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Incredible 6-week program turns expectant dads from bystanders into doula-level helpers

“I want men to understand: This isn’t just a woman thing."

Dads to Doulas

In 2017, Brad Edwards and his partner were expecting twins. By all accounts, it was a "normal" pregnancy, and Edwards assumed it would be smooth sailing when they got to the hospital. Tragically, and unexpectedly, both of his sons were delivered stillborn within a week of each other.

The statistics around black pregnancy in America are harrowing. Black women are three times more likely to die from pregnancy complications than white women, while the infant mortality rate is more than twice as high. The reasons are vast, and include systemic racism and inequalities in the healthcare system. A lot of things can go wrong.

One thing that can make a difference is parent education. So when the couple got pregnant again a few years later, Edwards vowed to never feel "helpless" in the delivery room ever again.

“Through my experience losing my twins, I realized that there was a lot I didn't know, and there was a lot that I didn't take the time to educate myself on,” Edwards told St. Louis Magazine.

“So by the time another opportunity came, when I was preparing to have my baby girl, I had become familiar with what a doula is. One of my good friends is a doula. I said, ‘Alright, I need you to help me create a playbook. What do I need to look for? What should her levels be? What should I be looking for with the placenta?’ So it was just a few different things I wanted to be educated on to make sure that I could be not only knowledgeable but also an advocate for her, because I know that Black women die at much higher rates than any other race.”

Edwards' daughter Carielle was born in 2020, but not without a scare. Edwards' partner dealt with severe preeclampsia — a high blood pressure condition that can be fatal — and having a doula on hand to walk him through what to do proved to be a lifesaver.

That's when he decided that dads needed way more training before getting anywhere near the delivery room. Edwards worked with trained professionals to create a 6-week course called "Dads to Doulas."

A man practices doula techniques on a baby dollDads to Doulas

Doulas are helpers that assist mothers through the process, and immediately after, of childbirth. Unlike midwives, they don't perform any medical procedures, but they're knowledgable in comfort measures, advocacy, knowing what can go wrong, being prepared, and more. Having a doula on hand during birth can decrease the risk of complications or certain health problems in the baby, especially for high risk pregnancies.

In other words, doulas can save lives. But less than 6% of doulas are men, and there wasn't much of an existing framework to teach untrained men everything they need to know in such a short amount of time.

But now there is. The course, offered digitally and in-person in St. Louis, is free to the public and takes dads from zero to doula-level knowledge of childbirth so they can be an advocate for mom and baby the entire way through.

The first classes cover the basics, communication activities, and discuss home births and hospital births.

The more advanced classes work on partner advocacy, birth plans, physical comfort measures, and emergency safety.

They also cover postpartum depression in great detail, for moms and dads alike.

This education is an absolute game-changer for men who, let's face it, may not start off knowing very basic biological facts about how women's bodies work. Hiring a doula can be extremely expensive, so getting dad up to speed can be an important and even lifesaving investment.

“I want men to understand: This isn’t just a woman thing,” Edwards says. “This is about the family unit as a whole.”

Dads to Doulas isn't the only course of its kind.

A man with his daughters sits at a table listening to doula trainingDads to Doulas

More and more training programs like it are popping up all over the country. Dad Doula Bootcamp in Kansas City is another big one picking up steam.

We've come a long way when it comes to expecting dads. In the 50s and 60s, dads were actually invited to have a seat in the waiting room or even go to a nearby bar and wait for the baby to be born!

Now, more and more men want to get educated and get involved. Organizations like Dads to Doulas make that possible. And it's leading to better outcomes for babies and mothers.

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Teacher uses a balloon and ping pong ball to explain childbirth in viral TikTok video

Brooke Bernal/TikTok

As someone who has given birth to three children and who was raised by a labor-and-delivery nurse, you'd think I'd have a good handle on the physical mechanics of childbirth. But despite knowing all the terminology and experiencing all the details first hand—uterine contractions, cervical dilation, etc.—I'm a visual person, and most of the birth process happens internally. Feeling it and being told what's happening isn't the same as being able to visualize what's actually happening.

Enter high school teacher Brooke Bernal, who teaches consumer sciences. She shared a video on TikTok demonstrating how she teaches her students about childbirth, which she says is her "all time favorite lesson," using a balloon and a ping-pong ball. It's a simple, but-oh-so-helpful demonstration that even helped me get a better grip on the miracle of childbirth. (Without the baby shooting across the room at the end, of course.)

Bernal explains that the big round part of the balloon is the uterus, the skinny tube part is the birth canal, and the opening is the cervix. Then she puts a ping-pong ball into the balloon and shows how the pressure of the contractions causes the ball baby to push on the cervix, causing it to thin out (efface) and open up (dilate).

@brookeebernal My all time favorite lesson! ##baby ##pregnant ##laboranddelivery ##fyp ##teacher ##teachersoftiktok
♬ original sound - Brooke

There's one little hiccup with this demonstration, which is that the "birth canal" isn't actually above the cervix like shown in Bernal's video. The cervix is immediately outside of the uterus, and then the birth canal is the vagina below that. So in a real birth, what you see happening with the cervix would happen before the baby goes through the birth canal (and is, in fact, what allows the baby to do so).

A video that may have served as the inspiration for this one (Bernal told Buzzfeed that she had seen the idea shared in a teacher group on social media but wasn't sure where it came from) illustrates that a bit more clearly:

Use a balloon and ping pong ball to show how the cervix thins and dilates during laborwww.youtube.com

Aside from the birth canal bit, Bernal's video is great. The first awesome part is how she illustrates the difference between Braxton-Hicks contractions and real contractions. For those who haven't experienced the joy of thinking you were in labor half a dozen times before you actually were, Braxton-Hicks contractions are basically practice contractions. It's your uterus running drills. Some people have them for weeks before real labor starts, and they can be pretty uncomfortable..

Real contractions come from the top of the uterus and actually move the baby down into the birth canal. This part of the video makes that difference so clear.

The other part that I found helpful was the effacement and dilation illustrations. Not being able to see your own cervix, it's hard to imagine what a midwife or doctor means when they tell you you're "90% effaced" or "7 cm dilated." You can see it in drawn diagrams, but I don't find those nearly as helpful as watching that balloon opening get thinner and wider as the ball was being pushed down.

"Normally, this demonstration does not faze my students at all," Bernal told Buzzfeed. "They are really just surprised that a ping pong ball can fit into a balloon and that a balloon can stretch like it does without popping. It's just a good visual aid for them."

"And, yes, they know a baby will not actually yeet across the room!" she added. "I personally feel that they get more out of me showing it this way than they would watching birthing videos because it's something that is hands on and they can't just zone out."

I will say, though, that as illustrative as it was to see the mechanics of contractions, effacement, and dilation goes, it's definitely a limited demonstration. First of all, babies are nowhere near the size of a ping-pong ball, and that whole contraction > effacement > dilation > baby popping out process takes a heck of a lot longer and involves a crapton more work than that. It doesn't even touch on the reality of what our bodies go through and what it's really like to grow an entire human being and then push it out through an opening that does not look or feel nearly large enough to do so.

So yes, this demonstration (with the caveat about the birth canal) combined with some real-life footage would go a long way in helping people understand what's happening during childbirth.

Well done, Ms. Bernal.

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Here's to another unsung hero of the coronavirus pandemic—the midwife

Photo by Alex Hockett on Unsplash

Imagine being pregnant in the middle of a pandemic, when a hospital full of potentially contagious patients is the last place you want to set foot. Where and how are you going to bring your baby into the world?

Thousands of parents-to-be facing this question have scrambled to make a plan that keep them and their baby safe during the coronavirus outbreak. And many have turned to the experts in safe birthing in non-hospital settings—midwives.

Depending on where you live, midwife-assisted birth in a non-hospital setting may be seen as totally normal, or it may be viewed with suspicions about safety. In the U.S., midwife-attended births had seen an uptick even before the pandemic, but the vast majority of births still take place in hospitals. In other countries, home births attended by midwives is the norm for low-risk births.

With the new coronavirus likely not leaving anytime soon, folks in the U.S. might want to hop on the "this is normal" train. With restrictions on visitors and birth support people, as well as the risk of infection, more and more parents are opting for an out-of-hospital birth experience.

Despite being the first state hit hard by the virus, Washington state has had a "tremendous leg up" on this front, says Jen Segadelli, Co-President of the Midwives' Association of Washington State and Clinical Education Supervisor of the Department of Midwifery at Bastyr University. Decades of relationship-building between the midwives and OBs in Washington has created a strong culture of collaboration, she says, making childbirth care in a pandemic far easier than in states where midwives and OBs operate mostly in separate spheres.

However, even in a state where doctors and midwives work well together, the unique circumstances of a pandemic create an entirely new set of challenges and considerations. Coincidentally—and thankfully—a playbook for handling childbirth during a pandemic had already been partially written in Washington before the virus even hit.

Seattle-area midwife Tara Lawal, who runs Rainier Valley Community Clinic, had written her Masters thesis on developing a midwife-led community-based model of care, which includes midwife-physician collaboration—a vital piece of the pandemic birth equation. And Emily Jones, a current Bastyr University midwifery student, is nearly finished writing her Masters thesis on the role of midwives in disaster preparedness. The central question of her paper: "What happens when hospitals run out of beds?" Talk about good timing.

Segadelli, Lawal, Jones, and other community birth providers in Washington have created a COVID-19 Response Coalition to address the needs of birthing families during the pandemic using the knowledge laid out in those midwives' research. "The goal is to not get ourselves to a place where we are suddenly New York and like 'Aw crap. We might have to divert two thousand births out of the hospital in two weeks, and where are we going to put them?'" says Segadelli.

For midwives, the specifics of "where" aren't as important as simply having a plan. "We can catch a baby anywhere," says Segadelli. "We would just prefer that there be four walls and running water and heat."

Washington has dozens of licensed freestanding birth centers, which offers a degree of out-of-hospital infrastructure in addition to home birth options. But not all states have those facilities. New York, for example, has just two freestanding birth centers, both in Brooklyn. So creative solutions have to be found when hospitals get overrun and birth centers aren't available.

Segadelli says one option is setting up ad-hoc birth centers in hotels or Airbnbs in addition to home births. However, varying state laws and regulations make those options trickier in some states than others. For example, some states don't allow midwives to carry certain life-saving medications, and some don't even allow midwives to legally practice at all.

Segadelli says differing state laws means a hyperlocal approach must be taken:

"This is the downside to the federalist legal system, right? We essentially have 50 different legal systems in this country. Our legality of practices are different state by state, and our scope of practice is different state by state. There are some states where you can't carry anti-hemorrhagic medication. You can't carry Pitocin to stop a postpartum hemorrhage. So the way that those midwives might be forced to manage this is going to look different than it's going to look like for midwives in Washington, who enjoy a pretty liberal scope of practice and a pretty extensive drug legend for emergency management."


Segadellisays midwives has seen a 25% to 100% increase in demand across the state since the pandemic began. Some requests are from patients who are near their due date, which poses an extra challenge for midwives who are used to working closely with patients throughout their pregnancy. Late-term transfers don't allow much time for relationship-building, and patients may not be prepared for the reality of an out-of-hospital birth without the option of an epidural. But in a crisis, people do what they have to do.

And problem-solving in real time is exactly what midwives do. "I think that's what midwives do well," says Segadelli. "We innovate. We problem-solve. We always have." Midwives also have valuable birth care expertise that traditional OBs don't. Doctors have begun approaching midwives in Washington asking how to get patients out of the hospital after birth quickly, which is standard practice for most midwives. Segadelli says that kind of knowledge sharing will serve birthing patients well, not only during this pandemic, but in any potential disaster situation.

"We are hopeful that we have somewhat managed to avert crisis in this state with early action with social distancing and preventative measures," says Segadelli. "But we are also hopeful that this has started a bigger conversation about when this happens again—I won't even say 'if,' we're way too connected as a global society for it not to happen again—or an earthquake or some other kind of crisis or disaster—when we're faced with it, that we've started to lay some groundwork here with our colleagues and as a healthcare system that recognizes we're going to have to have a plan. Because if we don't have a plan, the people who fall through the cracks are the birthing people and the babies."

While OBs are experts in surgical birth and high-risk birth situations, midwives are the experts in normal, low-risk birth. Both kinds of expertise are needed in a crisis, so the more birth care providers work in conjunction with one another, the better the outcome for all birthing families.

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Pregnant in a time of coronavirus - the changing risks and what you need to know

images.theconversation.com

"So, being pregnant and delivering in a pandemic … what's that gonna look like?"

That question, sent to me by a colleague who is both a registered nurse and an expectant mother, stopped me in my tracks. As an OB-GYN physician, I naturally focus on the science of health care. Her email reminded me of the uncertainty expectant mothers now face as health risks and the health care system around them change amid this coronavirus pandemic.

While knowledge about the new coronavirus disease, COVID-19, is rapidly evolving and there are still many unknowns, medical groups and studies are starting to provide advice and answers to questions many expecting families are asking.


Do pregnant women face greater risk from COVID-19?

So far, the data on COVID-19 does not suggest pregnant women are at higher risk of getting the virus, according to the American College of Obstetricians and Gynecologists. However, as we have seen from the flu they are at greater risk of harm if they get respiratory infections. Pregnancy causes a variety of changes in the body and results in a slight immunocompromised state which can lead to infections causing more injury and damage.

Does having the coronavirus create a greater risk of miscarriage or preterm labor?

Studies have not yet been done to show if having COVID-19 during pregnancy increases the chance of miscarriage, but there is some evidence from other illnesses. During the SARS coronavirus epidemic in 2002-2003, women with the virus were found to have a slightly higher risk of miscarriage, but only those who were severely ill.

Having respiratory viral infections during pregnancy, such as the flu, has been associated with problems like low birth weight and preterm birth. Additionally, having a high fever early in pregnancy may increase the risk of certain birth defects, although the overall occurrence of those defects is still low.

Can a mother with COVID-19 pass the virus to her baby in the womb?

This data is evolving fast. Two papers published March 26 describe finding coronavirus antibodies in three newborns of mothers with COVID-19. That could suggest they had been exposed to the virus in the womb, though the virus itself was not detected in their umbilical cord blood and researchers have raised questions about the type of test used. Researchers in an earlier study found no evidence of COVID-19 in the amniotic fluid or cord blood of six other infants born to infected women. While the research papers include only a small number of cases, a lack of vertical transmission – from the mother to child in utero – would be consistent with what is seen with other common respiratory viral illnesses in pregnancy, such as influenza.

There have been a few reports of newborns as young as a few days old with infection. But in those cases, it is believed that the mother or a family member transmitted the infection to the infant through close contact after delivery. The virus can be transmitted through a cough or sneeze, which could spread virus-laden droplets on a newborn.

How are prenatal checkups changing?

Prenatal care may look different for a while to control the spread of COVID-19 among patients, caregivers and medical staff.

Typically, a pregnant woman has about 14 prenatal visits. That may be reduced by approximately half, with telemedicine playing a larger role. Telemedicine is already endorsed by the American College of Obstetricians and Gynecologists for patients in rural settings. Now, the pandemic is making virtual care solutions an indispensable tool. Pregnant women are able to do some at-home monitoring, such as for high blood pressure, diabetes and contractions, and telemedicine can even be used by pregnancy consultants, such as endocrinologists and genetic counselors.

The frequency of sonogram appointments may also change. The Society of Maternal Fetal Medicine says it is safe to reduce "routine" ultrasounds at this time without jeopardizing the health and safety of the pregnancy. Of course, some patients with specific conditions like twins or babies with suspected birth defects may require more traditional follow up.


images.theconversation.com

What should I expect during delivery?

Hospitals are doing what they can to minimize person-to-person transmission, and that may mean delivery looks different, too. Some hospitals are screening all medical staff, including with temperature checks, at the start of shifts.

Visitors are also being restricted. Recently, a hospital in New York enforced a no visitor policy, including partners, for patients about to give birth, citing coronavirus risk. This is definitely not what laboring women envision for their delivery, but in times of widespread communicable disease, it is reality.

If I have COVID-19, will I need a cesarean section?

No. Having COVID-19 is not a reason for a cesarean. There's no evidence that either method, vaginal birth or cesarean, is safer when it comes to COVID-19. Although data is still limited, other coronavirus infections have not been known to pass to the child from vaginal birth.

Both the American College of Obstetricians and Gynecologists and the Society of Maternal Fetal Medicine believe, in most cases, the timing of delivery should not be dictated by the mother's COVID-19 diagnosis. Women infected early in pregnancy who recover should see no change to their delivery schedule. For women infected later in pregnancy, it is reasonable to attempt to postpone the delivery, as long as no other medical reason arises, until the mother receives a negative test result.

How long will I be in the hospital after I give birth, and what if I have COVID-19?

Expect a faster discharge from the hospital. To limit the risk of inadvertent exposure and infection, the ACOG says discharge may be considered after 12 to 24 hours, rather than the usual 24 to 48 hours for women with uncomplicated vaginal births, and after two days for women with cesarean births, depending on their health status.

For mothers with confirmed COVID-19, the Centers for Disease Control and Prevention advises that infants be isolated from them, which understandably is not ideal. That could mean drawing a curtain between the mother and newborn and keeping them at least six feet apart. The CDC suggests continuing that separation until 72 hours after the mother's fever is gone. If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed or suspected COVID-19 should put on a facemask and practice hand hygiene before each feeding or other close contact with her newborn.

Is home birth safer than a hospital right now?

If a woman chooses to have her baby in a hospital or birthing center, she will have a dedicated team of health care providers trained to protect her and her baby from COVID-19 and handle any unforeseen complications. There is some concern regarding person-to-person exposure with COVID-19 in a home birth setting due to fewer restrictions on visitors. Although the ACOG has not made a statement specifically on this risk, the United Kingdom's Royal College of Obstetricians and Gynaecologists has a statement advising against home birth for women who have been exposed to COVID-19.

Can I breastfeed my baby if I have COVID-19?

In limited cases reported to date, no evidence of virus has been found in the breast milk of women infected with COVID-19; however, precautions are still recommended. Breastfeeding is encouraged and is a potentially important source of antibody protection for the infant. The CDC recommends that during temporary separation, women who intend to breastfeed should be encouraged to pump their breast milk to establish and maintain milk supply. The mother should wash her hands before touching any pump or bottle parts. If possible, it is also recommended to have someone who is healthy feed the infant.

Having a child is a momentous occasion that should be celebrated, including during a pandemic. Do your part to keep yourself healthy. Wash your hands, maintain social distance and keep in close contact with your health care providers throughout the pregnancy. It may not be what you envisioned, but you will have quite a story to tell your children.

Hector Chapa is Clinical Assistant Professor, Director of Interprofessional Education, College of Medicine, Texas A&M University.

This article originally appeared on The Conversation. You can read it here.

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