By: Kima Tozay
Content Warning: This article discusses grief, hope, and healing after pregnancy and infant loss. This information may be triggering – please go at your own pace.
“When you are grieving at the same time as birthing, that just brings a whole different level of giving birth”.
I interviewed Teresa Robertson to better understand the role of a doula, particularly one that specializes in post-partum bereavement care. Doulas play an important role in ensuring pregnant and birthing people experience positive birth outcomes. Most of the time, the birthing experience is joyous and uneventful for the pregnant person and their family. Other times the birthing experience can come with expected or unexpected challenges that threaten the health and safety of the mother and/or the child such as a traumatic birth or loss of life.
Teresa is a certified DONA Doula, who specializes in Perinatal Loss Support and lives and works in Hawaii. She has cared for over 60 families in multiple capacities within the last 5 years as they have delivered their children either stillborn or with an anticipated short life-span.
1. How did you get involved in this work?
I have been doing this work for the last 5 years and I work independently. I help co-create an annual remembrance walk for Pregnancy and Infant Loss Awareness Month. I spent time volunteering for an organization called Now I Lay Me Down to Sleep (NILMDTS). That is where my journey began. Over that time, I was working in a hospital primarily that was extremely encouraging of what I did outside of photography.
As I was creating close relationships with nurses in Labor and Delivery and still learning how to better care for families. Three years ago, I noticed there was a lack in available resources where I currently live. It wasn’t that there weren’t enough resources, it’s that nobody knew about each other. No document that connects them all. It’s pretty important for families to know the different levels of care and where they can go for different needs. After three years I started checking back in with these organizations that already existed and there had not been anything that had developed and that is when I through myself into the work. I started working with families more intimately one on one through their birth and started providing education and resource documents to the birth community.
2. What can you tell us about the community you serve?
I serve any and all births so I work with families who choose to carry their babies to term, I work with families who have to make the decision to medically terminate. I work with families who seek earlier abortion or go through miscarriages. There truly is just no matter the birth outcome is, I see this as a birth and from the families I individually help them and customize the type of care I give to them and make sure that feel supported as possible and alleviate some of the stress that can go with walking through these journeys alone.
3. What is your role? What services do you offer?
I do have several roles. As a birth doula I care for families before, during, and after the birth process.
BEFORE THE BIRTH: For instance, before the birth process, some of the families I work with I go to doctor’s appointments with them. Because a lot of times when they go in, they feel very overwhelmed and have difficulty either remembering questions to ask or remembering exactly what medical provider has said to them in order to relay that back to their partner.
We also look at what life may look like immediately after they give birth and help pre-plan for that. I am certainly there in the birth room as a traditional doula support but I recognize the difference that can come about when there is a demise or a loss. There are lot of differences that go into these types of births especially from an emotional and psychological standpoint. When you are grieving at the same time as birthing, that just brings a whole different level of giving birth.
LEADING UP TO and DURING THE BIRTH: One of my roles is making sure it is being recognized through anyone and everyone that has a role to play when in that birthing space, and that my birth families are understanding their options being presented to them, that they are able to have more control of their experience the way they want it to be, and that they feel some level of safety within in the space and their own bodies. This is very important because this is obviously such a traumatic experience. This is all before they give birth.
AFTER THE BIRTH: As soon as the birth actually happens and the baby arrives, one of my roles is making sure these people giving birth are going to have a lifetime to grief, they have a very, very short precious amount of time to love on their babies and see the beauty in their babies. While the rest of the medical staff is caring for the birth person’s body from a medical standpoint, I’m able to help encourage moments of bonding, love and beauty between the birth parent, parents or other loved ones in the room and the child that is born. I recognize how fast that goes by and make sure we can make the most of the time for the families.
Afterwards, if we have time to come up with a postpartum plan, we need to list resources such as funeral arrangements, and if there are other medical providers that need to be followed up or seeing there is different insurance regulations, so I try to assist afterwards with all of that as much as possible.
It is really important to know as a birth professional, the resources and tips on how to better support when these experiences occur.
PROVIDING SUPPORT TO FAMILIES: One thing that is extremely important is that sometimes these families will not be ready to bond with their babies and that is OK. The last thing we should be doing to the parent is either shaming them or pressuring them into an emotion they are not feeling in that point in time. No matter what the emotional reaction is immediately after the birth that needs to be honored and respected. That doesn’t mean you can’t make suggestions. I have seen this time and time again where one of the worst memories a parent had had is of someone in the room trying to push them to do something they are not ready to do like hold their baby or look at their baby. I make sure their wishes are honored and respected.
HONORING & CELEBRATING THEIR CHILD: When it comes to a family that is ready to spend time with their baby and they want to bond with them, it can be an overwhelming experience and a lot to take in. I make sure to verbalize the small details to make sure they aren’t overlooked. I might say, ‘oh my gosh look at those toes, or oh look at their dark curly hair’ to honor and celebrate their child. This is a very sad moment, but I feel my role is to honor and celebrate their child. What an awesome beautiful honor I have to be one of the few people to meet their child. I don’t take that lightly and I make sure to help them love on their child as much as I would with anybody. We do that through the moment itself and while they continue to bond. I do things behind the scenes such as make sure there are photographs and keepsakes, make sure that every moment we can possibly document is documented because this is their only chance. But again, through celebration and love and not taking away that bonding time.
PERSONALIZING CARE: I am able to customize care and individualize it. Some families may have a large support network already in place. I do anything and everything such as going to doctors’ appointments to helping them plan funeral arrangements, if there hasn’t been enough time to make those kinds of arrangements, I will help them make phone calls to family members, I will make sure things at home are taken care of, and even if they have other children, I may help give them advice or book recommendations on how to talk to their children about what’s happening or give space to their other children. I make sure it is a healthy experience for them and normalize things for them. Most people barely give it a thought that it could ever happen to them. For instance, simple things like holding your baby, taking a picture of their baby or even having other children hold the baby and enjoy that moment. That’s something that I use in my role to make sure that out of this extremely painful time, there is still moments to look back at a smile on. That their child is not only known for pain and sorrow, that their child is known for joy.
4. What do you think are the most important issues facing the community you serve?
The most important issue is the disconnect of what is happening within hospitals and medical office. When you are grieving and planning a funeral, it is not that easy to go to therapy. There’s so much life that happens between those two acts. Families don’t always understand what is happening to them and are not able to make educated choices when they are presented with options and are grieving at the same time.
5. What tips you can you share for those who want to support a friend or family member but don’t know what to say or how to support them?
- Take a deep breath
- Don’t second guess yourself.
- Stay consistent (if you want to play a role) i.e set an alarm on your phone to send a text messages such as I am thinking about you today, I am here if you want to connect.
- You can’t do it all; let other people help you.
- Resources are available, can be hard to find. When you find a resource ask is there anything else I should know?
- Don’t try to be perfect.
- Not being silent. What hurts the most is we don’t talk about this. The more we acknowledge and honor how often this happens, the more we can learn.
- Keep making sure I am someone they feel they can approach. I try to connect the dots.
About the interviewer: Kima Tozay is a Licensed Clinical Social Worker and a bereaved mom who is dedicated to supporting and advocating for those experiencing infertility and perinatal loss. Kima and a team of bereaved mothers, were instrumental in getting the Certificate of Birth Resulting in Stillbirth legislation passed in WA. She is a Return to Zero Hope board member and group facilitator. Kima is also the Secretary of PSI’s Washington State Chapter and a member of the Snohomish County Perinatal Mental Health Taskforce.