Transcript of speech before the Childbirth and Postpartum Professional Association (C.A.P.P.A.) of Canada
(cappacanada.ca)

As the medical profession continues to make greater advancements in the fields of reproductive science and obstetrics they are making it possible for women who previously might never experienced a pregnancy to do so. Thus giving rise to the burgeoning field of Perinatology or high risk obstetrics.

What makes pregnancy high risk? There are two basic factors for increased risk in pregnancy: mother and baby.

The factors affecting mom are primarily physiological in origin and may even be limited strictly to the pregnancy. Medical management usually involves identifying the source of the problem, intervening with what is developing and redirecting it or eliminating it.

However several studies have show that lifestyle factors and social situations can also have an effect on pregnancy. These include such things as:

The addition of these factors in a pregnancy put it a higher risk.

While it is the jurisdiction of the medical profession to oversee and manage the care for premature labour, their focus is primarily on circumstances that arise as a result of biology. Leaving the social circumstance that affect preterm labour largely orphaned and poorly supported.

This is where the antepartum doula becomes important. Overwhelmed families may not be given effective tools to deal with these problems from their caregivers. Their caregivers may not have adequate resources or skills to help their clients deal with these issues.

Often clients are advised to take better care of themselves, quit participating in unhealthy activities, get more rest and relax. They may be referred out to another healthcare provider for management of their issues, fragmenting the care and making it easier to have them fall through the cracks in the system.

A study, released in the Archives of Pediatric Adolescent Medicine in January 2005 questioning the effect of pre-pregnancy health status had on the risk for preterm labour found that women who were in poorer physical health a month prior to undertaking a pregnancy were twice as likely to suffer premature labour than average. Another study in the Journal of Nutrition points to low maternal body mass as a strong predictor of preterm birth and or low birth weight infants. The March of Dimes has amassed a large body of evidence supporting the link between stress hormones and preterm labour. Smoking has long been linked to preterm labour and low birth weight.

While we know that many psycho-social causes that affect preterm labour can be mitigated, the question is how to put it into practice?

The antepartum doula with her specialized knowledge of high risk prenatal physical, emotional and social needs as well as her skills in other areas such as childbirth education and labour support acts as the bridge between the health care professionals advice and the practical needs of the client.

The antepartum doula's mandate is to have the time available for the clients needs to be met in way that is most beneficial to the client. This is a service that many of the primary caregivers are not able to provide. It is a functional difficulty of time and resources available that makes it difficult for them to ensure that their clients feel sufficiently informed or understanding of the circumstances.

The antepartum doula acts as a guide for the high risk client and her family by:

- Virginia Collins