for millennia, since birth began. We recognize the traditional birth workers who have learned from other traditional birth workers. We do not hope to live in a world where traditional birth workers are excluded.

However, we see a need for training and certification in a world where birth support is often difficult to come by. We recognize that many who want to provide birth support do not have access to simply learn, in-person, from a traditional birth worker.

This makes a doula training program, like IDI, available to help more people have access to birth support. By providing a comprehensive training program, certification, and the ability to join registries, we can support anyone wanting to provide birth support.

In an ideal world, every birthing person desiring birth support would have access to such support. Until we live in an ideal birthing world, IDI will continue to provide comprehensive training and certification.

We recognize that most of us live in spaces which require proof of training, professionalism, etc. This does not discount any traditional providers. Rather, we recognize the space which most of us live and thus value the opportunity to provide an avenue to professional doula development.

So, in short, IDI is recognized as a valid certification organization. As you embark and continue your birth work path, you can be sure you have chosen a top training organization. Not yet an IDI doula? Be sure to register today!

How Do Travel Doulas Work?

September 20, 2022

travel doulas There are some doulas who are not tied to specific locations. Some doulas are childfree, their children are older, or they have supportive partners with flexible schedules. For some in those situations, they choose an exciting career as a travel doula.

A travel doula works as a birth or postpartum doula while traveling to a variety of locations for their clients. They may offer unique services, such as prenatal education, support, and help setting up the nursery. Often, they will spend longer periods with or near their clients due to the unpredictable nature of birth.

The first step to becoming a travel doula is to get certified. With the International Doula Institute’s unique online platform, we make it easy for you to jump in and start training.

How Do Travel Doulas Work?

Once you become a certified birth doula, certified postpartum doula, or take the complete childbirth professional program, you are ready to jump into travel doula work.

Travel doulas will make connections, advertise all over, and make sure their social circles are aware of what they do. Do not wait until you complete your certification, start networking right away.

Traveling doulas will typically have a calendar set up and will book for chunks of time. So, perhaps they are based in Philadelphia, but they have a client in Florida. They will schedule to be available within a certain period before and after their estimated due date.

For traveling postpartum doulas, the scheduling is sometimes easier. Many traveling doulas will offer both birth and postpartum to their clients. This maximizes the amount of potential income from each client they travel to. Being able to offer multiple services to clients also creates a positive experience of continuity of care.

Once a schedule is set up, a traveling doula books clients in multiple locations. Some will choose to be “stationed” in a specific area for a few months and advertise for clients there. Others will travel specifically to a location requested by a client.

Is Travel Doula Work Sustainable?

Sustainability in doula work varies based on each doula’s needs, work model, and locations. The cost of living in some areas is higher than others. For a childfree or retiree who is choosing travel doula work, it can easily become a sustainable career model.

For those with higher expenses, children, etc., traveling doula work is likely to only represent a small portion of their work. They may take one or two travel doula clients per year. Then, they will take clients close to home to ensure they have a sustainable income.

For those who offer postpartum support, especially overnight and sleep support, scheduling a few several week clients throughout the year is common. These long stretches of continuous support for clients can make scheduling easy while maintaining a sustainable income. Travel doula work is sustainable for many.

How Do You Get Started as a Travel Doula?

As mentioned above, your first step is to get trained and certified. Ideally, you will want to complete both your birth and postpartum doula training. You can also be more in demand by completing additional certifications such as our certified breastfeeding counselor training.

Before you complete your training, get started on your web presence. Get on social media, create content so your followers see all you offer. Present yourself as an expert in all things pregnancy, birth, and the postpartum period.

As you complete your training, continue to network with birth workers near and fair. Plan ahead and see where on your calendar you have time for travel, what fee will make it sustainable for you, and when you will be ready to begin.

Most importantly, do not wait to seek clients. Begin networking as soon as you begin your training. The unique part of IDI’s training is you are prepared to begin taking clients as soon as you finish. There is no long wait.

Ready to turn your passion for birth into a career and an adventure? Start training now and get ready to become a travel doula!

Can a Retiree Become a Doula?

September 20, 2022

Doulas come from all ages and stages. However, is it possible for a retiree to become a doula? In short, absolutely! In fact, there are many benefits of becoming a doula as a retiree. If you are close to retirement or already retired, doula work is a great way to turn a passion into a flexible retirement job.

Sure, many retirees simply retire. However, it is not uncommon to retire from a full-time job and desire or need to work part-time. If you need or want to remain working after retirement, becoming a doula offers flexible work. Best of all, you can turn a passion for birth into a meaningful source of income.

Can a Retiree Become a Doula?

It is common to assume doulas are young, perhaps also in their childbearing years. However, not only is there a market for retiree doulas, but there’s also a need for them! Every doula demographic plays a significant role in ensuring every family can find a doula which meets their needs.

There are clients who hope to find the young doula who feels like a friend. Some clients seek out the experienced, but similarly aged, fellow mom who may understand exactly what their going through in real time.

However, there are also many, many clients seeking the doula who feels like a non-judgmental aunt or motherly type. They want the support of an experienced person who has been through and seen a lot of birth experiences. Some are seeking the soothing and calming temperament of someone who knows what is and is not a big deal.

There is an entire market of clients who only feel comfortable with doulas who have significantly more life and parenting experience than they have.

If you are a retiree with a passion for birth, you have a perfect niche client market. The sooner you begin your training, the sooner you can tap into that market.

Being a Doula After Retirement Means Jumping in is Easier

For many younger doulas, school, work, children, and other commitments can make it difficult to organize and jump into doula work. It is possible at any stage to become a doula. However, as a retiree, you may enjoy the benefit of an extremely flexible schedule.

Being on-call can be easier when you are not responsible for finding childcare. If you are already set with your home and living situation, you may find it less stressful to make a transition to a part-time career as a doula. For those still in the stage of life of navigating mortgages, car payments, etc., it could take more planning to make that shift in careers.

As a retiree, you can work on your training, at your own pace, wherever you want! The International Doula Institute’s unique go at your own pace program allows you to work anywhere, even from your smartphone.

Traveling? No problem. If you have internet access, you can train anywhere. Enjoying time with your grandkids? Read while they play or nap. Sit at the park, hang out at a coffee house, enjoy your patio at home while you tackle your training material.

You Have Important Life Experience to Help Clients

As a doula, you will receive training on evidence-based physiological birth, emotional intelligence, and more. However, there are some things we cannot teach, and that is personal life experience. As a retiree, you have a lot of life experience.

You have likely lived through many changes in birthing trends, realizing that physiology of birth does not change. Chances are you recognize the importance of birth and the impact it has on people. Most importantly, you have had enough interactions with people to know how important non-judgmental support is.

As a retiree, you have also learned business skills. At IDI we provide basic business information to help you get started. However, many retirees have business skills from their years of work.

Whether you were a teacher, a nurse, or worked in an office, you will have transferrable skills to help you as a doula. Even if you worked on a farm, in a factory, or a bank, there are still many skills from people skills to business skills which can help you transition to doula work.

What are you waiting for? Begin this second and amazing season of your professional life, even in retirement! Being able to turn your passion into part-time income can make for an amazing retirement!