What to cover in Prenatal Visits
When I first started as a doula, all of my clients came from the prenatal classes I taught. Back then we needed a captive audience to discuss what doulas were and how they helped ? I loved that I got to spent 6 weeks with people and then have another visit to recap how they were feeling. So all in all I spent about over 15 hours with clients by the time I was at their birth as their doula. The doula profession is different now in many areas. In our area doulas typically spend more like 4 hours with clients in prenatal visits. In adapting to this new way of doing things, I’ve realized that our prenatal visit time together has to be very effective and the time must be well spent. When I speak with new doulas after their first few prenatal visits, I often hear one of two things: either they went on for 3 hours, or they were done in 45 minutes. I’ve put together a few thoughts here to help guide you in your visits with clients so everyone’s time is well spent! (On a side note, I think the perfect timing is 90 minutes to 2 hours).
Goal of visits
The goal of our visits is always to deepen our connection with our clients, establish trust, and build rapport. We do this through active listening and good communication skills. I can’t teach you that here, but I encourage you to NEVER stop learning how to be a better communicator. Here’s an article that might give you some tips.
What should I cover?
So really it comes down to what to cover and how. If we look at adult learning theories, we know that people are going to retain more if they ‘do’ something with it versus just being lectured to. We’ll want to keep that in mind during these visits. Of course I begin each visit with a check-in to see what’s been happening, how they’re feeling, what worries have come up, questions, etc. This will help guide my visit, but many of the activities I have set are activities that will help answer all of these points. Here are some of the topics you may want to cover (as they come up):
- Discomforts of pregnancy
- Nutrition in 3rd trimester
- Body mechanics, posture, pelvic tilts, Kegels
- Stages of labour review
- Body’s normal physiological response to pain: Fear-Tension-Pain Cycle
- Physiological benefits of relaxation
- Various breathing techniques
- The doctor-patient relationship and assertive communication strategies
- Development of birth preference docs (aka birth plans)
- Negotiating with medical staff
- Signs of pre-labour and labour
- Emotional and physical response of birthing person to labour
- Back labour
- Hospital procedures: admission, labour & delivery, postpartum, discharge
- Ways of handling pain and comfort measures
- You may want to discuss how they FEEL about (though teaching it may be outside of your scope of practice)
- Intrapartum concerns (not-so-positive things that can occur during labour and birth)
- Medical interventions:
- Forceps and vacuum extraction
- Amniotomy (breaking your water)
- Episiotomy – research, how to prevent
- Induction/augmentation: natural ways and medical ways
- Medical pain management: epidurals, narcotics, other
- Cesarean: indications, procedures, emotional response, pain management, how to avoid
- Postpartum: in hospital, at home
- Adaptation to parenthood
How do I cover it?
As you look at the list you can imagine that there’s just NO way to cover all of that if you’re only seeing your client once or twice. I’d love to see doulas recommending their clients take a good childbirth education/prenatal class. Education is SO worth it. But I recognize that’s not always possible. Be sure not to fall into the trap of “I hired a doula so she’ll teach me everything I need to know”. That’s just not possible unless you’re spending 10-15 hours with each client AND you’re a childbirth educator!! (scope!!)
So here are some ways to cover those topics above in ways that increase learning retention and that are FUN. Please, let’s all commit to STOP BORING PRENATAL VISITS!!
- Labour positions: having printed labour stations that describe a position and then guide clients through a ‘pretend contraction’ with breathing and partner support (if applicable)
- Role play of difficult topics (things that really matter to them)
- Conduct a guided visualization
- Massage: teach support people how to perform a hand massage
- Show: touch relaxation, a couple of acupressure techniques (watch for scope here)
- Comfort measures grab bag: pull items out of your labour bag and ask people how it could be used, then try it out!
- Comfort measures pie chart: keep the chart going every time they express something they’ll use to cope, fill in one of the pie pieces
- Ice cube activity: to show the length of contraction and the difference between doing nothing and using comfort measures during a contraction
- Birth preference cards: most doula trainers teach this activity of 15 cards with opposites on either side of the card. Clients discuss why they chose each side as they go through. This is a great opportunity for you to make a list of any info you can send them (if they’re unsure of what they prefer). Then you ask them to flip 5 cards over (which 5 do they choose first, they’re now getting the opposite of their preference), and then 5 more. Watch how they prioritize things. What really matters to them? Then role play the top 5 left. How would they negotiate their wishes? What questions would they ask? If you’d like to get the activity, I’ve put it here to share with you. Print it on labels that are 5160/8160 size.
- Birth plan review: go over each point validating it but suggesting to remove anything nurses and docs don’t need to see (ie turning lights down, walking around, etc). Anything that can easily be discussed should be taken off to keep it short and sweet. Lead the activity in a way that asks “how could we make that happen?” so they see how much is in their control.
- Pain Management Preference Scale: this activity is great. I give each person a sticky note and ask the pregnant person to write what number they are on the scale, and their support people to jot down what number they expect was chosen. Then compare to see if they’re both on the same page. Then discuss how we’ll all support that preference. You can buy this and other tear pads on Penny’s site here
- Of course discussing “when to call the doula”, having general discussions around boundaries (when it’s ok to call for various types of inquiries, etc)
- Postpartum planning (lots of activities you can do here). I like to use a postpartum bag which includes things like: condoms, Epsom salts, plastic housecleaning glove, a dice (never know what we’re gonna get), a candle, watch, cell phone, pads, breast pads, peri bottle, etc. You can pull out an item and ask them what thoughts or questions it generates. Have a chat about each point.
This list certainly isn’t exhaustive, but I hope it gives you some ideas on how to have fun and be effective in a prenatal visit!
I’d love to hear your ideas and anything else that works for you.
Good luck my lovely doulas.
#WorldDoulaDomination #DoulaPrenatal #Connecting
About the Author
Stefanie is a visionary in the childbirth field. She leads the Discover Birth organization providing a variety of services to expectant parents and training for those wishing to pursue work in the childbirth field. Stefanie is a board member with the Association of Ontario Doulas, former Public Relations Director for DONA International, and sits on many local boards and coalitions to improve our communities. She is a DONA-approved Birth Doula Trainer, runs an Approved Program for Lamaze International and runs two doula agencies Discover Birth and The Nesting Place.
Stefanie is the founder of The Birth Doula Program at the Scarborough Hospital.
Stefanie is a contributing author in the best selling Power of Women United and the book Bearing Witness: Childbirth Stories Told by Doulas. She is a regular contributing writer and blogger, and has done many interviews online and for TV/radio.
Before becoming a doula, Stefanie worked in corporate intelligence, helping large companies keep abreast of their markets and competitors. She now works to bring some of those same skills to the doula profession, helping it grow and prosper, along with its many doula members.
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