As doulas, we know that a whole body, whole lifestyle, holistic approach can be important in maternity care. In understanding the physiology of pregnancy, this means we recognize that diet, lifestyle, stress, work, and many other factors impact a person’s body. New research found a popular diet, the Mediterranean diet, reduces risk of preeclampsia and gestational diabetes.

As birth professionals, it is not shocking that diet can impact birth outcomes. However, knowing that preeclampsia and gestational diabetes can impact any pregnancy person, even the healthiest, makes this study extremely encouraging.

Often, clients feel there’s little to no control over whether they will or will not develop preeclampsia or gestational diabetes. And while that remains somewhat true, this research is encouraging that there are ways to reduce the risk.

Popular Diet Reduces Risk of Preeclampsia and Gestational Diabetes – The Study

Despite being a developed country with access to food, medical care, etc., the US has poorer maternal infant outcomes than we should expect. Maternal child health statistics can help provide us with an overall picture of a county’s wellness. This means that maternal infant outcomes are a public health concern.

Researchers at Smidt Heart Institute at Cedars-Sinai looked at 7,798 and published the results in the JAMA Network Open. The results were created when:

“Women who were pregnant with their first child were asked to complete a semi-quantitative food frequency questionnaire during their first study visit, which occurred in the first trimester.

The questionnaire focused on the women’s eating habits during the three months prior to their visit. The participants were asked to report their intake of common foods and beverages. Individuals’ responses were then categorized into the nine components of a Mediterranean diet — vegetables, fruits, nuts, whole grains, legumes, fish, monounsaturated-to-saturated fat ratio, red and processed meats, and alcohol — to calculate a Mediterranean diet score.”

Using the score allowed researchers to see which women followed a Mediterranean diet, which is commonly referred to as anti-inflammatory.

While we have some theories, we do not fully understand preeclampsia. There are some notable risk factors. However, there are people with no known risk factors who still develop preeclampsia. With gestational diabetes, we know there are risk factors, genetic predisposition, etc., however, this is another pregnancy complication which can impact anyone.

What The Researchers Found With The Mediterranean Diet

“This multicenter, population-based study validates that a healthier eating pattern is associated with a lower risk of adverse pregnancy outcomes, the most exciting being a 28% lower risk for preeclampsia,” said Natalie Bello, MD, MPH, senior and corresponding author of the study and director of Hypertension Research in the Smidt Heart Institute. “Importantly, this connection between the Mediterranean diet and lower risk of adverse pregnancy outcomes was seen in a geographically, racially and ethnically diverse population.”

Given there are significant disparities in healthcare, it is encouraging that these results were seen in a diverse population. Certainly, ensuring access to Mediterranean diet friendly foods is a different hurdle, but nonetheless these results are encouraging.

Researchers also noted that there was an increased association in prevention of preeclampsia for one group especially. With this diet among those over 35 years of age. Those over 35 are typically referred to as “advanced maternal age.” They are often considered to be at an increased risk for complications.

The data found:

• Of the 7,798 women enrolled, 10% were 35 years old or older, 11% were non-Hispanic Black, 17% were Hispanic, and 4% were Asian.
• 20% of enrollees had obesity at the onset of their participation.
• A high Mediterranean diet score was related to 21% lower odds of having any adverse pregnancy outcome, as well as a 28% and 37% lower risk of having preeclampsia/eclampsia and gestational diabetes.

“We also looked at the individual components of the Mediterranean diet and found higher intakes of vegetables, legumes and fish were related to lower associated risk of an adverse pregnancy outcome,” said Bello.

What Does This Mean for Birth Workers?

For doulas, childbirth educators, etc., this study reinforces that diet can impact pregnancy outcomes. However, prior to this study, we did not necessarily have specific dietary recommendations which were associated with specific conditions.

Given that a Mediterranean diet is not a strict, fad, or come and go type of diet, it is one we can easily educate our clients about. It is also one which is sustainable for a variety of lifestyles, incomes, etc.

Finally, it is important that we use this study for what it found. The study found a reduction in risk associated with this diet. It did not say that this diet would completely eliminate the risk of preeclampsia or gestational diabetes. Some clients who go on to develop these conditions despite their dietary habits. We can reassure them that they did what they could, but some complications are unfortunately beyond our control.

As a doula, it is vital we use evidenced based birth information as we provide education and support for our clients. However, it is equally important that we also stay within our doula scope of practice. This means using evidenced based information to help us share options with our clients but never providing medical advice.

It is important we always remember we are not medical providers. Even if you are also a licensed medical provider, you cannot act as that medical professional while providing doula services.

Understanding evidenced based birth information and doula scope of practice is vital for providing the best and safest support for our clients.

What is the Birth Doula Scope of Practice?

During your birth doula training, you will learn all about your scope of practice. You will also learn how to apply that understanding in different circumstances. There are times clients will ask you medical related questions you know the answer to. However, it is important you do not provide direct medical advice.

In these situations, you provide general information and education, point them to evidenced based birth resources, and remind them to check with their medical provider.

The birth doula scope of practice is:

• Evidenced based birth education during pregnancy
• Being On-Call
• Continuous Attendance at the Birth
• Comfort Measures During Childbirth
  • Relaxation Techniques
  • Touch Techniques
  • Positions
  • Warm and Cold (heating pad or cold pack)
• Emotional Support during Pregnancy and Childbirth
• Advocate (Assisting in facilitating fluid communication between birth facility staff and the birthing family – we do not speak for our clients, rather we support them in self-advocacy)

While doulas are trained in evidenced based birth, pregnancy, and postpartum, we remain completely non clinical. Having knowledge is not equivalent to having clinical skills nor the ability to safely diagnose, treat, or recommend anything medical.

Doulas are not:

• A birth doula is not a medical professional.
• A birth doula is not a psychologist or mental health professional.
• A birth doula does not perform clinical tasks.
• Clinical tasks that a doula would NOT perform would include checking fetal heart tones, checking a mom’s cervix, taking blood pressure, suggesting medications including over the counter, prescription or herbal medications, vitamins or offering any other medical advice.
• A birth doula will not provide abdominal massage to help turn a breech baby.
• A birth doula will not contradict the healthcare provider’s advice.

Again, even if you hold a clinical license, when acting as a birth doula you do not perform any clinical tasks nor diagnose or treat anything.

Why Must Doulas Use Evidenced Based Birth Information?

As doulas, it is important we provide our clients with evidenced based information. There are endless sources of information, myths, and opinions floating around regarding birth. As professionals, we are obligated to provide our clients with accurate information to help them make informed decisions.

By providing clients with evidenced base information, we are giving them the tools to make safe choices about birth.  With many myths, half-truths, and opinions around, it is easy for clients to inadvertently make choices which are not always safest.

It is also important that we only provide evidenced-based information to ensure we are not putting clients at risk. It is perfectly acceptable to share opinions with clients, but it is vital our clients can easily decipher between our opinion and actual evidence we are sharing.

For example, if a client asks about when inductions are medically necessary, we can provide them with the most recent information from ACOG, WHO, ACNM, etc. We can also share when we would personally opt for an induction versus waiting. However, we need to be sure they understand which information is from the reputable sources and which are our personal opinions.

Always Refer Back to Healthcare Provider

It is also important to redirect clients back to their provider for more information about their questions. For example, if a client is simply asking about inductions, you may not know why their provider has recommended one. By redirecting them to their provider, they might find out they are showing signs of hypertension and it is an evidenced-based recommendation. Or they might find out their provider offered it as he does all clients, and it is truly up to the client’s personal preferences.

However, if you simply provide information about induction without redirecting to the provider, and the client declines an induction, they could be at risk if it was medically indicated. As a doula, we need to ensure we never give medical advice and put our clients at risk and ourselves at risk for liability.

Evidenced-based information is vital for our clients being able to make informed decisions. Practicing within our scope of practice is vital for ensuring the safety of our clients and protecting our liability.

Being a birth doula means spending quite a bit of time on call. Holiday birth doula work can be difficult to balance. However, it is possible to balance holiday birth doula work to meet your clients’ needs and your needs.

Sure, being on-call during the holidays can sound overwhelming. But with a bit of planning, realistic expectations, and flexibility, it is very possible to find a healthy balance.

In fact, some doulas enjoy taking the extra clients during the holidays when fewer doulas are available. It is a great time of year to jump in and get clients as you build your experience.

Holiday Birth Doula – Finding Balance

The most important part of being on-call as a doula during the holidays is finding that balance. Take time to look at your home’s needs before deciding how many clients you can take November through January (or fall for Jewish high holidays, spring for important Muslim holidays, etc.,).

It is also important to look at your income needs. While many birth workers (as well as healthcare professionals) would love to plan to be off every major holiday, it is important to meet your income needs. As birth is completely unpredictable, you would need to avoid clients with estimated due dates for nearly an entire month to ensure time off on certain holidays.

It can be helpful to sit down and look at your family’s needs both time and income wise and see how many clients you need per year. From there, look at how many you need per month. It will also depend on if doula work is used to supplement your household or if it is a full-time career for you.

As with all things, it can be helpful to see what is financially needed versus preferred. We know that time is fleeting and sometimes we choose to enjoy our time.

How to Find Balance – Work With a Partner or Team

There are several ways to support clients while working during the holidays and maintaining balance. One helpful way is to work with a backup partner or even a team. Sharing on-call time can make it easier to balance and meet your needs and that of your clients’.

For example, if your big family gather is on Christmas eve, but you are open to being called away on Christmas day, have a backup on-call (with your client’s knowledge) during the few hours you plan for your family event. After that, you go back on-call, or join your client if they had gone into labor with your back up.

Other doulas work as equal partners or teams. Clients get to know them and understand either doula may end up at their birth. Partnering with another birth worker with a different schedule than yours can be helpful.

Holiday Birth Doula – Be Flexible!

Flexibility is super important as a doula. Sometimes you will celebrate holidays on different days than planned. Occasionally, you will miss a big family gathering. Part of being on-call is expecting the unexpected.

Having a backup plan for celebrating if you are called away to a birth is important. If you have children, ensure they understand your role and when you will celebrate together.

The Holidays Are a Great Time to Get Clients

Many seasoned birth workers opt to limit clients around the holidays. They are experienced, have a large year-round client base, and have put their “time” in so to speak.

Some new parents will struggle to find a doula available if their due date is near a major holiday. This is especially true if they are looking late in their third trimester.

If you are looking to build your client base, birth experience, etc., advertising your availability around the holidays can be very helpful. Let other doulas in your area know you are available around the holidays; they may need places to refer their inquiries they cannot take. You can also let other doulas know you are available for backup during the holidays.

As a newer doula, it is important to be flexible when trying to build your experience and client base. Much of our work comes from word of mouth and networking. Being open to working around the holidays is an excellent way to jump into your new career.

Not prepared for holiday birth doula work? Be sure to register for birth doula training today and get started in your new career!

As a doula, you will support clients experiencing a variety of different pregnancies and births. A placental abruption is not a common complication, but it can occur in any pregnancy. Being aware of complications is an important part of being prepared to support clients.

Understanding pregnancy complications means knowing why it is important to remain within your scope and not provide medical advice. If a client expresses concerns about symptoms, you always refer them back to their provider.

You do not need to have a clinical understanding of placental abruption, but basic understanding is helpful.

What is a Placental Abruption?

“In placental abruption, the placenta detaches from the wall of the uterus before or during birth. The most common signs and symptoms are vaginal bleeding and abdominal or back pain. Placental abruption can cause serious complications if it is not found early. The fetus may not get enough oxygen, and the pregnant woman can lose a large amount of blood.”

That is the basic definition from ACOG and a great explanation to use with clients who have questions.

The placenta is meant to stay fully attached to the uterine wall until after the baby is born. Typically, the placenta detaches about 5-30 minutes after birth. Anytime the placenta detaches prior to birth, it is a placental abruption.

Partial Abruption vs Complete Abruption

There are two types of abruptions. A partial abruption is when the placenta does not completely detach from the uterine wall. With this type, there is often some pain, though not always, some vaginal bleeding, but there is not always immediate and obvious signs. Therefore, any second or third trimester bleeding, cramping, pain, etc., should be discussed with a provider if a client is concerned.

A complete or total abruption occurs when the placenta completely detaches from the uterine wall. This type is a serious emergency and often has a lot of vaginal bleeding. Birth is immediately necessary in the case of a complete placental abruption.

How Is Abruption Managed?

In the case of partial abruption, monitoring and rest may allow the pregnancy to continue. It does increase the risk of preterm birth and complications; however, it does not always mean an immediate birth.

For clients who had planned for a homebirth or birth center birth, a partial abruption typically risks them out of that type of birth. While labor can go smoothly, it does increase the risk of a full abruption during labor.

For a complete abruption, birth is almost immediate. This may look like an emergency c-section or an assisted vaginal birth if already fully dilated. Quick action is necessary to prevent fatal hemorrhaging for the parent and hypoxia for the baby.

Unfortunately, if a complete abruption is left untreated, or it occurs before viability, can be fatal to both the birther or the baby.

Is Abruption Common?

While a serious complication, fortunately, abruptions are rare, especially complete abruptions. Abruptions occur in approximately 1 in 100 singleton births. This means that generally, clients have a 99% likelihood of not experiencing an abruption.

Are There Risk Factors For Abruptions?

Generally, the overall risk remains low, and it can occur in any pregnancy. However, there are certain risk factors which can increase someone’s likelihood of having a placental abruption.

Some risk factors include:

• Smoking
• Having a previous placental abruption
• High blood pressure
• Any abdominal trauma (e.g., falling, car accident, etc.)
• Multiples pregnancy
• Uterine infection
• Folic acid deficiency
• Polyhydramnios
• Experiencing preterm labor or preterm premature rupture of membranes

It is important to remember that an increased risk is not a guarantee. Whether or not your client has any risk factors, it is important they maintain regular prenatal care. They should discuss any concerning symptoms with their midwife or doctor.

Pregnancy and birth often unfold well without any complications. However, occasionally things deviate from low risk. When that occurs, as doulas, we can provide support and education to help navigate their unexpected birth experience.

As doulas, it is safe to safe that many of us hear clients say pain is a major concern for their birth. Many wonder how they can navigate a positive birth experience while experiencing the intensity of labor. Mandy Moore recently shared about her second birth – complete with her doula.

Some families choose and desire an unmedicated birth. Other families, like Mandy Moore, have medical conditions necessitating unmedicated birth. Whatever the reason, support is key to navigating unmedicated birth. Well, all births, but especially unmedicated.

Mandy Moore Shares Her Birth Experience

So often we only see highlight reels from celebrities. While birth is certainly a highlight reel, Mandy Moore definitely kept it real throughout her previous and current birth experiences.

In a July Today Parents interview, Moore shared about not being able to receive an epidural during childbirth due to an autoimmune disorder called immune thrombocytopenic purpura (ITP). She had an unmedicated birth with her first son, Gus, as well as her newest son, Oscar.

“My platelets are too low for an epidural. It was awful. But I can do it one more time. I can climb that mountain again,” Moore said.

She continued, “I wish medication was an option — just the idea of it being on the table is so nice. But we’ll just push forth like we did last time.”

As doulas, you will have clients who genuinely aim for, and even express joy in unmedicated childbirth. For others, it is simply something they must navigate and hope to do so in the best way they can given their circumstances.

Her Instagram post included photos and a sweet caption stating:

“One month with our Ozzie,” Moore wrote alongside the sweet photographs. “I’m still able to access everything about that moment, which simultaneously feels like one second ago and also unimaginable to fathom life before.”

“Thank you, Dr. Waldman, our rockstar L&D nurse, Athena, and our doula (and photographer) @rebeccacoursey_photosandfilm for holding space and allowing for such a transcendent birth experience.”

“Baby boy came into this world to the soundtrack of Willie Nelson’s ‘Stardust’. Good choice, sir!”

Doulas and Celebrities

Once upon a time, many connected doulas with a hippy style homebirth. And while we certainly attend those, doulas truly support all births.

Part of the increase in awareness of doulas is seen in the number of celebrities choosing to work with doulas. In fact, many well-known celebrities birthed with doulas, including:

• Kelly Ripa
• Mayim Bialik
• Erykah Badu
• Nicole Kidman
• Tamera Mowry-Housely
• Alyson Hannigan
• Kristen Bell
• Meghan Markle

Using a doula is evidenced-based for more positive birth outcomes and experiences. Backed by research, we know continuous labor support, like that of a doula:

• Reduces the risk of interventions
• Includes a lower rate of pharmacological pain relief
• Increased likelihood of reporting a positive birth experience

And many more benefits.

Are Doulas Only For Unmedicated Births?

As mentioned, doulas attend all types of birth. From home water birth through complicated, high-risk, scheduled medical births – and everything in between.

For those unable to, or those who desire not to, use pharmacological pain relief, a doula is an excellent tool for coping with the intensity of labor and birth. As you know, as doulas, we provide continuous physical, emotional, and practical support.

These supports are vital during unmedicated birth. However, they are also incredibly vital during all births. There is no such thing as a completely pain free, intensity free, emotion free, birth.

Doulas are not only for celebrities. Doulas are not only for unmedicated births. Professional doulas support everyone!