This article is the second of three in a series directed towards Childbirth Educators, working with couples pregnant after a loss. Part one provides important language and understanding about the many different experiences of loss. Part two discusses creating an empowering birth team. Part three describes why couples should complete childbirth classes after a loss, what classes are appropriate, and what the instructor needs to know.


ChildbirthEducationTwo

Creating an Empowering Birth Team

Finding a skilled provider with a great bedside manor is critical for newly pregnant couples. Loss couples oftentimes need extra time at general appointments as they come with a list of questions. They may need constant reassurance that their baby is ok. They might have extensive lists of complaints and concerns, requiring increased monitoring to verify mother and baby is ok. The provider needs to be willing and able to address anxieties and needs before, during and after the birth.

At the time of delivery, extra time will need to be spent on reviewing how birth may play out and reasonable expectations of medical management while focusing on the parent’s wishes and expectations. The parents will need to be introduced to all staff and their role explained to them. They might request avoiding a specific labor and delivery room or nurse as their presence could remind them of their previous loss. They also may need to meet with anesthesia ahead of time to discuss specific needs based on complications from the previous birth.

Some families will desire a more personalized approach and need to know who is on call ahead of time. They need their story to be important and their needs meet. For these families a birth doula experienced in loss can be very powerful.

Doulas work with couples before, during and after the birth. Their role is to support the family as needed and desired. Their goal is to support the family as they want to be supported with out judgment or bias. There are many ways a birth doula can support the birth.

When there is a loss the doula can assist in birth processing and answering questions. A doula might have a written story or time line to help the family to remember the events sequentially if desired. She might be able to help with family and friend notification. Make arrangements for the family and the baby. Coordinate with a birth photographer or photo document the baby herself. She can hold the space, allow the family to grieve, and just be present when they need her. When the family is ready, she can make professional recommendations for support.

A doula can also support a rainbow birth as the family prepares to welcome another child. The pregnancy after loss can be a long nine months for a couple: full of anxiety, grief and denial. It is not uncommon for the couples to need someone to help them to carve out time to reprocess their birth, journal their thoughts and plans, look at photographs, and share their story. A doula may be able to help to understand the couples needs and share with them providers, locations and options for the upcoming birth to reduce their stress. She may also be able to remind the couple to celebrate daily milestones and to celebrate each day of the pregnancy. Pregnancy is a time to focus on self-care especially after loss. She can help them to create a mantra or relaxation practice. When the couple is ready she can help to make suggestions about home preparation.

At birth the doula can support the family and facilitate good communication with the whole birth team. She can follow the family from home to birthplace and be their anchor in a world of unknowns form location, to provider on call, nursing staff and general admittance. She can be 100% present with the family though their experience including immediate postpartum and postpartum care once home, supporting the family as needed and requested.

Another critical player in the birth team is the mental health provider. Ideally, she/he is trained specifically in loss and perinatal mood disorders. This is the best support person to help the family to guide grief, work through upcoming fears and to set up goals moving forward. Ideally they work with the Medical provider and doula to create a buffer around the family enabling them to have the best possible experience.

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