A diagnosis is the identification of a medical condition that affects the future of the person receiving it. It may be minor or life altering, temporary or permanent. Sometimes this comes about as a result of genetic testing, a problem with the baby during pregnancy, or the pregnancy itself brings an otherwise unknown health condition to light. A medical diagnosis will often change how a person perceives their state of health or identity.  It may limit their options during birth.  Doulas can contribute to their client’s well being by offering emotional, informational and practical support during this difficult time.  Everyone else will likely want to offer a medical opinion or advice. When we refrain from doing so we empower our clients to find their own answers.  Medical people can put the medical condition in the center and focus on it as a problem to be solved. There may be little support for the person having the problem. Doulas can put our clients in the center and support them wholistically through this health care journey. 

Adjustment to the diagnosis will depend on how prepared they were for it and how life altering it is.  Many of our clients have thought of themselves as primarily healthy so the idea of a medical diagnosis can prompt a shift in their self-concept. This can be a crisis for your clients, even more so than the birth.  It may be the first time our clients are dealing with medical issues that limit their life choices. We need to provide them with support and also with some context. Most people eventually have limitations placed on their activities because of health conditions. But this is often invisible or kept private. So even the idea of having a limitation may be an adjustment for your clients.

Some diagnoses may only last for the length of the pregnancy or a few weeks postpartum.  But make sure your clients understand the lifelong implications of a pregnancy condition. Preeclampsia, HELLP syndrome, and high blood pressure indicate cardiac issues in later life.  Other diagnoses, such as kidney disease or diabetes, may have lifelong healthcare implications and trigger a major change in lifestyle. If our clients have a genetic condition, they may worry about passing it along to their baby. Most genetic testing centers do have counselors and social workers. But wait times can sometimes be months long. Part of your role as the doula could be to figure out what supports are already available for your clients. Major medical centers may have educational classes. While doulas are not trained counselors, simply by listening fully and using our emotional support strategies (Gilliland, 2012), doulas can help. 

 

Helpful Emotional Support Actions:

1. Listen.  Listen carefully, listen thoughtfully.  Hear what isn’t being said by paying attention to when people pause. Often other friends and family members will rush to share information, remedies, and stories of other people with the condition.  Doulas listen and use what they are hearing to craft their responses. 
2. Empathize and reflect their feelings. Some people know what they feel right away. Others may take hours or even days to process and for their feelings to come to the surface. Everyone else in their lives is also affected emotionally by this diagnosis. It’s normal to go through a grief period. People may be in denial. They may be angry or sad, or wonder if they’ve been offered other options or made different choices if the outcomes would be different. These are all typical responses and the best thing we can do is to normalize them. Allow our clients to feel them fully in our presence without trying to fix things. The caring detachment that a doula brings can be the calm that people need at this time. 
3. Center them in the present moment. What response is required right now?  Is there any? Unless there’s an imminent decision to be made, it’s usually okay to take time or create breathing space with the situation. People may begin to think ahead and wonder how they will handle a problem two weeks from now.  I call this “getting on board the anxiety train”. It’s rushing out of the station accelerating one’s anxiety with a lot of  “what if” scenarios that don’t exist now. Doulas can remind them that they can take time and that the rest of their lives are waiting for them. Dogs still need walking, and laundry still needs folding. 
4. Help them to figure out what they need. Then, figure out the best ways to meet those needs.  This can give people back a sense of control if they feel out of control.  Identifying specific needs and wants and concrete strategies to meet them can also relieve anxiety.