Talk With A Doc

Talk With A Doc: Wellness Brief: Doulas
Transcript

Jennifer Semenza
Hello everyone and welcome to top of the docs Wellness Briefs, a podcast offering a quick dose of healthcare information on a wide range of trending topics in under 15 minutes. In recent years, there's been a noticeable increase in the popularity of doula care for childbirth, driven by a variety of factors. Including a desire for more personalized care, the natural birth movement, and changing perceptions about the safety and efficacy of doula led. I'm Jennifer Semenza and here with me today is Natasha Blanchard a doula for Swedish First Health. Welcome, Natasha.
Natasha Blanchard
Thank. Thank you for having me.
Jennifer Semenza
Absolutely. You know, yours is a profession that's been around for centuries, but there's not always a great understanding about the full scope of what doulas and midwives do. I want to help our listeners get a clear understanding of. Role of doula. So can you kind of talk with us about what your role is?
Natasha Blanchard
Yeah, of course. So do you like you said, have been around for centuries, and during that time, doulas roles have changed as far as modern society. So when we look at doulas now, especially in the hospital care setting, we're looking at doulas as educators. Informed care, we're looking at support and safety and advocacy. Those are the main core parts and they can branch off to many different meanings for different people depending on the situation, but it is primarily. It's. It is making sure they're making informed decisions off of that educated care, making sure we're advocating for our clients in the space, such as a hospital, which can be kind of scary for a lot of people. Doesn't matter what demographic background you're from, it can be scary. And then also providing that support. And it extends past just the client or the patient from the hospital point. It since the family as well, so we support the family we support by providing food, meals, meal prep. Birth. Childbirth education, lactation support newborn. It can go pretty much in depth, but those five, those four or five core parts are really what it means to be a doula in today's day and age.
Jennifer Semenza
That's really exciting and we're going to get a little deeper into some of those areas. But what kind of prenatal care can or should a pregnant person expect from a doula?
Natasha Blanchard
Oh, it can range, but prenatal. You should definitely make sure that you have a doula who you meet with early on in your pregnancy, because this person is going to be supporting you. So that can range from prenatal visits, usually two to three. 3 is about standard, and then you can rely on them to be there throughout your labor and delivery from. Time that you request your doula to support you and be there, your doula will be there. You and then. Either two or three hours after delivery, depending on status of. The baby and the birthing person, the doula, may stay a little bit longer if there's if there's some type of emergency. But it also when we go back to prenatal care, prenatal care is childbirth education. It's the stages of Labor. It's if you choose to chest feed or breastfeed. How can I do? How can I navigate my home that may have stairs and I'm going to be healing, navigating how to support the rest of my family? If I have extra kids and I need more support, finding childcare. That is really what the scope of a doula is and how prenatal care. Can get across from not just the pregnant person, but through the whole family.
Jennifer Semenza
Yeah, that makes sense. Can. Kind of talk about how you tailor your approach to prenatal care to meet the unique needs of each client.
Natasha Blanchard
Yeah, I. The reason why I do postpartum and prenatal visits is basically offer the needs of what that person is asking for. When I do an initial interview with one of my clients, they typically tell me what they need and so I tailor that. So some people are like, I don't think I need too much about childbirth education. I pretty much know a lot, but I need you to tell me how to navigate these new pregnancy pains. Right.
How my breasts are changing now all of a sudden? My. Pregnancy went. I thought I was going to have a vaginal delivery to. Now I'm going to be having a scheduled C-section. How can I navigate that so creating more care that's tailored towards C sections versus vaginal delivery? Not saying we don't touch on those anyway, but that's tailored specifically to that clients needs. And the way that I do it, I like to have in person meetings and I like to have virtual because it's not always possible for our clients birthing person to sit with them in a two to three hour prenatal visit because that's typically how long mine lasts somet. Four, depending.
So I like to do virtual and I like to do. In person and I tailor that on how comfortable they feel with me coming into their home. So sometimes. People don't want you in their homes and that's OK we can meet at a coffee shop and we can discuss how we are going to layout your labor and delivery plan. So I tweak it depending on what we talked about in the interview and how that pregnancy changes throughout the whole entire. 9 to technically 10 months.
Jennifer Semenza
It sounds really, really personalized. Amazing. Can you describe a typical prenatal visit? It kind of depends on on where they are in their in the process and and you know kind of how far along they are. But what are the typical things that happen in each prenatal visit?
Natasha Blanchard
Yeah. So typically my first prenatal visit. Usually my clients like to do virtual my first prenatal visit. We go over childbirth education. Have they sign up for a class? They need support doing. And then we move into the birth plan and advocacy and what they're looking for to make them feel safe. That is the very first thing. Do making sure that my client feels safe that their family feels safe. And then the second prenatal is really hands.
I love to do in persons and it's almost required if you're hiring me personally, that we're doing an in person. I have office spaces that I can use places within the hospital that we can do that, but I require my clients to do that because I teach them. Hands on comfort measures. And technique. And different ways to position and hold baby ones. Baby is born, and then we go into how this pregnancy has been so far. Our second prenatal is usually further on in the third trimester. Our first virtual. Usually you're a little bit earlier on. If I get my client that early, it's usually around 25 weeks. 30 weeks and then our second prenatal is usually around 34 to 36. I don't like to do it too much later because you never know what's going to happen, right? So.
Jennifer Semenza
It gets. Little dicey at the end to know exactly when that baby's coming. I imagine, yeah.
Natasha Blanchard
Exactly. And we are on call. So yes.
Jennifer Semenza
Yeah, yeah. And you know, kind of switching gears to to that labor and delivery, oftentimes the surprise process, you know my daughter had her first baby about a year ago and she used a doula during the labor and delivery process. And it was an amazing experience, you know, not only. For her, but for her husband as well. The. Just really made it even more special. So let's talk about your role during labor and delivery. How do you handle emergencies that arise and what protocols are in place to keep everybody safe?
Natasha Blanchard
Yeah. So I'm gonna start. Protocols are always followed by whatever that hospitals protocols are because we are doulos and we don't overstep our scope of practice. Not medical professionals. We follow whatever protocol is in place for our scope and for the hospital to make sure that client and birthing person. And their people? Everyone baby is safe, right? And then emergencies were actually pretty cool. We're pretty cool as a cucumber. It sounds people are like, oh, you're pretty. Wrong. A lot of times with an experienced doula.
I've been doing this for 15 years. You've seen a little bit of everything. Right. And so we're often the voice of. We are the ones saying, breathe, take a deep breath. We're massaging your forehead. We're giving information to the parents who may be waiting for that child to give birth, right? We're the liaison between. The client and their their family that might be waiting in the waiting room, right? And then when it comes to emergencies, I have a specific one with a client of mine who ended up pushing for a very long time and ended up with something called a contractual ring, which required an emergency C-section and. It was very unexpected because everything was going very. It's a phenomenon they don't even know how it can happen sometimes.
But what I did was I provided actually more support to this birthing person's partner than I did to the birthing person. Because that birthing partner. Was very afraid and very apprehensive. This was something that was not prepared. This was something that all of us were not prepared for, but in this instance they asked to be prayed for. They asked to be prayed with, and so we prayed and we. Calmed each other down. And we also were there to make sure that those pictures were still being taken that. The love was still in the room and the reassurance and guiding them and letting them know that everything was going to be OK in emergencies. Just just don't end at the hospital, right? Emergency can still carry on to postpartum support as well, as far as like elevated blood pressures or weakness or numbness in the legs. When it comes to handling those. First and foremost, we always call the hospital or let them know to call the hospital. But we will meet our client up at the hospital even after labor and delivery. If there was an emergency just to still support them and. Family.
Jennifer Semenza
That's. It really sounds like you're working not only with the birthing person, but their their support network or their partner during that, that process as well. That's really encouraging.
Natasha Blanchard
Yes, I love working with families.
Jennifer Semenza
Yeah, I imagine you'd have. What are some of the common challenges that you face during labor and delivery, and how do you address those?
Natasha Blanchard
I wanna say, you know, that's kinda hard to answer. I don't. I'm a pretty versatile person. I haven't experienced too many. The biggest thing that I see. With us, doulas is not being looked at as a support person who knows and has a lot of education on this client already. So when we have sometimes providers coming in and they're like, well, this is what's going to happen, this and this and this and the wording maybe wrong, right.
Or the the approach may be wrong and. And so coming from the doulas lens, we are an advocate for our client and a lot of times our clients are asking us to speak up on their behalf. And sometimes that may be frowned upon or made it seem like we are looking at that provider like they don't know what they're doing. However, we are not. Looking at that scenario and we're saying this is what our client needs to feel safe. So please let's put this into place. Not saying you don't know what you're doing. Are the medical professional here?
However, we are this person support. They chose us and they feel safe with us and comfortable for us to approach you and have this conversation. That is what I see the most commonly being a challenge working in a. It's a lot different when you're in the birthing space, at a home, or in a midwifery care center or birthing center. But that's one of the challenges that I see. A lot is just making sure that we're. Crossing those fine lines, and if they feel like we are kind of smoothing them out to make sure that they know that we're doing this for our client and not for ourselves or our own ego.
Jennifer Semenza
Yeah, I bet that.
Natasha Blanchard
Does. Make sense?
Jennifer Semenza
Yeah, definitely. It sounds like it's kind of a bit of a delicate dance between, you know, staying within the scope of your work, but also advocating for the for what your client wants most. That's that's a really delicate balance.
Natasha Blanchard
Yes it is. It is.
Jennifer Semenza
Yeah, yeah. So let's talk a little bit about postpartum care. How do you support breastfeeding and the postpartum recovery process?
Natasha Blanchard
There's so much, but postpartum, we usually stay two hours after a delivery. Like I said, two to three. And during that time we are trying to incorporate that golden hour are typically golden. Two hours now, and we're trying to make sure that baby latches well if they can. And or helping that birth in person who has chosen to breastfeed and give their. Maybe colostrum help them to massage their breasts and chest to make sure that they can get some colostrum out or at least stimulate the tissue as baby would be doing right if they were latched. If babies unable to.
So breastfeeding support a lot of us have that general, all of us doulas have that general lactation education. There are also quite a few of us that are lactation peer counselors and or I BCLC. However, we do not step over that boundary when we are doula, so we stick with the basic breast. Care support. And then we have resources where we send them over to it could be nurturing expressions in Seattle or the Lidl Center in Swedish Providence and have them connect with IBC. Just to make sure that they're getting the appropriate support and it's covering all the bases and we're not stepping over our scope of practice and.
Jennifer Semenza
Yeah.
Natasha Blanchard
Then when it comes to postpartum and recovery, it all varies and it's different. A lot of us offer massage, a lot of us soak feet. It also depends on cultural practices and that family. Going to let you know what they want in the postpartum. Their post pattern visits. So you know the case in point. I had a client that I was serving and what she wanted was her feet to be soaked and her feet to be rubbed and to be fed. I feed my clients on their first postpartum visit.
If they invite me into their home, I feed them why they're feeding baby. I may give them a scalp massage. I may give them a shoulder massage. Their feet, like I said, rub. Postpartum visits are about checking up on the well-being of the birthing person and the baby, but also the mental support has to be there, making sure that they are getting fed, making sure that they have bath, you know, making sure that they have snacks and good food. And they also are making sure that their blood pressure is monitored. That is one of the things that I am a stickler about because postpartum hypertension is very real. And so I make sure that my clients have a calibrated. Blood pressure cuff at home so they can take their blood pressure as the six weeks to 8 weeks really to make sure that their blood pressure doesn't spike because it's something that is very silent and I check up on them when I'm done with my. And. Hey. So how was your blood pressure today? Was it great? How was your bleeding things like that so? That's what a typical postpartum support recovery process can look like. There's much, much. But you know that's typical.
Jennifer Semenza
How do you help new parents adjust to life with a newborn once they leave the hospital? Hospital.
Natasha Blanchard
You know, once they leave the hospital, I check in on them. I make sure that I call them. Next day or text them if they're not up to talking. I called them or I text them. See how they're doing? I schedule an appointment with them to check up on. I asked how they're feeding, how they're sleeping, how they're eating, and this goes for the birthing person. And then I ask, how is the baby feeding? How is the baby pooping? How is the baby's color? How do you feel like baby sleeping through the night?
And then I give them tips that are educating. And also, what's the word I'm looking for? Evidence based. So I give them evidence based. Care for their newborn and how to navigate those. Say if babies not latching super well. I may give them evidence, care in a handbook or in an e-mail, or in a text message. Where they can get that information and then make the decision on how they want to move forward.
Jennifer Semenza
That makes sense, yeah. So when someone is looking to select a doula for their labour and delivery process and and prenatal care and all the services that you provide, what are the types of questions they should be asking during that first consultation?
Natasha Blanchard
They should be asking really, how that doula can support them based on what they're looking for. So if you're doing an interview with someone, make sure that they're aligned with what you want. Make sure if, especially if it's cultural, make sure that they are going to respect and be able to be in alignment with your cultural practices. That can be something as small as I want to make sure that I do skin to skin right away, even if I'm in the OR room or could be something as big as we believe. And what they call a Lotus birth, right where the baby is still attached to the umbilical cord.
You want to pick a doula that respects your views and can give you educated evidence based information on how to move throughout that. Instead of somebody like I just want. I'm not going to do it. That may not be the doula for you, because you don't know. What else they may say no to that they won't support. You're going to be looking for a doula who has her certification, who has her continuing education. It's nice to have a doula who has worked in both atmospheres in the hospital and in a birthing center or at home because things can change from a home birth to a hospital really fast, so being able. To have that flexibility is great. Also making sure that that doulas has a backup and they have somebody that. Their backup is in alignment with you as well, so they can just choose somebody random if that makes sense. You don't want. You want somebody who has a pretty good concrete. This is who I have as my backup, and I'd like you to be introduced to them within the next couple of weeks if you choose to hire me.
Jennifer Semenza
Yeah, yeah, that makes sense. Let's let's switch. Little bit and talk about equality and inclusion. What efforts are being made to address health disparities in maternal and infant health outcomes, especially among our marginalized communities?
Natasha Blanchard
There's a lot that's being done right now, one number, one having to do is. Hospital having doulas working in the hospital is really, really important. At Swedish Providence, they have cultural navigators on the floor at certain hospitals, but they also have access to them at different hospitals, through telephone or e-mail. That is bridging the gap of people who may feel like they're not being heard. So having a doula on the floor, having a doula that's part of the care team is really important.
Speaker
Hmm.
Natasha Blanchard
And then also, we're having more studies being done. Around high C-section rates. And the necessity behind them and then also making sure that teams are being educated on maybe shoulder dystotia like the whole team, it's not just. It's not just going to be nurses and providers, it's going to be the doulas who are going to be in there, right? Making sure that they are culturally accepting each patient as they come into the hospital. Kind of taking that hat off.
There's also other companies that are out here doing equity work, and so they're offering more support for low income families. And one of the things that has happened because of a big program here at Swedish, but also because of. The black Birthing equity initiative here at Swedish, we have now been able to accept and bill for Medicaid, Medicare and that is really, really, really important because a lot of people may not get the care because they cannot afford it so. We're making sure that we are making it equitable for everyone to have access.
Jennifer Semenza
Yeah, yeah. And can you talk with us about some of those cultural considerations that you consider when providing care to diverse populations?
Natasha Blanchard
Yeah, of. I mean, there's there's so many. If I'm working with a family who is not from here, they may have a certain drink, right that they drink in postpartum or right after delivery or even during delivery. It's something that we need to make sure that we are reiterating to the care team across the board and the reason why is because that is something that is cultural and it. So you know, you know the whole protocol if you can't eat when you have an epidural, right? You can't. Don't eat anything but clear fluids and jell-o and things like that.
Well, in this particular culture, they may always eat or they may always have this drink. It is something that every birthing person has when they're in labor and they're not. Deter from that, so we need to make sure that we are. Are making sure every single provider, every single person that touches that room, knows that this is what they want and they understand the risk and do not push them on it. Know what I mean?
Jennifer Semenza
Yeah.
Natasha Blanchard
And it's really important that we also culturally we also talk about how some families don't let men in the room, right. Cultures are like no, no men, and we need to respect that when it comes to anesthesia. If we can. If not, we need to make sure that we inform the client first. Hey, we have an anesthesiologist coming in here and it is a male. You OK with that? A lot of times they're going to say yes, but if you didn't give them the option, they may feel like they were slighted or not listened to.
Jennifer Semenza
Yeah, it really just sounds like a lot of. For what your client is wanting, not only from like their birth plan, but also just what's important to them from a heritage standpoint and cultural standpoint, it sounds like you're really helping to create a beautiful environment for that baby to come into the world.
Natasha Blanchard
I try really. You know we with the work that we do, it's deep within us. Every time I train someone to become a doula or I'm talking to them or their, I'm their mentor. I'm telling them that they say, well, I don't know you are here because you do know. What's innate in you? It's empathetic. It is something that it's ingrained in your DNA. It's who you are. You will see a lot of doulas come in and they come in and they're doing four and five births a month and people are like, how do you do it? They do it because they can. Care when you first get into do the work, it is not.
Speaker
Yeah.
Natasha Blanchard
There's not a lot of pay, right? You just don't get a lot of pay. OK, but you're there for that client? You're there for that. You're there supporting them and that overall. Shows just how much doulas are needed across the board. We show up when we don't always. To you know.
Jennifer Semenza
Yeah, Natasha, this has been a really helpful conversation in understanding the role of doulas and whether or not doulas are are right for our listeners. That are going through this. Thanks so much for joining me today.
Natasha Blanchard
Yeah. Thank you for having me. I hope I answered all your questions and I appreciate your time.
Jennifer Semenza
Absolutely. Thank you.
Speaker
I.
Jennifer Semenza
Also want to thank our audience for joining us today on talk with the Docs Wellness brief. We look forward to continuing the important conversation on health and Wellness, with more experts from Providence and sharing our mission of help for a better world. To get continued information on other important healthcare topics, please subscribe to talk with the doc on your favorite podcast platform and on social media. With us on. TikTok and X at Providence. And on Instagram and LinkedIn. Under Providence Health System, to learn more about our mission, programs and services, go to Providence. For all of this and more, please download the Providence app on your smartphone and Please remember the information provided during this program is for educational purposes only. Should always consult your healthcare provider if you have any questions regarding a medical condition or treatment. For listening.