The Work of a Bereavement Doula in miscarriage, stillbirth and the perinatal stage
by Samala Kriedemann
After the birth of my 4th child (which was a beautiful waterbirth) I decided to change my profession from being a Social Worker to a Birth Doula as I had experienced how beautiful and empowering birth could be when well supported.
Now, many of you may be asking- “what is a Doula?”
Doula is the Greek word meaning ‘A woman who serves”, and so we are woman who serve the mother/couple during pregnancy, labour and birth. We provide the couple with physical, emotional and informational support. While we are not medically trained (like a Midwife) we are trained in the Physiology of Pregnancy, Labour and birth and we are trained in natural pain relief methods to assist mom during her labour.
So back to my journey. I trained to be a doula and then my very first client had a stillbirth at 39 weeks! In that moment my Social Work background kicked in and I knew she would need ongoing support. I began searching for a baby loss specific support group for her and found nothing!! I could not believe that there was no support for these mothers. I responded to this lack by starting my own support group for mothers who had lost babies through miscarriage, stillbirth and infancy death. Over the following few months I listened to these mothers’ birth stories and I heard how traumatising their births were. Obviously experiencing baby loss is traumatic, but I heard repeatedly how they felt unsupported during their births as the staff did not seem to know how to deal with them. Many shared their deep regrets of not being allowed to see their babies, hold them, say goodbye or did not think to take photos, and now those precious few moments they had were gone forever.
It was then that I thought, surely, I could be a doula that supported in loss and not just in live births. I began researching and found an international course for a Stillbirth Doula and signed up for this and trained and began serving in this capacity. I soon saw holes in my training as it was American- based and as America is a first world country they have access to such incredible resources which we simply do not have in South Africa. I then made the decision to start training Bereavement Doulas in South Africa with an understanding of the South African context.
Footprints in ink and clay, part of the memory or Hope Boxes:
The stark reality is that 1:4 woman will suffer loss (miscarriage) and 1:6 will be a stillbirth! As people do not want to focus their attention on sadness and loss of babies, many of these couples who experience baby loss have no idea that there is support available to them both during the actual birth of their babies as well as afterwards on their grief journey. Most couples will be left to grieve silently, as society does not give them space to share their feelings, their loss nor space to acknowledge their babies.
Many people are uncomfortable with baby loss as babies represent joy and new life and therefore it feels so unnatural when a baby dies and so due to their own discomfort people minimise the loss of the couple. This can be seen in how people respond to these couples with words like “Oh well at least it was early, you can always try again”, “Be grateful as clearly there was something wrong, so actually it’s a blessing” or “This must have been God’s plan” or worse “It’s time to move on”. All these things, while meant to comfort, only alienate the couple and send a message that your feelings are not valid.
Couples that have experienced loss need to know that there is support and that their feelings are valid, and their babies mattered.
This brings me to the important work of a Bereavement Doula.
What is a Bereavement Doula?
A Bereavement Doula provides support to families who are experiencing or anticipate a loss. They understand how grief affects people. We offer assistance for miscarriage, stillbirth, or terminal diagnosis during pregnancy, sudden infant death and NICU care.
We provide comprehensive physical, emotional and information aid through the journey of loss.
Circumstances in which can we assist:
Miscarriage – we can supply support to a couple deciding if they should allow a natural miscarriage or have a D&C. If they choose to miscarry naturally at home, a bereavement doula can be with her to support during the miscarriage and offer her guidance and ways to say goodbye to her baby;
Late miscarriage – this is when baby is birthed after 12 weeks. Here the Bereavement Doula can attend the birth offering emotional and physical support and once baby is birthed the doula receives baby, cleans baby and then presents baby to the couple. She will help the couple to say goodbye to their little one and depending on gestation, she will offer various memorabilia to them. This includes hand/foot prints, hand/foot moulds, cutting a lock of hair, photos and more.
Medical Termination & Stillbirth – Again the Bereavement Doula may support during the birth should the couples desire this. Alternatively, directly after the birth the Bereavement Doula will again assist the client in meeting their baby, saying their goodbyes and in creating memories.
NICU Support – Here the Bereavement Doula can be called in should the couple be facing the decision to turn off the machines or baby has already passed. The Bereavement Doula will provide emotional support, gently guide the couple in any decisions that need to be made and again give the parents time with their baby to hold him/her, say their goodbyes and help them create memories.
Perinatal Palliative Care – The Bereavement Doula can be called to support a couple that has chosen not to terminate their baby who has a fatal or life-limiting diagnosis. The Bereavement Doula can sit with the couple and assist them in writing a birth plan as well as a Farewell Plan. This enables the couple to plan ahead and minimise the regrets they may have otherwise had. The Bereavement Doula can assist at the birth, ensures that the birth plan and farewell plan is carried out and that if any changes do occur that the couple is supported to try to alleviate any unnecessary stress or trauma the changes may bring. She can also do home visits if baby is discharged and she can be the link between the palliative care team and the parents, calling for assistance when the time is right.
The Bereavement Doula will also provide informational support to help her clients to make informed decisions. For example, before 26 weeks of gestation in South Africa a foetus that showed no signs of life after delivery are disposed of as medical waste. However, the Bereavement Doula can ensure that the couples’ baby’s remains are treated with dignity and assist in giving the couple the option to have them cremated or buried. This makes a significant difference to the couples’ grief journey.
Planning for a funeral is the last thing on the mind of a couple that has lost a baby, and they are still in shock. The bereavement doula can provide the couple with information on the best options for them and their baby.
The role of Bereavement doula is to reduce trauma in a highly traumatic situation and to minimise the couple’s regrets. Those few precious moments that they have with their baby will be all they will ever have and so we do our best to ensure that they are special and meaningful.
Mama Nurture Bereavement Doulas also form part of a network of support and are therefore able to refer the clients to Psychologists, Social Workers and Professional Counsellors after the birth. This ensures that our clients get ongoing support once they have discharged from the hospital. We want our families that we support to know that they are not alone and there is support available to them.
I am deeply passionate about this work and I see the huge need for such care and support in all hospitals in South Africa. My heart is to change how baby loss is handled in South Africa.
Myself, and the doulas I have trained that are signing up with Patch SA are excited to be collaborating with this incredible organisation as we see that we share hearts on making positive changes as to how our children in South Africa are treated both in life and in death.
Should you like any more information on my upcoming trainings or make contact with me, please feel free to do so on 083 389 6929 or email me on firstname.lastname@example.org. You can also gain more insight into what my business does by going to www.mama-nurture.co.za.
Thanks for giving me the opportunity to share my heart with you all,
Samala Kriedemann is a qualified Social Worker, an Internationally Accredited Birth, Bereavement and Adoption Doula with SBD University and a member of PLIDA (Pregnancy Loss and Infant Death Alliance). She is also a member of Patch SA (Palliative Treatment for Children South Africa). She runs various support groups for mothers and couples that have lost through miscarriage, stillbirth and infancy death.
Samala is a trained counsellor and offers individual sessions to mothers going through the traumatic and heart-breaking journey of grief. She also offers birth debriefing for any mother who has experienced a traumatic birth.