The Distance Doula

I’m writing this during the 2020 Covid-19 crisis, but I want to make it clear that the skills we are being forced to learn right now are not new for some of us, because we have been offering ‘Distance Doulaing’ or ‘Digital Doulaing’ for a long, long time. If I can see any positives, it will be that there will now be a generation of families who can publicly attest to how deeply and effectively they were supported by their doula, even if they couldn’t be with them in the flesh.

If you want to offer distance doula services, here are some very obvious tips for getting started.

1. Pretty obvious one this one: get online. If you don’t have an insta account, a twitter account or any other socmed, now is the time to dive in. Ask your kids or a local doula for help if you need it. Share useful information, videos of yourself talking calmly and quietly about how pregnant people and new families can benefit from online support and connect with other doulas and birthworkers who are offering a similar service. The community is what keeps us sane.

2. Work on your website. Edit the content to show that the support you offer can be provided online. Get familiar with a platform that allows you to see each other – like Skype or Zoom or WhatsApp. Help potential clients see that they can receive almost the same service remotely. Think of a name for this kind of offering – I call it ‘Distance Doulaing’ or ‘Digital Doulaing’ because I can never resist a bit of alliteration and because I don’t like the word ‘virtual’ with its overtones of ‘not real’.

3. If things are quiet, take some time to go back to the sections in this course about your ideal client and your Unique Value Proposition. Who are your clients and how can you reach them online?

4. Mobilise your followers. Do you have happy clients who have become big fans? Would they help you with your marketing by sending you a testimonial or sharing on social media how much they love you?

5. Think about pricing. I’ve reduced my fee for consultations by a little bit because if I’m doing it via zoom I’m saving on petrol, parking etc. You may disagree – let’s share what we’re doing in the facebook group or patreon chatroom and see what’s working and what isn’t. If you’re teaching classes, zoom seems to be a dependable and fairly user-friendly platform. Consider upgrading so you can have a session that lasts longer than 40 minutes and gives you added functionality like whiteboards and breakout rooms.

6. Communicate with other doulas. This is vital. I’ve seen well off doulas giving away online stuff for free. This is hugely big hearted of them but fails to recognise that some of us have to try to continue to make a living! If you want to give yourself away for free, please consider making it very clear that your free offerings are for those most in need and that if people can pay something to support their friendly, local doula, they really ought!

7. Take care of yourself physically and emotionally! That means not staring at a computer screen all day. If you’ve got kids at home try to get some fresh air and exercise. Take time to breathe and relax. Do you have any of the doulavation downloads yet? Both the Grounding Relaxation and the Abundance tracks are even more vital for us all right now. Get them, plug in, breathe and float away!

Create Your Offering

What are you prepared to offer online? Some doulas may not wish to be on call for phone births at all so may tweak their service to just antenatal support or postnatal. That’s fine. Do what feels right for you.

How are you going to describe your online service? Remember, people need to hear the benefits of what you’re offering, not just the features. Edit your website and doulaographies to reflect this new way of working.

Set you fees and reflect on them regularly. Many of us are finding that we do not need to discount our fees, nor do we feel we should when we are successfully providing the same (or more!) support to our clients via virtual channels.

Club together: The power and magic of the doula community is how we can band together not just to provide each other with emotional support but to creatively work together to scratch each other’s backs. Are there a number of doulas in an area singly offering zoom antenatal classes? Perhaps you could band together and create some co-branding? Together your marketing will be louder, you will appear a larger, more professional organisation and attract more credibility and more bookings!

Gather testimonials from as many clients as possible to show the world that online doula support can be amazing.

Deepening the Doula Relationship

I have found that ‘virtual’ relationships can be just as deep and even more intense than normal doula relationships, especially in late pregnancy. It can feel for the client that they have their ‘doula in their pocket’ 24/7, so it can be helpful to be clear about your boundaries, right from the beginning. This is what I say:

“You are welcome to message me as much as you like and whenever you like. I want to make sure I am available to you. However, I have other clients and a family, so I will look at your messages and unless it appears urgent, I may sometimes need to wait a while before I respond”

I use email for longer, more formal communications, especially if I want to attach documents. I use whatsapp for quick voice notes, little videos of me showing them how to do something like put on a sling or breastfeed lying down, or to send photos – maybe of a page of a book I think they’d like, or of me giving them a big thumbs up! You can also do video calling on whatsapp, which can be a useful tool, especially as it is so easy to use on a mobile and can therefore be used while they are in labour, if you’re offering remote labour support.

If you’re not going to be there during the birth, upskilling the partner is even more important than usual. Is it worth connecting with them outside any whatsapp group you have set up, so that they can communicate any questions, fears or worries to you without upsetting or worrying your pregnant client? Especially in labour I’ve found it can be useful for the partner to be able to pick our brains privately. Antenatally we can teach them all the comfort measures we doulas have in our toolkits, so that hopefully during labour all we need to do it remind them and perhaps suggest a tool to pick up.

Building Rapport

When we are on camera it can be harder to build a relationship. Try to make sure that your background isn’t too busy and your house isn’t too noisy so that distractions are kept to a minimum. A little peek into your life – perhaps seeing your cute child or seeing your partner walk across the screen can be lovely – doula relationships are informal and easy, after all. But screaming kids and chaos won’t allow you to really listen and focus on your clients.

We need really use our listening skills even more in this way of working. We don’t have as much body language clues as normal, so what your clients say, their tone of voice and facial expressions will be even more important than usual.

Likewise, think about how you are coming across. If, like me, you are a tactile person, how can you use your voice to comfort and calm her instead of your loving hands and arms?

Birth Support

I suggest you talk in great detail about how this might work in advance. Some people may need a few short check-ins in early labour and once they have made the decision that it’s time to go to hospital, you may hear no more until after the baby is born. I have found it useful to paint pictures antenatally of lots of possible scenarios and this one, it helps to tell them that once they hang up on you and go to hospital, they won’t leave your mind and you’ll be on tenterhooks waiting for news!

Other clients may want or need long video calls with you during labour. Hospitals are (or should be) welcoming of this – especially during a crisis situation and will just ask that clients respect the privacy of other patients in communal areas and be mindful of disturbing people who may be trying to sleep. If you are hearing about hospital staff trying to restrict the use of technology during antenatal appointments or during labour, please do contact AIMS or suggest your clients do. We have template letters on our website to help people write to trusts asking them to justify draconian measures.

During labour you won’t have your hands for comfort and support, so your voice and any breathing you do with them will be even more important than ever. Repetition of phrases, gentle calm tone of voice, melodic phrasing, praise and validation are all useful tools. Use your voice to lull her, like when you are trying to read a toddler to sleep!

Be Adaptable

Our job as doulas is always to help clients bend with the wind. During coronavirus this is even more of an important skill! At the moment I’m calling myself Doula Justina Case!

• What if their partner becomes symptomatic?
• What about childcare for older kids?
• What if the homebirth service is cancelled?
• What if the Trust withdraws waterbirth facilities?
• What if only one birth partner is allowed at a homebirth?
• What if they want or need to get to hospital and don’t have a car?

Postnatal Support

Help them to make a list of tools that they have already in their toolkit and others they may decide they want. What preparation for infant feeding do they have? Some knowledge of normal newborn behaviour and things to watch out for is more important right now as there are far fewer face to face visits from midwives and health visitors. Give them a clear checklist so they can assess that their baby is getting enough milk.
Check in with them every day after the baby is born. Lots of people hate to reach out, but will let all their worries flow in response to a quick ‘Morning! How was your night?’ kind of message.

Encourage them to connect with their family and friends via video call regularly. Isolation and stress are big risk factors for postnatal depressions, so keep a closer eye than usual.

Safety

Online support is needed, effective and increasingly popular, but unfortunately it can sometimes attract a small number of people with a compulsion to pretend to be pregnant or in labour. These people are mentally ill and are very convincing. Here are some ideas on how to stay safe online.

Don’t be identified as a victim: They are looking for people who jump in with a need to rescue. Maintain strong boundaries from the beginning and act on instinct. If it feels a bit off, it probably is.

They want to build rapport and empathy. So they will pull on your heartstrings and have some trauma or crisis going on. There will be things that are designed to convince you – pictures of the bump or baby or the red book for example. There will be logic and persuasion to hook you in and a detailed story that you begin to feel emotionally engaged in. 

They listen very hard to you, to learn things about you so they can deepen your belief in them. They also research you online to find personal details about you and your family. They will have a pseudonym which maybe the same as someone close to you.

If you express doubt or say no, they will attempt to persuade you with emotion, an urgent crisis, praise or flattery. 

They may pull you in further by using mild insult. For example, saying something like “but I’m sure you’re too busy and important to help me” or tell you what an angel you are: “you are doing too much, I don’t deserve this wonderful support”.

They will come across as very confident, they may even almost believe the story they are weaving – they are called ‘confidence tricksters’ after all.

Social proof – they will dress or behave in a way that inspires belief, or tell you that you have a friend in common.

Ego boost – they will be incredibly grateful and praise you to the skies.

They will have done a lot of research and know lots about pregnancy, birth and babycare and a lot about the way doulas work. This is because they’ve done it before to other doulas, sometimes scamming them for months or years. Don’t let that happen to you.

The story they weave is typically full of trauma and often baby loss.

Other scams suffered by doulas is this one:

“I’m in labour now, the baby is coming. Do you have zoom or skype? I was raped/am all alone/want a freebirth and I need your support right now”

They will refuse to talk on the phone and if you say yes to video call, the camera “won’t work”. You will hear breathing through “contractions” and be entreated to coach ‘her’ through pushing.

This may well be a man with a strange sexual kink.

We don’t have any evidence of any of these hoaxers extorting money from doulas. It seems they are after a more twisted ‘fix’. However, this doesn’t mean it is a victimless crime. If you have any doubt at all, keep records of all communications because these can be compared with others to spot patterns that may save you from weeks of emotionally draining support.

Below are some safety guidelines for online support developed by Verina Henchy, a Developing Doula and trainee DD facilitator.