By Nikki Mather
Working as a birth and postnatal doula, providing support and information to parents, overcoming new challenges is familiar territory, and is part of the support we provide to families during the exciting journeys they are on during pregnancy, birth and beyond. This year, 2020, with a novel virus thrown into the mix, has been no exception. The only way in which support has been able to continue is by being adaptable. This is a challenge faced by doulas and all birth workers who are providing support during the pandemic.
Online and contact-free versions of doula support, antenatal classes and infant feeding support across the UK have been on offer in abundance. Some doulas have seen an increase in the range of services that they have been able to provide to families, and also the geographic areas they are supporting widened as services are moved online. Sadly, some doulas have had to stop working for the time being, for various reasons relating to the pandemic, including having children at home from school, or vulnerable family members needing extra care, or due to the visiting restrictions imposed from hospitals and birth centres (despite the 5th June update).
A great skill honed by many doulas in their work is adaptability. The possibilities are endless when you are able to look outside of the box and that has certainly been needed in abundance this year in order to continue supporting clients. The range of new versions of support services available to parents across the country is nothing short of amazing. Course providers have supported their cohorts to adapt to their new services, added information to their websites to explain why doula support is still beneficial to families and advertised and shared across social media.
My work involves several elements which complement each other across the maternity journey of families. They have all needed various adaptive measures to ensure that they are Covid safe and working alongside government guidance and legislation. For services where in-person collection is necessary, such as Placenta Remedies, was rapidly adapted to be safe and compliant with new legislation.
During the first lockdown I spent all of my time adapting my offerings and providing support online. In the beginning, people were a little reluctant to accept online services and this was tricky for some clients who were already working with me and who chose to wait and see if the in person sessions they had booked could resume in a couple of weeks. Zoom meetings became the normal way to communicate, developing packages of online support to ensure that parents make most use of the sessions and felt supported during this time of isolation. As the news rapidly changed and it became apparent that we would not be reunited before their babies were born, I helped families to adapt and change their own birth preferences to include support measures relating to COVID-19.
As doulas, our work is mostly focused on person-centred services. Our support services are usually in a family’s own house, bespoke to their own journey, reflective, adaptive, tactile and full of the sharing of food and space. Focussing on the things we could do, rather than couldn’t, was paramount to ensuring parents still got as close as possible to the support we usually offered, albeit online. As maternity services reduced rapidly (one local maternity unit closed 4 days after lockdown to provide space for ICU), parents needed a source of support more than ever, and families who would not have usually have opted into private support engaged doula support.
I worked alongside families during the height of the first lockdown in different ways, adapted to each family’s individual needs. A fundamental Doula skill that I used daily, listening to the difficulties experienced in maternity during this time, was invaluable to new parents and those who were pregnant. Having somebody around as a continued source of support and to share their stories of joy or heartbreak was reassuring to parents – essentially having a ‘Doula in your pocket” to bounce ideas around with.
Antenatal sessions worked well online and for a time became the completely normal way to provide support. Having offered workshops online via Zoom pre-lockdown I was familiar with the system, which made this change relatively easy. I found that being adaptive and flexible was key to ensuring parents felt supported during these sessions. We built birth plans, we worked alongside midwives and obstetricians to support their birth choices, offering availability to be ‘on call’ whilst they were in labour in case they needed a reassuring voice, or support whilst making decisions about their care.
Many people can find Zoom sessions are exhausting and find it hard to engage. There are added layers of difficulty when offering support remotely that are taken for granted during in person meet ups. Reading people’s body language is hindered on a video call, which we so naturally adapt to and use unconsciously in real life. This made some sessions harder than others and I found myself adapting to each situation by asking different questions or offering information in different ways for optimum engagement.
Infant feeding support and postnatal support was surprisingly useful for parents when offered remotely. It meant they often did not wait long before a “visit” was booked and could get information and support quickly. General infant feeding support could still be provided using video links and clips or photographs. Support for complex situations which I was used to dealing with in person as an Infant Feeding Specialist became a new way of working to resolve challenges remotely.
Working in partnership alongside healthcare professionals was also key. Gaining permission to share information with health visitors and having scales dropped off on doorsteps where concerns were raised about a baby, or special arrangements made for an in-person visit whilst they were suspended was especially important for some families. Families were able to reap the benefits of advocacy from the doula experience, and in some cases this was a crucial part of the care they subsequently received.
By the summer, garden visits with social distancing measures became the new way of seeing families, and postnatal and antenatal visits could resume as other ‘in-house’ services resumed. By October, another change to the guidance meant that we had to ‘work from home where possible’. Whilst disappointing, parents adapted again as I moved my antenatal services back to remote sessions, with only postnatal services being offered in person if they could not be offered remotely.
Self-isolation has been challenging; I had a client test positive resulting in me having to self-isolate for 2 weeks in October, and after 4 days ‘out’ of self-isolation I contracted COVID-19, leaving me extremely unwell for several weeks and unable to resume even online services until 3 weeks after, in a very limited capacity as I continue to regain the energy lost during the illness.
As we reach a new set of restrictions in the ever-changing landscape of living and birthing during a global pandemic, doula support continues to be an essential part of the support parents receive as they navigate the new challenges the pandemic has brought. Adapting the doula support to fit alongside the bigger picture is paramount to providing safe services. The doula support I now provide may change at a moment’s notice. To truly meet the individual requirements of my clients, including their wider support network and also support my own family’s needs is a balancing act that will continue to change and develop into 2021.