What would you want doulas to know?

This section is for discussions with other women who have probably been through the same signs/symptoms that you may be experiencing. Please note, we cannot offer medical advice and encourage members to discuss their concerns with their doctors. New members, come on in and introduce yourself!
ilovepie
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Re: What would you want doulas to know?

Postby ilovepie » Tue Feb 08, 2011 11:00 pm

Thank you - both of you! This doula group is through the organization I took my childbirth education classes through, have attended playgroups through, etc. etc. I personally know at least a few of the dozen or so birth doulas that will be there. So I'm pretty comfortable, but I want to give a really clear picture of preeclampsia and the train wreck that it can become. I am 20 kinds of bizarre in my own experience (and more kinds of lucky), and want to make sure I'm speaking in facts and (as best I can) from a broader perspective than my just own preeclampsia story.

I will make sure I print out some simple information from this site, and will suggest they order some of the print info to add to the info they give to and discuss with their clients!

kara
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Re: What would you want doulas to know?

Postby kara » Tue Feb 08, 2011 10:41 pm

I was an exhibitor at a Doula conference this past August in Albuquerque, NM. There were several reoccurring questions and/or statements that might be useful to you in your presentation:
1. Doula's weren't aware of the FREE materials the PF offers (and in Spanish and other languages) - Signs & Symptoms brochures, magnets, Rx pads, etc. (They like to have materials to give their clients, and it's one extra way for a woman to get the info into her hands - and it's free, less snail mail shipping, through our website).
2. Many weren't aware that women die from PE or complications of PE. For the ones who've seen PE, it's been mild, late term, with no consequences. There were a few who got a taste of HELLP with a patient and are now very alert for it. Spouting statistics worked quite nicely with this group. Most were quite eager to learn new information.
3. Because Doula's often have more time to spend with a patient than a midwife/OB, and often have a closer relationship with the patient, she is in a prime position to be on the lookout for symptoms, ask about symptoms (particularly PP doulas), and encourage the patient to ask more, or specific questions of her doctor. She can even urge her to be seen if something isn't quite right. Of course, this means she needs to be educated on signs & symptoms.
4. Many doulas at the conference complained about OB's rushing women into an induction or C-section. My response was, "There must have been something, or a lot of little somethings that made the doctor decide it was time to deliver. Being non-medical folks, we can't second guess, or urge a patient to resist the advice of a medical professional." Most agreed with this line of thinking.
5. There are classes for doulas who work with women during a "birth trauma". The word "trauma" is relative - an unplanned c-section might be traumatic for a mom, and then there are us severe PE moms at the other end of the trauma spectrum. There will be a time when a doula works with a woman who has a delivery like one of ours (train wreck), and there will be women who hire doulas to work with them during a subsequent pregnancy that may or may not become a train wreck - so I'd urge them to take these types of classes in preparation. They could be of great service to a woman and/or her family.
6. Cucumbers do not = prevention. ;-) Ok, I'm being smart, but I did have to answer that question a couple times. It REALLY is important that doulas NOT give advice on specific diets, supplements, herbs, medications beyond "take the prenatal your doctor rx'd, and eat a well-balanced, healthful diet". They are not pregnancy nutritionists or OB's, and pretending to be can put their patient in danger. No matter how many times they've seen a particular diet, herb, or remedy work, does not mean that it is right for every woman.
7. I'd urge doulas to come to our website for provider info, to learn more about preeclampsia, and see our stories. They truly have a heart for women and childbirth, and so do we. We WANT to have a beneficial relationship with them, partner with them in community outreach, and support them in their practice to promote preeclampsia education by providing materials.

Good luck! They are generally very warm, welcoming, and eager to learn. Let us know how it goes!

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caryn
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Re: What would you want doulas to know?

Postby caryn » Tue Feb 08, 2011 09:35 pm

It's not the expansion of plasma volume that lowers risk of stroke, but the lowering of blood pressure. But expanding plasma volume also likely has benefits with respect to the ability of the mother's bloodstream to perfuse the placenta. The swelling we often experience happens because most of the fluid in our bloodstreams has moved to the interstitial spaces between the cells, so we're actually simultaneously dehydrated *and* swollen. So less blood in our systems, so harder to supply the placenta.

Re: diets -- http://www.preeclampsia.org/forum/viewtopic.php?t=9742 handles one common one, but the more critical information is just that preeclampsia has been pegged to an initial failure of implantation for a host of complex reasons which are primarily genetic ones, a conflict between the mother's genes and the father's, so there's no obvious way for diet to affect it. This is also useful for that: http://www.preeclampsia.org/forum/viewt ... 28&t=35000 (particularly the research links on diet and exercise, which pretty much always come back "null result" or "needs more study, crosses the no-effect line, we might have designed the study wrong or it might actually not do anything useful but we're not sure" and occasionally "supplementing this actually makes things worse." Vitamin D and CoQ10 are at the second point, most supplements are at the first point, and vitamins C and E are at the third point.)

For me, what would have helped in the emergency situation I was in was someone who had a decent explanation for what was going on. To be fair, this was in 2002, and there really wasn't a decent explanation out there yet. Nowadays, thanks to our push for a ton of basic research plus popularization of the research at this site :D there is.

I know Kara has given a similar talk! I will holler at her for you...
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

ilovepie
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Re: What would you want doulas to know?

Postby ilovepie » Tue Feb 08, 2011 07:40 pm

a) Epidurals lower blood pressure and expand plasma volume, so they are often a good thing for PE mothers as they probably lower risk of stroke
b) abruption is a much higher risk, so expect docs to mention it as a risk and to proactively monitor for it. Fetal monitors are therefore often a good thing for PE mothers depsite the fact that they can lower mobility in labor.
c) yeah, labor. Some of us never get that far, so doulas will want to support the mother in ways that don't assume labor.

Will keep thinking.
Strictly speaking, it's the fluids given with the epidural that expand plasma volume, correct? And how does that prevent stroke?

And I definitely want to hear more about ways doulas can support mothers in emergency situations and c-sections. I finally got the PE diagnosis in labor (bedrest and scariness before then, but not the actual Dx), so I can say what would be helpful (for me) in that situation. But I'd like other perspectives!

It seems to me that telling them what the standard of care is, so that they can sort of help communicate to the mother in a potentially chaotic situation, may be the biggest benefit?

I am also thinking I should address the supposed "prevention" diets and whatnot. Any favorite studies, info, etc on that, Caryn?

These doulas do prenatal visits, labor/birth support (some have been present for c-sections, or are there immediately afterwards. Our doulas for both my births also were there to support my husband - who was quite possibly more traumatized by the preeclamptic birth than I was), and they do postpartum visits (usually just one postpartum visit).

I'm going to talk for 10-15 minutes.

I was asked to give this talk because I'm fairly knowledgeable, but I don't feel like I'm knowledgeable enough!

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caryn
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Re: What would you want doulas to know?

Postby caryn » Tue Feb 08, 2011 05:33 pm

a) Epidurals lower blood pressure and expand plasma volume, so they are often a good thing for PE mothers as they probably lower risk of stroke
b) abruption is a much higher risk, so expect docs to mention it as a risk and to proactively monitor for it. Fetal monitors are therefore often a good thing for PE mothers depsite the fact that they can lower mobility in labor.
c) yeah, labor. Some of us never get that far, so doulas will want to support the mother in ways that don't assume labor.

Will keep thinking.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

ilovepie
Registered User
Posts: 48
Joined: Tue Dec 09, 2008 11:53 pm

What would you want doulas to know?

Postby ilovepie » Tue Feb 08, 2011 10:40 am

I am talking to a group of birth doulas (and possibly some postpartum) about preeclampsia at the beginning of March. What information about preeclampsia do you wish all doulas knew? What specific actions would you want a doula to take for a mom with preeclampsia? I'm thinking in regards to helping catch it early, bedrest support (helping set up meals, dropping in and making sure a mom is taken care of with snacks, water, and company, etc), birth support (familiarity with what aspects that differ?), and postpartum (detection of pp preeclampsia, emotional support, etc).

I am just starting to think about what to say and would love any input!!


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