This Is What Working With a Virtual Doula Really Looks Like

In pandemic times, some hospitals' COVID-19-related rules turned expectant mothers' lives into despair by disallowing not only doulas, but also partners in delivery rooms. Rena Carlton of Rena Carlton Doula Care, a certified DONA (Doulas of North America) doula and former educator, was heartbroken for the isolated families.

"Labor and delivery progress more smoothly when a woman feels loved and comforted," explains Carlton, a mother of three school-age daughters. Under normal circumstances, doulas who are trained birth coaches, provide physical comfort and emotional support to women before and during childbirth by facilitating communication with medical staff, partners, and teaching comfort techniques.

To help bolster the bleak pandemic situation, Carlton joined a group of volunteer doulas who posted flyers in hospitals hoping to provide virtual telephone assistance to laboring women. She also championed the hospitals that adapted quickly and staffed day-of-birth doulas. She knows the experience differs from traditional doula offerings, but at least it provides much-needed support for all women, and that's been her passion ever since she tended to her sisters through each of their pregnancies.

Carlton says she can't wait to get back to the "old way" of doing things, yearning to assist in-person births again. But for the foreseeable future, they won't "get me holding them up with my own two arms. I'll use my words instead." Here, she gives a closer look at how her role has changed so expecting parents can know how they can be supported virtually by a doula.

Even if other doulas are stressed by having to morph a once hands-on business into a virtual one, Carlton isn't worried because the transformation acts as a conduit for greater birth support awareness and partner interaction. The reason she's so positive? Communication has always been the cornerstone of Carlton's success. She'll give the same professional guidance but now she'll place an even higher emphasis on empowering partners to "hold up" their laboring counterparts. In pandemic times, their arms will do the best job.

At peace with fluid hospital regulations, which she guesses might fluctuate from hospital to hospital depending on outbreaks and curve flattening of COVID-19, Carlton now arranges for multiple prenatal and at least one postpartum online visit, and unlimited phone privileges during clients' pregnancies.

Implementing various means to cope with discomfort is her secret sauce, so she illustrates coping techniques via prenatal Zoom sessions well in advance of labor. She uses her kids to model relief positions that mothers can practice beforehand and demonstrates procedures companions can administer, such as applying a pressured hand to the woman's lower back or encouraging hip squeezes. Her philosophy has always encompassed the idea that couples will be well-prepared for childbirth and co-parenting if armed with substantial prenatal support, so not much has changed. She also coaches teams that "getting through one contraction at a time and portraying safety" goes a long way.

It's also important to support the laboring woman in a way that's properly aligned with her birth plan. "It's hard to see someone you love in pain, but I remind them that they both have a voice" so the expectant mother should make empowered decisions to implement pain interventions herself.

"When a woman expects a pain-free birth and doesn't get an epidural in time, she can feel traumatized." During COVID-19, Carlton has seen many third-trimester mothers-to-be panic and ditch hospital delivery plans, scrambling to find midwives to perform home births instead. She cautions against switching abruptly unless a couple is committed to forging the effort required to prepare for a non-hospital delivery.

Once restrictions eased, and many hospitals started allowing one partner be present at a birth, it restored Carlton's optimism. "Laboring women will finally get some of the appropriate support they deserve," albeit from a single support person of their choice. That's great because she believes pregnant women benefit most if their partners are responsible for their emotional support, as hers was during childbirth. As long as both participants are allowed in labor and delivery rooms, couples start parenthood feeling confident.

To be super-safe, Carlton stands firm that she won't assist with in-person births, even home labors, but stresses the importance of a secure doula/client connection because they'll be at their most vulnerable moments together, even virtually. If anyone is uneasy, then it's not the right fit. She advises her clients to "practice strict social distancing, wear masks, and follow their doctor's advice," given the lack of pregnancy studies and unknown factors surrounding the novel illness.

Guidelines change daily, so Carlton leaves herself open to policy revisions. Right now, tests are sometimes unreliable, and if a "doula attends a client's birth, then she probably attended others as well." She warns that this is a consideration point because if anyone tests positive, a newborn could spend time in the NICU.

She's considering birth centers, which have recently become a popular choice as an intermediary between hospital and home births. "I like these facilities because there's usually an obstetrician on staff, a hospital nearby, and at many of them, [COVID-19] tested doulas are welcome." Although, she isn't comfortable attending a birth at one just yet.

In passing, a nurse might have imparted vital information about her client's condition, or if the room was bright, Carlton shut the lights. For now, small nuances like those might be lost virtually. To help compensate, she provides couples with a flexible gooseneck phone holder so "they can have their devices on at all times and feel like I'm there rooting them on" during virtual but "together" service. Although Carlton concedes, it's difficult to provide the same level of detailed help over FaceTime during marathon births because gaps in communication occur. But she's already seen improved partner involvement and for someone who considers that person an extension of herself, she concludes doulas are still superior facilitators for a satisfying birth experience.

"Unfortunately, we're all lacking physical contact, and nothing can replace that, especially during childbirth. But there's emotional comfort that comes from conversation." Social distancing rules naturally opened the door to more pre-birth communication. Now, there is more "empathy that's going into this, and I'll do as much as they need to make them feel ready."

The pandemic has shown Carlton that online support can be successfully employed when a relieved client cried over Zoom because "she felt heard" and appreciated the doula's actionable feedback. Carlton dreams that society's attitude towards birthing in hospitals transforms because "pregnancy isn't an illness" and she hopes more birth centers evolve with operating rooms attached for emergencies. She's also excited by some insurance company's discussions to cover home births, which would be "a pretty big deal."

According to Carlton, the pandemic makes "people aware of how little is in their control, so they reach for knowledge which includes consulting with doulas instead of relying only on mainstream birth proficiency, which is limited." She hopes COVID-19 will force crucial changes that alert the public to the importance of support for laboring women with doulas like Carlton regarded as necessary bridges.