Archive for the ‘birth doula’ Category

Doulas and Home Birth

Monday, May 4th, 2015

Is there benefit to hiring a doula for a home birth? I say YES absolutely.


An oldie but a goodie, from Desirre, in honor of International Doula Month.

As a seasoned doula who has attended home births as labor support and now an  intern midwife who clinically supports the mother, I believe that many women can keenly benefit from a doula when having a home birth.

The most simple reasoning is that the doula is there physically, emotionally and educationally specifically for the mother and family just like at the hospital or a birth center. She (he) is an integral part of the birth team.

  • The doula will likely be laboring with the mother first, providing a continuous care support framework for when the midwifery team arrives.
  • As the midwifery team sets up and prepares the space clinically, the doula is right there maintaining the comfort, peace and encouragement of the mother. Often lessening any disruption that new people in the environment can cause.
  • The doula is there SOLELY for the mother and husband (partner), step by step, eye to eye while the midwifery team is there to first and primarily clinically assess, maintain safety and be unobtrusive as possible.
  • The doula offers guidance and suggestions for position changes, physical/emotional comforts and helping to ensure the mother eats, drinks, voids and rests.
  • The doula gives the husband (partner) the opportunity to rest, have less stress, do the very best he/she can do along with enjoying the process more.
  • A doula can be present specifically to help with the other children.
  • A doula’s presence offers reduction in any interventions and cesarean.
  • A doula’s presence offers increased satisfaction with birth, bonding and breastfeeding……….

Simply put. A doula being present at a home birth is effectively the same as at a hospital or birth center, with the general exceptions that she would have to help a mother and family self advocate or navigate  institutional policies,  protocols and staff.

I again say YES to doulas at home births.

 

 

Dad Matters – A doula’s perspective

Sunday, September 29th, 2013

Many men in our culture are fairly apprehensive about birth. Most have never seen a real birth, or talked about it outside of sex ed. They are often nervous about birth itself, seeing their partner in pain, the what-ifs, and all that may come after. They doubt their ability to support their partner in her journey, and wonder if they’ll be strong enough.

In fact, they often doubt and fear and wonder just as much as their partners do, but are often not allowed to express it, because they’re not the ones giving birth, so they feel that they don’t really matter. They may feel like they don’t have much voice in the process, and are just expected to go along for the ride, smiling and nodding whenever the experts speak.

Yet, at the same time, they are expected to know everything about birth, protect their partner, communicate her wishes, and support her physically and emotionally without pausing for breath.

Many worry that they just can’t live up to all of that. It really is an awful lot to ask of one human being, after all. Especially since history shows us that there have always been many support people surrounding a mother during birth.

Still, many men don’t realize just how much they are capable of. They don’t realize that they matter, too, and that they can enter their partner’s birthing space with confidence, ability, and strength to meet the challenges of supporting a labor and birth.

 

So, how do we help fathers to step into the birthing space with confidence?

 

We free them to be who they are, that’s how. We let go of our expectations, and help them to form their own expectations and desires for supporting the birth of their child. We help them to see that they alone can define their role in the drama and sacredness of birth.

I would suggest two important things that may help a father gain confidence and acquire tools to help him fulfill the role he wants to play during birth: 1) Independent childbirth education classes, and 2) Hiring a doula.

The more a man knows, the less he will fear birth, and taking Childbirth Classes is one of the best ways to lower anyone’s fear level in anticipation of birth. Many men appreciate information given in practical, interactive ways, and independent childbirth classes are often right up his alley. He can join with like-minded dads, ask questions, and have his concerns addressed more readily.

Information is a great, big factor in helping couples manage their stresses and fears regarding birth—as much for the father as it is for the mother. As an educator, at the beginning of a series, I usually see high levels of apprehension, which quickly fade from week to week, to be replaced by realistic expectations and informed confidence in both parents.

This is just as powerful for the father as it is for the mother. When Dad has confidence in Mom’s ability, she believes in herself all the more, and Dad begins to see that he has power to influence her for the better! Dad is able to acclimate himself more readily to the realities of birth, and begins to realize that he is an important part of her support team. Perhaps the most important part.

He feels a little more ready to step into his support role, and probably has clarified what he wants that role to look like. He will feel more confident about what he can do, and more realistic about what he might not be able to do.

 

In which case, he may begin to consider…

 

Hiring a Doula to help him fill in the gap in the support team he might not be able to fill himself. If he participates in choosing and hiring a doula, he is much more likely to have his own expectations met, as well as those of his partner. When Mom and Dad are both fully supported, Dad is far freer to just be and do what his partner needs him to be and do.

While he will likely remember a lot of what he has read and learned about, that information may become secondary to him during the birth, and take a backseat to more immediate concerns in his mind.

He may become simply focused on loving this woman who is birthing his child. And why shouldn’t he? Why should he have to remember every counter pressure technique? Every massage technique, position change, or even the water jug and bendy straw? Why shouldn’t he be the face close to hers, his eyes beaming his love, concern for, and confidence in her?

A doula allows Dad to be front and center in the support role he always wanted to fill for Mom, in whatever way makes the most sense for their individual relationship in this particular moment. If he wants to be the Expert – he ought to be equipped to do that. If he doesn’t, then he needs the space and freedom for that, too. Or anything in between.

When he is free, all his anxieties and apprehensions tend to fall away, and he finds that birth is a challenging, beautiful, amazing space to be in with his partner. He finds that he is strong to meet the challenge, just like she is. Together, they grow in strength and confidence, becoming truly ready to meet this tiny new person they have made.

Doulas help open wide the door, making the birthing space more navigable, understandable, and pleasant for fathers. This, in turn, can only benefit the mother as she is able to rest in the support of her birth team. She no longer feels concern for her partner, because he shows no reason for her to be concerned. She is able to just birth.

Then, we can just step back and watch, as he exceeds all the expectations we have laid on him, and as he steps into Fatherhood in the way that makes the most sense to him and his new family.

Tiffany Miller, CLD, CCCE

Scavenger Hunt Contest

Monday, December 3rd, 2012

Preparing for Birth is having an online scavenger hunt to ring in December.

 

You could win this cute pocket diaper.

 

Here is the scavenger hunt:

Answer:

1)      How many births has Desirre Andrews attended?

2)      Name a doula that is working through Preparing For Birth?

3)      How many on average gel capped pills can be made from a placenta?

4)      What breast pump brand does Preparing for Birth have for sale?

 

Answer these and provide a link to the source:  

5)      What is the most common risk of induction?

6)      What is an evidence based reason for induction?

7)      What is the Bishop Score used for?

8)      What are Daniel Berwick’s three principals of patient centered care?

 

Find:

9)      A picture of a child nursing in a funny position.

10)   A picture of artwork that’s at least 100 years old depicting a woman in labor.

 

Bonus Questions:

1)      What is your favorite pregnancy or childbirth related blog?

2)      What is your favorite pregnancy or childbirth related book?

Send your entry to nichole@prepforbirth.com by 9pm Wednesday December 5th.

The winner will be announced Thursday, December 6, 2012, and must be able to pick up the prize in person. Everyone who enters will get a coupon for a free birth or postpartum plan session with one of the doulas from Preparing For Birth.

Could this be labor?

Wednesday, September 21st, 2011

For first time mamas, previously induced mamas or those who have loads of prodromal labor, getting a handle on the nuances of when labor is going to start or if it is lasting labor can be really confusing. There is no way to know exactly when labor is going to start, but there are many things to look out for that can give clues and signs that onset of  labor is sooner rather than later.

Here are my favorite categories to look at and simple ways to decipher what is going on with your body at the end of pregnancy.

Remember to take a look at the whole puzzle picture not just one piece.

  • Vaginal Discharge:
    • Loss of mucous plug (after 38 weeks);
    • Steady mucousy output;
    • Thin and watery mucous;
    • Blood tinged – similar to the beginning or very end of a menstrual period. This means there is effacement and ripening of the cervix going on and even a bit of dilation happening.
  • Contraction Characteristics:
    • Longer and more intense contractions that most often find a pattern;
    • They do not stop or even increase with activity change;
    • Sudden increase or onset of regular Braxton-Hicks;
    • Low period crampiness, pelvic heaviness, off and on backache, thigh achiness.
  • Other symptoms
    • Increased nesting;
    • Insomnia or excessive tiredness;
    •  Flu-like symptoms;
    • Intuition/Instinct;
    • Loose bowels;
    • Weight Loss in the last week.
  • Testing out contractions for possible labor:
    • Change activity level – if resting get up and move, if moving sit down and rest;
    • Drink a large glass of water;
    •  Eat a snack, preferably higher protein;
    • Take a bath or shower.

After doing these things if contractions continue and increase in intensity over another hour or so likely labor is becoming established. Congratulation! As always, contact your care provider at the agreed upon time.

A Guide to Finding Your Doula

Tuesday, August 2nd, 2011

Building a labor support team is part of conscious preparation during pregnancy for your labor,  birth and life with the very newborn. Hiring a labor doula continues to gain in popularity for the expecting family. Your doula comes alongside you in pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula is a great addition.

Step 1: Finding a Doula

  • Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle, Cloth Diaper store), childbirth educators, care providers, prenatal massage therapists, prenatal exercise instructors, lactation experts and chiropractors for referrals.
  • Use your favorite search engine and type in your city or area name with the keyword doula
  • Search training and certifying organizations such as CAPPA, DONA, ICEA ToLabor , Birth Works and Birth Arts International
  • Search general doula sites such as All Doulas, Doulas.com, About.com, Doula Match or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is  to make contact. You will likely find that most doulas are women though occasionally you will find a male doula in your area.  After visiting any websites; phone or email only the doulas that most interest you and fit your particular needs.  Generally there is not much need to contact more than three perspective doulas.

During your initial phone conversation or in your email be sure to include:

  • Full name
  • Contact information
  • Estimated Due Date
  • General location where you live
  • Care Provider
  • Birth Location
  • Top needs and desires for birth
  • If referred, by whom
  • Any financial considerations

Step 3:  Setting up the Interview

I encourage after the phone or email contact and response, set-up in-person interviews with the doulas you found most compatible with you.

  • Unless the doula you are meeting has her own office, interviews are usually held in a public place such as a coffee house, restaurant, library, park, or shopping center. If you meet at a place where beverages or food will be ordered you can offer to pick up the tab for everyone if you desire, but it is never expected.
  • Your partner, husband or other support who will be attending the birth needs to be at in-person interview if at all possible.
  • Expect the interview to be approximately an hour and to be free of charge.

Step 4: The Interview

The interview is to gain more detailed information from the doula, as well as, share more  about yourself and what you want.  It is customary for the doula to either email ahead of time her client packet or bring it with her to the interview. It may include her professional profile, client agreement, services, and support details, as well as, additional offerings.

Suggested Interview Questions:

  • Why are you a doula?
  • What is your philosophy of childbirth?
  • Where did you get your training?
  • Are you certified? Why or why not?
  • How long have you been a doula?
  • What is your scope of practice?
  • What types of births have you participated in?
  • What types of birth locations have you been to?
  • How many births per month on average do you attend?
  • How many clients would max you out in a month?
  • Have you ever missed a birth? Please explain why.
  • Do you specialize in working with a specific type of clientele or birth plan?
  • What has been the most challenging birth you have attended? Why?
  • How do you work with my husband/partner/other support?
  • Have you worked with my provider before? If yes, please describe the experience.
  • How many prenatal visits would there be?
  • In general, what is covered in the prenatal visits?
  • Will you help me make a birth plan?
  • Please explain how your fee is structured.
  • Do you accept barter?
  • Do you have a back-up and do I meet her ahead of time?
  • When do you go on-call?
  • Do you labor at home with me?
  • What do you do if I am induced or need to schedule a cesarean?
  • When will you see me postpartum and what does it include?
  • What are your expectations of me as a client?
  • How long do I have to decide before you would contract with someone else around my EDD?

Of course that is a fairly long list of overview questions. Brainstorm some of your own. The interview is not meant to be a free prenatal visit, it is simply to find out if you and the doula are a fit personality wise and in how she practices.  Most doulas do not expect to be hired on the spot. You  need time to think and process after each interview. If a doula is pressuring you to hire on the spot because she fills so quickly, that could be a red flag and cause for you to take a pause.

Step 5: Hiring the Doula

Within 1-2 weeks,  contact the doula you would like to hire and proceed and those you did not choose to let them know you have hired someone else so they will not be holding your EDD space open any longer.

Details to be clear about when initially hiring your doula:

  • Sign and return the agreement/contract she gave you at the interview (if applicable).
  • Return any intake paperwork by mail or email.
  • Payment  – First portion of fee is usually paid upon hiring a doula.
  • Ask her usual business hours and contact preference for non-emergencies or labor related needs.
  • Let her know your contact preferences and all phone numbers to reach you and your spouse/partner or other support.
  • Set the date and time for the first prenatal appointment. Give her directions if your home is not easy to find.
  • Get clarity on what routine contact she would like from you (updates after care provider appointments, etc.)

Happy doula-ing!

Posptartum and the Great Abyss

Monday, November 29th, 2010

The postpartum period is a critical time for the health, attachment and emotional adjustment for both mother and baby.

It has become the expected norm that women are left with very little medical or care provider support/assistance in handling the many norms, transitions and stumbling blocks that present in the first 6 weeks postpartum with her and her baby.

The general exception to this rule are women who birth at home with a midwife or in a free standing birth center where the rest of the perinatal period has several (approximately 6 visits) scheduled for follow-up care for both mother and baby. In this case, a family practitioner or pediatrician is unnecessary unless a need outside the norm arises.

Sadly with the majority of American women birthing within the hospital environment, she will leave the hospital with a stack of papers, a resource list, perhaps after viewing a newborn video and be left to her own devices until that 6 week appointment with her  care provider (yes, some hospitals offer a visiting nurse once or maybe twice after birth, but is not the norm).

This is so stunning to me. Absolutely hair raising the lack of care women get. It is akin to entering the open sea with a poorly written map and expected to find the “New World” successfully and without setback.

As a doula and educator, I field emails, texts and calls from my clients and students asking questions, needing breastfeeding feedback and help navigating life.  WHERE ARE THE hospital care providers in this time?  Even without being able to offer home visits (except there could be a staff nurse, PA or NP to fill that roll), why are OB’s and hospital CNM’s not having their patients come in to the office at regular intervals post birth? For example, days 3, 7, 14, 21, 30 and then at 6 weeks? This sort of practice could address both emotional, physical needs and very well catch many other things BEFORE they become issues.

The longer I am in the birth professional, I am simply appalled by what passes as good care. No wonder so many women have recovery needs, postpartum mood disorders missed and breastfeeding problems. After months of constant contact and appointments (albeit not usually comprehensive), a woman is dropped into the abyss of postpartum without a safety net.

One practical solution is for a mother to secure a labor doula who would work with her prenatally through the early postpartum period and then hire a postpartum doula to continue care and assist in the rest of the perinatal period.

Another is for the mother to have a trusted, knowledgeable and skilled family member or friend come and stay with in her home from the birth through at least 6 weeks post birth. This person would help the mother learn to mother and not be “nannying” the baby similar to that of a postpartum doula.

Lastly, for truly comprehensive care, there is always the option to switch to a provider that offers it or one never knows what would happen if it is simply requested as part of the maternity care package of her hospital-based provider.

I hope you found this food for thought invigorating! I look forward to your comments.

Grateful For My Birth(s) Carnival

Wednesday, November 24th, 2010

I am so thankful to all of the submissions I received for this Why I am Grateful for my Birth(s) blog carnival. I have found no matter what a woman can learn something and be grateful for something in every birth experience no matter how difficult or wonderful. Enjoy these quips and please go to their blogs to read in completeness.

Tiffany Miller of Birth In Joy says in an excerpt from her post The Most Important Piece, “I am thankful that Mom believed in my ability to breastfeed my new baby, even though it hurt at first. She never told me that I had so severely damaged her nipples, as she tried to learn with no support whatsoever during my own newborn days. Nary an ounce of bitterness did she carry from that time. She knew and accepted that my path was my own, and supported me completely.” She goes on to further outline how the mentoring and support of her mother paved her way.

How grateful she is for all four natural births and her mother’s unwavering assistance. Assistance and presence she could never imagine doing without.  Just beautiful and shows how important in our lives are the ones who came before.

Kristen Oganowski of Birthing Beautiful Ideas in her post Your Births Brought Me Here writes this gorgeous, tear inspiring letter to her two children about what amazing changes they spurned in her own life, in the very life that they would come to know. Without one birth, would the other have come along the way it did?

Here is an excerpt: “When you both were born, I called myself: Graduate student (unhappily).  Teacher (happily).  Feminist (always).  Mother (timidly). Today I call myself: Doula (happily).  Birth and breastfeeding advocate (unflinchingly).  Blogger (smirkingly).  Writer (finally).  Feminist (permanently).  Mother (confidently).  Graduate student (temporarily). Your births brought me here, to this place where I am (finally) content and impassioned. All wrapped up  with a Love, Mom.

Our next post is by Sheridan Ripley of Enjoy Birth. She writes very plainly about how grateful she is for varied experiences that give her insight to what other women experience and that she is better able to support them.

Here is a peek.

  • If I had only amazing natural birth experiences would I have judged those moms who choose epidurals?
  • If I had only vaginal births would I have understood and fought so hard for VBAC moms?
  • If I only had easy times creating that nursing relationship with my boys, would I have been as supportive of my moms struggling with nursing?

Very poignant and open…..

We come to Bess Bedell of MommasMakeMilk.Com came to a place of self-awareness, peace and a fierceness to help others in her experiences. Like others her heart grew and expanded with her own knowledge and walk. A strength and confidence awoke in her to the benefit of so many coming after.

My two births birthed a new women. A mature women who has opinions, knowledge, experience and a passion in life. If I had not had my c-section I may never had given VBAC a second though. The lack of VBAC support and availability would probably never have entered my radar. My second birth showed me that success and perfection are not the same but both are wonderful and I can be happy for and embrace a mother and her experience even if it wasn’t a completely natural, completely med-free birth. Both of my experience have prepared me for the future. My future of birthing, and next time I plan on birthing at home, and my future of educating and supporting pregnant and birthing mothers.

And lastly my own blog post entry. I know I rarely speak of my own births in any detail unless it is one on one. As a community member, advocate, doula, educator, I strive NEVER to be an intervention on a woman. Today I decided to give a small window into my own experiences and why I am grateful. Please read and comment freely – Grateful For My Births.

Thank you so much to those who submitted posts. The openness of other women allow all of us to learn, grow and share as we are meant to within a healthy society. We are not there yet, but I have a hope that through this sort of connection, we are healing some brokenness.

In reading all these posts, not one is the same, not in tone or style, but every woman was changed positively in the end.

Grateful For My Births

Wednesday, November 24th, 2010

Focusing on Thanksgiving, I asked others to submit a “Why I am Grateful For My Birth(s)” blog post.  In the spirit of that, here is my own blog posting. Stay tuned for the Carnival of posts to be up by Thanksgiving morning.

I myself have had four varied labors and births, one of which could be considered a “normal” and natural birth experience.

From my first labor and birth, I learned that maternal ignorance no matter the intention can get you into the OR  I had to travel 45 minutes to my birth location, was only a 2 cm but nurse admitted me because she did not want me to go all the way home (she of course did not tell me that or we would have rented a hotel room nearby to labor in), I then allowed the same nurse to perform AROM at 3 cm’s because she figured it could speed things up because early labor you know is slow often for first time mothers.Walked stairs for hours but….. Now came the pitocin because my waters were broken and I was not moving fast enough. Then came horrid, blinding back labor. At some point I got a partial dose of fentanyl. Then another. Finally in transition about 20 hours in, I thought I wanted the epidural. I did not get one as I was complete and pushed for nearly four hours. Then finally after a failed vacuum assist to rotate his head and help me I ended up in a cesarean for deep transverse arrest for an acynclitic, deflexed baby head.

Baby number 2 27 months later and I was for sure in no way going to get to the hospital before I was in very well established labor. VBAC, whatever, I knew if things were okay. I would never have pitocin in labor again or have my waters broken. So I labored beautifully, with no fear, hey there was some ivory tower mama left in me still. After having contractions work up to 2 minutes apart and 90 seconds long, I decided it was time to leave. My husband ran back in the house and put a water proof pad on my seat (what a very intuitive man). On the way during the 15 minutes ride to the hospital, my water broke, I mean BROKE – kaplooey. Yep water proof crib pad saved the passenger seat if our minivan. In triage I was checked and behold I was a stretchy 9 cm’s. Everyone was so happy. A VBAC good for you mama. No saline lock. Some monitoring. Then the trouble started.  The on-call doc came in and was impatient. I pushed for about an hour (mind you I was a VBAC) and when he was low enough she cut an episiotomy and used forceps on him.  Very little conversation, my husband just said she insisted and there he was. So a natural labor and almost natural birth. I still felt great. Episiotomy was far less painful than surgery…. I got my VBAC. Though  my baby ended up in NICU overnight because of forceps. That was awful. We were both very mad after we could process it. He nursed well nonetheless. Took him home the next day.

Labor and birth number 3 is told in detail on my blog post A Woman’s Voice Birthed Into Fullness so I will not report on it here.

My 4th labor and birth had me in the place of I am arriving at the hospital very late in labor even though this time I was a 1VBA2C mama. Funky contractions of a few hours each over three nights including one trip to the hospital thinking it MUST be labor, had me sitting at 7 cm’s dilated WITHOUT being in labor. How did I know that? I asked my midwife to check me every day after the short bout of contractions. I just laughed and laughed about being in “transition” dilation wise but not being in labor. On the fourth night of when the contractions started, I said OKAY I am having this baby. I did some nipple stimulation and acupressure over an hour, next thing I know 3 minutes apart contractions then closer. We got to the hospital I was 8 cm’s, walked for a half hour. Then I was 9 cm’s and pattern was back strong. Midwife came. After some odd and funny asides. I allowed AROM baby was +1 and in good position. She promised me. PROMISED me as I glared her down that this would not cause another cesarean. Baby was in perfect position. Gulp. OK. I trusted her and knew she did have our best interest at heart. No baby did not fall out. Have I mentioned I have an android pelvis? I was completely shortly after that and pushed. He was born about 45 minutes later. That for me was such a short amount of time to push. He was in my hands and on my chest with the exception of maybe two minutes for FIVE hours post birth. FIVE. He had about a 14.5″ head and came out over an intact perineum.  I was, well, normal, everyday, usual. Yep. I basked in the no nonsense aspects of it.

I learned so much through all my labors and births. Through #1 that though I made many excellent choices in my care provider and birth location, heck we even took out of hospital independent birthing classes, that maternal ignorance and a willingness to believe no nurse would do something that could cause harm was really am ivory tower point of view that women can just have babies. I knew I could birth, but knew I needed to know even more.

Through #2 that on-call providers can be dangerous people and that I COULD birth.

With #3 my voice came into being. I turned into who I am now. Like a butterfly with the roar of a lioness.

And #4 oh my baby. I became normal, just like every other woman who had a natural labor and birth. Just another birthing woman. Not special. I really liked that title.

Yes I am grateful or I would not be the advocate, doula, educator, flag waving proponent of informed consent AND refusal, strive to help and support women in their childbearing years…. oh so much more. I am grateful because in all of this I have found my calling.

Thank you to K, L, J and D for being my sons.  Thank you to bad on-call doc, well meaning but harmful nurse, horrid nursery staff, and C.E. the midwife who believed in me and my body as much as I did.

What’s a doula to do?

Sunday, October 10th, 2010

There is such a deep chasm and fracture within the doula community regarding in-hospital and out-of-hospital birth. On the one hand there are those who say anything goes in supporting women and their choices. On the other, there are those who say no doula should support a woman in the hospital environment because it is a “bad and dangerous” place to birth,  or at the very least should get kicked out if she is doing her job “right”.

Who is right? This is where it gets tricky to be sure.

With upwards of 98% of the birthing women going to the hospital in the United States, are WE really within the general doula scope of practice by taking such a hard stance of ignoring those women in need? Who is benefiting here? It is well known, that I am all for a doula deciding her practice style, what scenarios she is best suited to support within, and knowing who she is best able to support.  But to abjectly say, no doula should ever support a woman in a hospital birth, is to me akin to very interventive practitioners who believe that birth is inherently dangerous and a trauma waiting to happen. Thus, viewing every women and baby through high-risk lenses and subjecting them to high-risk protocols where there is no medical need encourages more intervention and higher-risk scenarios to actually occur.

Who does this serve taking such a hard line? Perhaps those speaking it, thinking they are pressing for the greater good. Definitely not the mothers who need the support and assistance navigating a sometimes difficult and stressful system. The mothers and babies are caught then between a rock and a hard place. Then they are effectively forced to go without support and help. The truth is women having hospital births NEED DOULA SUPPORT MORE than women choosing an out-of-hospital option.

Bottom line: I make no claim that it is an easy task to doula within the hospital environment. It is not. It can be brutal. Imagine for a moment, really, close your eyes and think of what happens, what you witness as a doula when you are there — then think of all the women who have no doula present — what happens to them? What do those women experience? What do those babies experience? Now, open your eyes and breathe for a moment. It is not pretty is it?

Right there is what keeps me taking hospital birthing clients. It requires very open communication and immense work prior to labor during prenatals running through scenarios, detailing needs and desires, making certain informed consent and refusal is understood for a variety of procedures, medications, and cesarean. A mother needs to be well-versed in how to use her self-advocacy voice as does her husband, partner or other main support person.

Looking at the flip-side now.

So the other ideal, er rather idea, is that a doula should support anyone and anything because she is a doula poses other issues in my mind.  I do not see anywhere in the job description that this is what a doula ought do.  Any one doula cannot be the right doula for every mother or scenario. This way of thinking can fall into  a cookie-cutter way of practicing, thinking one can be all to everyone. Doulas are people too. Each has individual abilities, biases that need to be addressed, history and points of view.

I think it has been mistaken that a good doula is one that has no say in how she practices or who she is best to serve.  I believe there is a doula for every type of scenario and mother. It is a very individual pursuit and fit.

I know some amazing niche doulas out there who support only high-risk mothers, multiples, same-sex couples, in-hospital birthers, planned cesareans….. The list could go on.

Honestly, I will say there are some amazing doulas who can work under this very open practice style effortlessly and with excellence.  I applaud those doulas, though I think that is the minority and most are not able to keep it up without finding a comfort zone long haul.

Childbirth is such a deeply intimate and intense process with so many variables, being the right fit all the way around is necessary in my humble opinion.  I have seen doulas deeply wounded and traumatized by what happens in the birth room. Sometimes that is unavoidable, but through years of interaction with many doulas, the running thread is that the doula had misgivings even during the interview that this was probably not a good fit but chose not to refer the mother out to someone she knew was better suited for whatever the reason.

Are women and babies really being served best under this model of practice? This is for you to go ahead and answer for yourself.

Bottom Line: Women and babies need individual care whether from a doula, nurse, or care provider. Can a doula be all things to all mothers? Some, I am sure. Overall I believe not. For the health of a doula and the health of her ability to practice and support well, finding the “comfort zone” can make the difference for the mother, baby and doula. Why? Because doula work is such an intense giving of oneself (emotionally, physically, even spiritually). A continual self-assessment needs to be done just where her true and honest “comfort zone” is. By doing this, a doula is caring not only for herself by avoiding burnout, but also for her future clients and her ability to care for others with excellence and utmost professionalism.

Finding and Hiring A Labor Doula

Thursday, February 18th, 2010

Building a labor support team is a vital piece of conscious preparation during pregnancy in preparation for birth and life with the very newborn. Today as part of that support team many women are opting to hire a labor doula to come alongside them at the end of pregnancy through labor and delivery with some additional early postpartum follow-up.  For additional after birth support, a postpartum doula can be hired.

Step 1: Finding a Doula

  • Inquire with friends, family, local support/informational groups (for example – ICAN, LLLI, Birth Network, Birth Circle), childbirth educators, care providers, prenatal massage therapists, prenatal exercise instructors, lactation experts and chiropractors for referrals.
  • Use your favorite search engine and type in your city or area name with the keyword doula
  • Search training and certifying organizations such as CAPPA, DONA, ICEA ALACE and CBI
  • Search general doula sites such as All Doulas, Doulas.com, About.com or Doula.com

Step 2: First Contact

Once you have located local area doulas, the next step is a visit to make contact. You will likely find that most doulas are women though occasionally you will find a male doula in your area.  After visiting any applicable websites, phone or email only the doulas that most interest you and fit your particular needs.  Generally there is not much need to contact more than three perspective doulas.

During your phone conversation or in your email be sure to include:

  • Full name
  • Contact information
  • Estimated Due Date
  • General location where you live
  • Care Provider
  • Birth Location
  • Top needs and desires for birth
  • If referred, by whom
  • Any financial considerations

Step 3:  Setting up the Interview

I encourage an initial interview via phone prior to meeting in person to get more of an idea for compatibility that email alone cannot offer.

  • Unless the doula has an office, interviews are done in a public place such as a coffee house, restaurant, library, park, or shopping center. If you meet at a place where beverages or food will be ordered you can offer to pick up the tab for everyone if you desire, but it is not expected.
  • Your partner, husband or other support who will be attending the birth needs to be at in-person interview.
  • Expect the interview to be approximately an hour and to be free of charge.

Step 4: The Interview

The interview is to gain more detailed information from the doula, as well as, share more detailed information about yourself and what you want.  It is customary for the doula to bring a client packet with her that may include her professional background, client agreement, services, and support details and offerings.

Suggested Interview Questions:

  • Why are you a doula?
  • What is your philosophy of childbirth?
  • Where did you get your training?
  • Are you certified? Why or why not?
  • How long have you been a doula?
  • What is your scope of practice?
  • What types of births have you participated in?
  • What types of birth locations have you been to?
  • How many births per month on average do you attend?
  • How many clients would max you out in a month?
  • Have you ever missed a birth? Please explain why.
  • Do you specialize in working with a specific type of clientele or birth plan?
  • What has been the most challenging birth you have attended? Why?
  • How do you work with my husband/partner/other support?
  • Have you worked with my provider before? If yes, please describe the experience.
  • How many prenatal visits would there be?
  • In general, what is covered in the prenatal visits?
  • Will you help me make a birth plan?
  • Please explain how your fee is structured.
  • Do you have a back-up and do I meet her ahead of time?
  • When do you go on-call?
  • Do you labor at home with me?
  • What do you do if I am induced or need to schedule a cesarean?
  • When will you see me postpartum and what does it include?
  • What are your expectations of me as a client?
  • How long do I have to decide before you would contract with someone else around my EDD?

Of course that is a fairly long list of overview questions. Brainstorm some of your own. The interview is not meant to be a free prenatal visit, it is simply to find out if you and the doula are a fit personality wise and in how she practices.  Most doulas do not expect to be hired on the spot. You  need time to think over all the interviews before making a decision. If a doula is pressuring you to hire on the spot, that could be a red flag.

Step 5: Hiring the Doula

When you make your decision, please also contact those you are not choosing as well to let them know you have hired someone else so they will not be holding your EDD space open any longer.

Details to be clear about when initially hiring your doula:

  • Sign and return the agreement/contract she gave you at the interview (if applicable).
  • Payment  – First portion of fee is usually paid upon hiring a doula.
  • Ask her usual business hours and contact preference for non-emergencies or labor related needs.
  • Let her know your contact preferences and all phone numbers to reach you and your spouse/partner or other support.
  • Set the date and time for the first prenatal appointment. Give her directions if your home is not easy to find.

Congratulations!