Choosing the place of birth for your baby – It is incredibly important that you understand where you fit best prior to choosing where to birth your baby. Take hospital and/or birth center tour, call and talk to L&D floor, get facts on home birth by talking to home birth midwives, other moms who have had home births, online and in books. Being intellectually safe is not the same as being safe. Know the facts before you choose.

· Does the location offer what is most important to you (tubs, birth balls, wearing own clothing, intermittent monitoring, fetascope monitoring, etc.)?

· What are standard protocols and practices that are followed? Is individualized care a norm there or is cookie cutter style?

· Is water birth available?

· Are birthing stools or non-reclined pushing and delivery positions encouraged?

· What are the no/low intervention rates? These numbers are tracked monthly.

· What is the induction, epidural, cesarean rate? Are VBAC’s supported and encouraged?

· Are mom and baby friendly practices used? (no routine interventions, no separation of mom and baby, breastfeeding is the norm, movement in labor is utilized, doula accompaniment is accepted, labor induction rates are low, etc.)

· What if I choose to decline an intervention, medication or procedure? Will my decisions be respected? Are patient’s rights taken seriously?

Points to Ponder afterward –

· Will I be able to have the type of birth I truly desire?

· What location will I ultimately feel most comfortable in physically, emotionally and spiritually?

· What location is ultimately safest for my specific needs (I am currently a low-risk or high risk)?

· Is insurance or lack of it the reason I am choosing the location?

· Do I have realistic expectations for the location?

· Am I willing to take responsibility for my birth in the location?

· Is staff open to working with a doula or natural birth?

· Are there any compelling reasons to choose one location over another?

Choosing your care provider: Use this as a template for the interview process or to discern you are of the same philosophy and belief system with current OB or Hospital/Birth Center Midwife.

· What is birth philosophy? What is philosophy of pregnancy?

· What makes up majority of experience in practice? Has provider seen normal labor and birth? How often?

· How is the “due date” approached? When is “full term”? When is “overdue”?

· Will questions be answered over the phone?

· How much time will be spent with me during each appointment?

· What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why?

· Are there restrictions on the type of childbirth or breastfeeding class I take? If so, what and why?

· What routine tests are utilized during pregnancy? What if I decline these tests?

· What are intervention rates? (IV, AROM, continuous monitoring, episiotomy, etc.) Cesarean rate? VBAC rate? Induction rate? What induction methods are used? When are forceps/vacuum used? These numbers are tracked.

· What positions is care provider comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than “c” position?

· If I choose an epidural, when can I get it or when is it too late?

· What about a birth plan? Does CP agree with them or not?

· Is an on call rotation utilized or does CP attend all own patients? Will back-up or on-call CP honor the requests we have agreed on?

· Are there any protocols that are non-negotiable? If you cannot refuse – you are not consenting.

· What if I choose to decline a recommended procedure or intervention? Will my decision be respected?

· How long is provider with patients during labor?

Points to ponder afterward:

· Did you feel immediately comfortable and respected at the interview? If already with a CP, do you feel comfortable, respected and heard at each appointment?

· Was or is care provider willing to answer questions in detail without being annoyed?

· Is choosing your care provider based on your insurance or lack of insurance?

· What are you willing to do in order to have the birth you really desire? Birth location?

· How much responsibility are you willing to take for the health care decisions for you and your baby?

Women have supported women throughout the ages.  In our very busy and ever transient culture, the woman to woman education and support of yesteryear is sorely lacking.  It is very common for an expecting woman not have family nearby or to have support women who know the ways of natural, normal pregnancy, labor, delivery and immediate postpartum. The labor doula was born out of this need.  Essentially this is a woman of knowledge and skill in pregnancy, birth, and immediate postpartum (yes there are a few men in who are labor doulas as well) who comes alongside a pregnant woman (family) offering education, physical support and emotional support to both the mother and partner/husband/other support.

Below is a detailed description of what a doula is and does according to CAPPA a wonderful organization that trains a variety of doulas and other birth professionals.

What is a Labor Doula?

A doula is a person who attends the birthing family before, during, and just after the birth of the baby. The certified doula is trained to deliver emotional support from home to hospital, ease the transition into the hospital environment, and be there through changing hospital shifts and alternating provider schedules. The doula serves as an advocate, labor coach, and information source to give the mother and her partner the added comfort of additional support throughout the entire labor. There are a variety of titles used by women offering these kinds of services such as “birth assistant,” “labor support specialist” and “doula”.

What Does a Doula Do?

The following is a general description of what you might expect from a CAPPA certified labor doula. Typically, doulas meet with the parents in the second or third trimester of the pregnancy to get acquainted and to learn about prior birth experiences and the history of this pregnancy. She may help you develop a birth plan, teach relaxation, visualization, and breathing skills useful for labor. Most importantly, the doula will provide comfort, support, and information about birth options.

A doula can help the woman to determine prelabor from true labor and early labor from active labor. At a point determined by the woman in labor, the doula will come to her and assist her by:

• Helping her to rest and relax
• Providing support for the woman’s partner
• Encouraging nutrition and fluids in early labor
• Assisting her in using a variety of helpful positions and comfort measures
• Constantly focus on the comfort of both the woman and her partner
• Helping the environment to be one in which the woman feels secure and confident
• Providing her with information on birth options

A doula works cooperatively with the health care team. In the event of a complication, a doula can be a great help in understanding what is happening and what options the family may have. The doula may also help with the initial breastfeeding and in preserving the privacy of the new family during the first hour after birth.

What does a doula cost? This can be a huge spectrum and is defined by where you live.  A labor doula may volunteer, work for barter, or basics like gas reimbursement, childcare coverage, snacks, etc.  I have heard of fees from $100 to $1800 (mind you this is in NYC).  On average I would say a labor doula costs $250-$600 in many areas.   Call around or visit websites in your area to get a firm idea.

What about insurance? Private doulas usually do not bill insurance though many will give a super bill to be submitted for reimbursement by insurance.  many insurance companies after some effort will pay a portion of the fee as an out of network provider.

Will a doula provide my complete childbirth education? Sometimes.  Often not.  Some doulas are educators. I provide classes separately from doula services. The labor doula will often fill in the blanks and personalize the education the client already has.  Many doulas have lending libraries or recommended reading and watching lists.

If I am going to a birth center or having a homebirth will a doula still benefit me? Yes in both cases.  When going to a birth center a doula would labor at home then arrive at the birth center at the same time as the laboring mother just as with a hospital birth.  In a homebirth scenario the doula who is not a midwife and does no medical tasks is often a welcome extra set of hands and does the same emotional and physical support as she would do in any other location.

Does evidence support that having a doula in attendance has benefits? YES. Here are some of the benefits. Lowered epidural, narcotic, induction, cesarean, and instrumental delivery rates. Increased satisfaction, breastfeeding, and bonding.  Also shorter labors!

For more information, email me at desirre@prepforbirth.com.