What is an Antepartum Doula?

I've known Darline since I was a birth doula. She's been helping her clients on prescribed bed rest in Austin for a long time, and I'm happy that she's written a guest post to share her experience and inform us all about antepartum doulas.

I started Mamas on Bedrest & Beyond in 2009 following my four pregnancies, the two surviving being high risk. My daughter’s birth was a nightmare, complete with borderline crash c-section at 36 weeks 6 days, intrapartum hemorrhage and her being rushed off to the NICU with breathing difficulties before I really got to see her face. There had been problems throughout the pregnancy and looking back, I think that I was in preterm labor beginning at about 18 weeks. Every time my OB suggested bedrest, my daughter would settle down and we’d make it to the next visit until I finally went into unstoppable labor.

When I became pregnant with my son three years later, bedrest was a topic of discussion early on as my OB wanted to avoid the chain of negative events that had occurred with my daughter. However, it was an impossibility. My then husband was working in the semiconductor industry and was traveling the world for work, only home on the weekends. My family lived 2000 miles away. When I asked my OB if home health in the form of a visiting nurse would be provided, she looked at me as if I had asked if she could behead me. There were no supports or services in place for high-risk pregnant women prescribed bed rest in the Greater Austin area, and women prescribed bed rest were left to their own devices to cope. I worked with my OB to devise a modified bed rest plan and vowed that after the birth of my son, I’d address this issue. My son was born in March of 2006 and I started Mamas on Bedrest & Beyond in 2009.

I went to my first “client’s” home with my son strapped to me in the baby Bjorn. My services consisted of tidying up her home and running a few errands. I didn’t advertise or have a real business structure at the time, I simply wanted to help out a friend of a friend. But I knew that there had to be more women in need and so I worked with a business coach to devise the business plan and map out the services I’d provide. I still had no idea I was doing doula work, and it wasn’t until very recently that I actually gave my work the name “antepartum doula” and have become certified as a birth and postpartum doula (despite doing the work for years!).

So what is an antepartum doula?

An antepartum doula is a woman who supports and assists high-risk pregnant women (on or off bed rest) who are at risk of going into preterm labor and delivering a premature infant.

What is the goal of an antepartum doula?

The goal of the antepartum doula is to help her clients to get as close to full term in their pregnancies as possible and to deliver healthy (full term) babies.

What do antepartum doulas do?

Since doulas don’t provide medical care, how is this done? Antepartum doulas are very similar to postpartum doulas. They provide home care for childbearing women who are unable to meet their home care needs themselves. Antepartum doulas do light housekeeping, make meals, grocery shop, run errands and care for and support the expectant mother while she is “sidelined”. The 4 key skills that antepartum doulas need are the ability to:

1. Provide physical support to the mother without disturbing the pregnancy. If making meals, doulas must make sure that meals won’t exacerbate Gestational Diabetes Mellitus, Pregnancy Induced Hypertension or any other metabolic problem. If helping mothers to be more comfortable in bed, doulas must know how to add pillows and position mamas so they don’t develop additional pain, stiffness or in the worst case, bed sores. The role of the antepartum doula is to make being on bed rest or activity restriction as comfortable and easy to adhere to as possible.
2. Be a strong emotional support. High-risk pregnancies are almost always unexpected and are usually no fault of the mother. However, most women will spend endless hours wondering if they in some way caused the situation that has resulted in the risk to their unborn babies. Much of the work of an antepartum doula is being present and just listening. It is critical that you help your clients to remain calm and worry free so that they avoid any stress that could cause them to go into preterm labor.
3. Know your limits and have a wide range of resources available to support your clients. Above I made mention of potential dietary precautions. For women with Gestational Diabetes Mellitus or Pregnancy Induced Hypertension, they should have consultations with Registered Dietitians/nutritionists and receive specific dietary instructions. Often the OB will refer for these services, but if they don’t, have resources that you can share. If a woman is having mobility issues, she should have a consultation with a physical therapist, and again, you should have a resource you can share with her. As far as comfort measures, if you are a massage therapist with additional training in prenatal massage, then, by all means, serve your client. If you don’t have these skills, share with her the names of some professionals in her area.
4. Support your clients as much as possible, but never tell your clients “Everything is going to be alright!” While I believe in positive thinking, high-risk pregnant women often defy the odds (positive and negative). High-risk pregnant women on pregnancy bed rest have a higher than average risk of having a negative birth outcome, and it’s impossible to predict what will happen. It’s tempting to want to say, “Oh don’t worry, it’s all going to be just fine,” but the reality is that this may not be the case. Rather than offer any sort of predictive outcome, simply assure your clients that you are there for them no matter what and will support them to the best of your ability-even attending prenatal visits if this will help. This in and of itself may put your clients in the best psychological state to be able to cope with the ups and downs of their pregnancies.

I love being an antepartum doula and love that I can support my clients through the full spectrum of pregnancy. I come to the work with a built-in understanding that I think has served me well. However, this doesn’t mean that if you didn’t have high-risk pregnancies-or any pregnancies-that you cannot serve high-risk pregnant women as an antepartum doula. The most important quality you need to have as an antepartum doula is compassion and the desire to provide comfort and unwavering support to women facing very scary situations. If you have the heart for this population, are a skilled/certified doula (especially a postpartum doula) you can develop the additional skills needed to successfully serve this population.

Darline Turner began her career in women's health as a physician's assistant after earning her Masters in Health Science from Duke University. Early in her clinical career, Darline realized that the current US health care system lacks the tools and resources necessary for women to make wise, informed health care choices. Lack of available support during her own high-risk pregnancies motivated Darline to launch Mamas on Bedrest & Beyond where she offers antepartum doula services and blogs about ways to support women on bedrest. During her second pregnancy in 2006 she produced Bedrest Fitness, an exercise DVD of modified prenatal exercises for pregnant women on prescribed bed rest. In 2014 she wrote and published From Mamas to Mamas-The Essential Guide to Surviving Bed Rest.

Darline continues to advocate for best practices for best birth outcomes for ALL pregnant women. Now a birth and postpartum doula, Darline is currently utilizing her expertise to develop programs that eliminate the disparities in birth outcomes in African American women and infants. Those interested in learning how to support women on bedrest as an antepartum doula can contact Darline for 1-on-1 coaching.