When a Premature Birth Seems Likely

By Adrianne Gordon, MBA, CD(DONA), Blog Manager

This month we recognize Prematurity Awareness Month with tips for doulas supporting families at risk for premature birth.  Whether you are a new doula or have years of experience, we hope these reminders and resources help you better navigate the challenges of supporting a family anticipating an early arrival. Check back later this month for tips on supporting families of premature babies during the postpartum period.

Stay Calm

Whatever the reason for the chance of an early birth, it’s important that you as the doula stay calm for your client. If the circumstances are concerning, it’s OK to let your client see that you understand the gravity of the situation. As the family’s professional support provider, your role is to help them understand the information they are receiving, ask appropriate questions and make informed decisions. You may also need to help them process their emotions and decide if and how to share the news with other family members. Fulfilling your role during this important time requires a clear head. Get the support you need from a trusted doula colleague while maintaining your client’s confidentiality so you can fulfill your role to the best of your abilities. Remember to maintain appropriate professional boundaries. Your client’s situation is their situation. You are a professional support provider, and while our work is very intimate in many ways, maintaining separation between the client’s experience and your own is key to operating within our Code of Ethics.

Plan Ahead

Consider how an earlier than expected birth impacts your schedule and other clients. Update your backup doula or doula partners and make any necessary adjustments to on-call schedules or backup arrangements. While doulas should always have a plan for which birth they will attend should two clients go into labor at the same time, think through any changes you might need to make  to meet all of your clients’ needs in this situation.  The client at risk of a premature birth is likely to need additional support, including prenatal visits and on-call support earlier. They may also need additional support after birth. Premature babies are at higher risk for health complications and longer hospital stays. Review your personal plans and obligations with an eye for any times you won’t be available or reachable. Address any scheduling challenges with your clients in advance to avoid last minute stress or frustration for them.

Take Care of Yourself

“Secure your own oxygen mask first,” isn’t just a nice idea; it’s critical in order to  help others. The extra time and attention your client needs can take its toll. What will you need to have the energy, focus and stamina to support this family and meet your other client, business or family obligations? Rest, hydration, exercise, support and eating well will all help you be able to be present for your client. Are there commitments you can postpone or delegate to create more space in your schedule and ease your own burden?  What will you need after the client’s birth to recover and resume your other obligations?

Help Your Client Prepare

Your client may first experience a bit of shock at learning they at risk of a premature birth. The circumstances surrounding this news may be very difficult to take in. Once you have provided emotional and informational support, your next best method of assistance is practical. What do they need to do to be ready for an earlier than expected arrival? Is their hospital bag packed? Is the car seat installed? If they have other children, what are their options for childcare? Should they have some preemie sized clothes and diapers on hand? Suggest they keep the tags on clothes and receipts for purchases so they can be returned if not needed. Can a friend begin setting up a meal train for them? If the mother is on bed rest or hospitalized, help the family think through their needs and support options. Reach out to your doula colleagues and ask for their advice and resources for supporting a client at risk of premature birth (as always, do not share specifics about your client’s situation).

What are their postpartum support plans? If they have a postpartum doula lined up, have they shared the potential change in expected arrival date? If not, would postpartum support be helpful when baby comes home? Is there a preemie support group in your area? Find out and have that information on hand for after the birth. Look for ways to help build a support network for the family wherever you can.

Get Informed

While sometimes premature births happen without warning, other times a medical condition is involved. Learn what you can about the condition and how it may impact your client’s labor and birth, as well the overall health of both mother and baby. Premature babies are at higher risk for longer hospital stays, often in the Neonatal Intensive Care Unit (NICU). Are you familiar with the NICU’s current policies? Policies do change, so even if you’ve supported a client with a baby in the NICU in the last year, it would be wise to confirm current policies and procedures. What are visiting hours? Are siblings or extended family members allowed to visit? What are the procedures around storing and offering breastmilk? Do they support kangaroo care? Can the hospital facilitate the client obtaining a high quality breast pump should it be needed? Having this information will help your clients have a smoother transition to the postpartum period with a premature baby.

Resources

We encourage doulas and families to obtain information from trusted sources. This list of resources is not an endorsement from DONA International, but a selection of the available sources of information. As always, review information with a critical eye for evidence to support claims or recommendations, how recently it was updated, the credentials of the author or source, and whether or not it’s  consistent with other trusted sources.

March of Dimes – The world’s leading organization working to address premature birth, the March of Dimes has a number of resources on premature birth and babies. They go to great lengths to keep their materials readable for non-medical professionals. Their monthly Twitter chats address a variety of topics and include medical professionals making them a resource for doulas to learn more (dates and topics listed on their blog).

Preterm Labor & Birth – definitions and explanations that may be helpful for overwhelmed parents or to share with family members who have questions

NICU – including explanations of equipment, breastfeeding information, family visiting, etc.

CDC‘s page on Prematurity Awareness Month – This overview of premature birth also includes links to additional resources.

Graham’s Foundation – This family non-profit’s website offers an online community, preemie mentors, and care packages for NICU stays and the transition home. Their blog includes stories from parents of premature babies, tips on what to expect during NICU stay and more. Note that the authors are not medical professionals but parents of premature infants sharing based on their own experience. This resource may be helpful for families feeling isolated and overwhelmed, particularly those with a very premature baby.