Last updated 13-4-2020

To my wonderful clients and families and the Adelaide birthing community

We are living in uncertain times at the moment and many of you may be feeling anxious.
When I'm feeling like this, I like to make lists, research and be prepared. I reflect on what I know to be factual right now and check if am I having thoughts and feelings that are trying to predict the future. This post is long and contains extensive links for your own research. 
My hope is to bring you calm and reassurance with this post.

First of all, I want to share with anyone who is pregnant the following resources to relieve any immediate anxiety. The current recommendations and evidence show that the virus is not passed between mother and baby in-utero and that the mother-baby dyad should be kept together after birth. Breastfeeding is highly encouraged for its immunological benefits. Your baby and breasts communicate to provide your baby with specific support for any pathogens that may be present.

I am following the best practices for health, with my clients and my own family. These preventative measures include:

• Washing our hands with soap and water for at least 20 seconds. If soap and water aren't available, we use alcohol-based hand sanitiser.
• Avoiding touching eyes, mouth and nose with unwashed hands.
• Avoiding close contact with individuals who are sick.
• Staying home if we are unwell.
• Avoiding crowds.
• Cleaning and disinfecting frequently touched objects and surfaces.
• My children are not attending school and we have been social distancing since mid March.

I also know that COVID 19 is bringing changes to the way hospitals currently function. 
As of today, Hospitals are asking to limit visitors to 1 support person at birth and postnatally.  Other changes include the prohibition of gas for pain relief and labouring/birthing in water.
I have also seen one hospital recommend all women are asked to have an epidural ...

Please discuss all your options with your primary care provider or myself. 
I can support you to labour at home or have a homebirth with a midwife present!

For my placenta encapsulation clients:

You are still able to keep your placenta and have it encapsulated. The only change that is necessary is that your partner or a support person will need to meet me at the hospital entrance to give your placenta to me. I am then not "visiting" you in hospital and this will also help minimise my exposure so that I remain well for all my clients.

You also have the option of taking your placenta home and I can collect it from there. If you would like to do this, please refer to your booking confirmation for details on keeping your placenta cold at all times or call me during business hours for further details.
For those who do not have collection & delivery as part of your package, you are still welcome to bring your placenta to me.  Contactless delivery is practised at all times.

If you would like me to wear protective gear during our meeting (even though this isn't currently required if we are both healthy), just let me know so I can organise this in advance. I always sanitise my hands at hospital visits and after handling placenta containers anyway but I am happy to wear a surgical mask and gloves if you wish. Should you or I show any signs of having COVID 19, let's have that discussion when it happens. The limited research available shows that the virus is not found in amniotic fluid, breastmilk etc of infected mothers.

I am here for you so if I can reassure you in any way, please email me.

I also want to remind you of my standard infection control procedures. I only process one placenta at a time and my "placenta lab" and any equipment is thoroughly sanitised between each placenta. I wear personal protective equipment at all times and my sanitisation procedure includes the use of Clinell Wipes, Soapy Water, Viraclean Spray & Bleach Solution. I am well-stocked in these products and personal protective equipment.


For my doula clients:

Just like birth, we are dealing with the unknown. We don't know exactly what is going to unfold or how the timing of the event will play out. As a doula this is part of my job. I have a key skill set in dealing with the unknown and living with the now and I can't reiterate enough that I am here for you.

All pre and postnatal visits are still available. As with placenta clients, if you would feel more comfortable with me wearing personal protective equipment, then just let me know. I will bring hand sanitiser with me as well. If we all practise hand-hygiene that is a great way to prevent transfer. If anyone in your family is unwell or if I become unwell, we'll discuss our options. We can still talk over the phone or through video conferencing via Zoom.

When you are in labour, I will be there to support you to labour at your home as long as you feel comfortable to do so. This has always been part of my service, COVID 19 or not =)

As hospitals are currently only allowing 1 support person, unfortunately my physical support will need to finish at the hospital door.  I will still be there for support via video calls at any time.
If you do not have another support person, I can accompany you into hospital.

If you are my client, you know that I am big on you having all the information to make an informed decision and on my clients feeling comfortable in advocating for themselves. So I'm laying it out for you here. The daily uncertainty of support should not be the thoughts of any pregnant person. Here is some information for your family, some steps you can take and things to discuss with your hospital:

1. Doulas are not visitors. I am a professional support person contractually hired by you. I work for you, not the hospital. The fact that you have hired me means you see me as an essential part of your wellbeing and care and hospitals should too. I also value the work I do and will not just step-aside as a "passive visitor" unless my clients ask me to do so.

2. I am happy to comply with the same personal protective measures that the hospital requires of its midwives and doctors.  That may include registering at reception and completing a screening by their staff.  And of course I will wear any protective equipment they require.

For your extra information I have always done and will continue to do the following:

• Wash my hands upon arrival to hospital and use gloves or hand sanitiser as appropriate.
• Bring a spare pair of clothes with me to births in case I come into contact with bodily fluids.
• Change out of my work clothes immediately upon returning home. These are washed in hot water along with my rebozo.
• I clean any of my reusable supplies used during births such as my portable speaker, massage tools or TENS machine with hospital disinfecting wipes. Depending on what you use, my supplies may also be covered in the birth space with removable single-use hospital linens.

3. I am not a lay person. Doulas are para-professionals in the birth space. I have undertaken extensive training from numerous organisations. Not only in perinatal support but also in hand-hygiene, infection control and the governments COVID 19 training. If your hospital would like to see copies of my certifications, please let me know. I have attended enough births that would be required of a student midwife to complete their studies. Doulas are an irreplaceable part of your health care team.

4. I hold my own insurance.

5. Please print out this letter and give it to your care provider during your antenatal appointments. Tell your provider that we all want to be on the same page and ask them to advocate for you and your doula at any facility policy meetings.
Have these discussions as soon as possible and let me know any outcomes. We will work together for the best outcome for you.

6. Ask the manager or director of birthing services for written verification that I will be "allowed" to remain on your birth team in hospital.

7. If you receive support from a mental or allied health professional, ask them for a letter of support requesting that I continue as part of your care team for the benefit of your wellbeing.

8. You care about the quality of your birth experience and desire the best possible outcome for you and your baby. Evidence shows that continuous support can decrease the risk of cesarean, the use of medications for pain relief, and the risk of a low five minute Apgar score.
Labour support also increases satisfaction and the chance of a spontaneous vaginal birth. Continuous support may also shorten labor and decrease the use of synthetic oxytocin. These outcomes are backed up by solid research and evidence. You can access a summary of the research at this link.

9. It is your human right to decide who attends your birth. If the hospital denies your choice of professional labour support attendant, they are negating your human rights. 
The World Health Organisation includes support from a companion of choice as one of their recommendations for a positive birth experience. 

10. AWHONN (the Association of Women's Health, Obstetric & Neonatal Nurses) released a statement on 11-3-20 stating that they recognise that doula services contribute to the woman's preparation for and support during childbirth and opposes hospital policies that restrict the presence of a doula during a person's active labour.

"Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period. Most doulas have been contracted by patients weeks to months ahead of time and have established provider relationships. They are recognised by AWHONN and ACOG as essential personnel and part of the maternity care team."

You or your provider can read more about their statement here.

11. Practise with your partner what you want to say to your provider.  You can use these statements to advocate for your right to doula support:
"My doula is not a visitor. She is an essential support person and member of my care team."
"No matter the restrictions, this hospital should acknowledge my values and personal agency."
"I will not give birth here without my doula."

12. When you call the hospital to let them know you are in labour and heading in, tell them "We are bringing our professional doula with us.  She will complete the screening process along with my partner."

13.  We can plan for me to accompany you to hospital regardless of any uncertainty.  It is harder for staff to turn me away if I am already present and you are insisting I support you.

14.  If your hospital refuses to let me physically support you, you can:

• Decide not to birth at that setting and see if another facility or care provider will support you.
• Look into birthing at home if a provider is available
• Birth without me physically present.  I will still support you via phone or Zoom. 

This is why it is important to have these discussions as early as possible so that you can maximise the options you are comfortable with and avoid unnecessary confrontation.   I want to work with your hospital, not against them.

15. In the case of my clients or myself being unwell, the hospital refusing entry to myself or you choosing not to have me present at the birth, we still have the options of using a backup doula or utilising technology so that I can be a virtual presence in your birth space.
Your options will depend on the situation and what you are comfortable with.
But as with birth, you always have options.  It is always your choice, even if it is a hard decision to make and  I will always support your choices.

These are unforeseen circumstances and I will do my best to provide you with the support you hired me for.  Let's all support each other and our communities.

​Be alert but not alarmed. Be well.

Kelly x

Elemental Beginnings - Adelaide Doula Services
Name: Kelly Harper
Services: Birth Planning & Coaching, Private Childbirth Education Classes, Birth Doula
​Website: http://www.elementalbeginnings.net
Location: All Adelaide metro & hills locations, Mt Barker, Gawler, Flinders Medical Centre, Women's & Children's Hospital, Lyell McEwin Hospital, Ashford, Burnside, Calvary, North Eastern.

Enlightened Birth and Beyond
Name: Edriana King
Services: The Hypnobirthing Australia Positive Birth Program provides expecting mothers and their birth partners with knowledge, tools, techniques, support and preparation for a more positive birth experience.
Website: http://enlightenedbirthandbeyond.com.au
Location: Para Hills West

During pregnancy and birth, one of the biggest decisions you will need to make is who you are going to have supporting you and present in your birth space.  That decision includes the possibility of hiring a doula to provide information, resources, physical comfort and emotional well-being.

Often it is the mums-to-be from around Adelaide who will contact me first.  We'll have a bit of a chat and then they'll take some time to discuss it with their partner.  Sometimes I'll have a chat with the other parent at the same time and often their questions or concerns centre around what role a doula will play.  Will I take over their role?  Why do they need a doula if they have a midwife or obstetrician taking care of them? Why should we invest in a doula when I can support my wife myself?

To help answer these great questions, I thought it might be best to hear from those I have worked with so you can get first-hand information.  I sent out some interview type questions for Dads to answer to hopefully make things easy for them.

Thanks to Simon for being the first Dad to share his thoughts on hiring Elemental Beginnings as their doula.

​

1. What were your honest thoughts when Kate first mentioned hiring a doula?  
My first thoughts were very positive. I knew a bit about Doulas before we looked further into it.
I knew that Doulas are quite simply an added set of safe hands who have a lot of experience and knowledge with birth, labouring and after birth care. I knew that having a Doula present before/during and after the birth of our son was always going to be valuable source for us.

2. If you had any initial questions or concerns about working with a doula, what were they?
I had no concerns at all. We had an instant connection with Kelly so I (we) knew it was the right thing to do.

3. Could you talk a little about our work together, both during the birth and before and after, from a partner's perspective?  
Reassurance was the key. This was the first time I was involved in the birth of a child. I was nervous but with all our preparation I was fairly confident. I was nervous that I was going to do or say the wrong thing, especially in labour. Kelly was gentle, and her presence was always felt. She knew when to be involved and when to step back. Her subtle guidance just reassured me that I too was doing a good job.
 

4. If your birth didn't quite go to plan, how did having me there or our prenatal sessions make a difference for you?  
Our plan/preference was to have a home birth, surrounded by love and support instead of machines, bright lights and interference. The labour was very long (24 hours) and our son was a little stuck by the end of it. My wife’s heart rate was getting higher and higher so the midwives called an ambulance. We always knew that our ‘plan’ might not go perfectly so we were prepared for the hospital.
​
Having Kelly there, especially after the call was made to go to hospital, made me feel comfortable knowing that this is something that can happen and that everything was going to be ok. She reassured me that this was normal procedure and our midwives had my wife and son's health as their top priority - something that can be forgotten about in the heat of the moment.
 

5. How would you explain a doula to your best mate?  
A Doula is someone who has a lot of experience in childbirth, someone who offers knowledge, comfort and ongoing support with child birth and after care.

6. What is your advice to other dads and partners who may be considering hiring me, now that you've experienced birth with a doula?  
My advice is do it. It is a guarantee that someone will be working with you. Someone who has experience, a safe set of hands, and someone who will help you have a memorable and empowering birthing experience.

During your pregnancy it is common to experience various discomforts such as morning sickness, hemorrhoids, prenatal anxiety and heartburn. You can speak to your doula and ask for recommendations about who to see and of course check with your care provider about your concerns.
​
Below is a list of frequently recommended professionals who support pregnant women around Adelaide.

The Little Oak Studio
Redwood Park
Rachel specialises in Maternity, Newborn and Family Photography in her home studio in Redwood Park. She will be launching 'Fresh 48' sessions in hospitals soon too!
www.thelittleoakstudio.com.au

Evolve Chiropractic & Wellbeing
Walkey Heights
​www.evolvechiroadelaide.com.au

Climbing Tree Chiropractic
Chandlers Hill
​Facebook

Lea Papworth Acupuncture
Hilton
www.acufertility.com.au/

Health & Harmony
Gawler
​Facebook

Well2
Norwood
​well2.com.au/

Essence of Yoga
Valley View
essenceofyoga.net.au/

The Yoga Centre
Adelaide
www.theyogacentre.com.au/

Coast Yoga
Glenelg
​www.coastyoga.com.au/

Nest Yoga & Wellbeing
Walkerville
A beautiful boutique studio for pregnancy, postnatal and well woman yoga and chiropractic in the eastern suburbs of Adelaide.  Services include prenatal yoga, mums & bubs yoga, Birth planning, Childbirth education and active birth workshops and chiropractic for pregnancy, postnatal and children
PH: 0431051031
http://nestyogawellbeing.com/


Paediatric & Perinatal Centre
Tusmore
Psychological support for families from pregnancy planning through birth, postnatal and early childhood. We provide evidence based clinical psychology for anyone in this period who could benefit from professional assistance with fertility issues, worry, poor mood, difficulty adjusting to parenthood, traumatic birth, relationship stress in this period, concerns about relationships with baby and everything else!​
www.paediatricperinatal.com.au/

Breathe Stretch Float
1/153 Flinders Street, Adelaide
www.breathestretchfloat.com
We provide flotation therapy, it allows a mother to float in 350 kg Epsom salt and take all the weight from their joints.  We also provide salt therapy and have Adelaide's only salt cave. Salt therapy is very relaxing and is a great drug free way to alleviate symptoms of cough, cold, hay fever, asthma and other respiratory conditions as well as skin conditions like acne, eczema and psoriasis.
Lastly we conduct havening technique a psycho-sensory technique to remove or reduce fears, phobias anxieties and the bodies reaction to traumatic events. Very helpful for mothers suffering anxiety about the birth.​


Healthful Women's Wellness Clinic
Seacliff
www.healthful.net.au

Integrative Health Solutions
Belair
www.integrativehealthsolutions.com.au/

Women's & Children's Health Network
Pregnancy and birth information
​Website

Pregnancy - SA Health
Government information and fact sheets on pregnancy topics and related policies
​Website

If you provide services to pregnant women around Adelaide or the hills and would like to be included in this resource guide, please contact me and send through your details.