Archive for the ‘Preparing For Birth’ Category

Do’s and Don’ts in Labor & Delivery (a.k.a. Getting What You Want, Kindly)

Monday, April 20th, 2015
Created using canva.com

Created using canva.com

Birth plans. Epidurals. Natural Childbirth. Doulas. Induction. Cesareans. And more…

The list of decisions about birth goes on and on…

More women are becoming dissatisfied with the status quo in American maternity care, and are asking for something outside the norm for the hospital where they plan give birth. Naturally, this might make for some conflict between a birthing mother and her care provider and nursing staff.

Conflict.

There. I said it. Right out loud.

There might be conflict in the labor and delivery room when a mother is giving birth. I am not writing this post to tell anyone how to avoid conflict, but how to manage it in a healthy way, so that the birth experience is not characterized by the conflicts that arise, but by the solutions everyone involved is able to come to.

Here are some do’s and don’ts that may help you in the labor and delivery room to self-advocate effectively, while creating a human connection with the nurses and provider caring for you and your baby.

DON’T: Expect care providers or nurses to offer much in the way of comfort during labor.
It is not the responsibility of a care provider or nurse to make a birthing mother comfortable. Their first priority, and indeed, their entire job, is the safety of mother and baby. Period. Your comfort is a distant second to safety, and that’s exactly the way it should be.

DO: Hire a doula to offer you comfort and support.
Your comfort is the entire responsibility of your doula. Period. That is all that she is there for. Emotional, physical, and informational comfort and support are her expertise. You will not be disappointed if you lean on a doula for this need.

DON’T: Make demands.
This only causes a heightening of conflict. If you want something different than protocol, shaking your fist and demanding it is not the right tack. You might get your way, but you may not end up getting the best care if you treat the nurses as if they were there to grant your every wish.

DO: Ask for exceptions.
Think about it. How would you feel if a stranger came to your house, and began to dictate to you how to load your dishwasher, feed your kids, or fold your towels? You would be offended. This is what we do when we demand our way in labor. When you want something outside protocols, try this: “I understand that this is your normal protocol, but I need you to make an exception for me this time. Thank you.” This invites conversation and cooperation, and is less likely to put a nurse (who is technically your advocate) on the defensive.

DON’T: Be rigid.
Refusing to budge on the smallest things is unfair, especially when you are asking for things outside the box. Remember, you are a rare breed to these nurses. Asking them to step outside their norm is a big deal. Respect that.

DO: Be flexible.
Compromise is the name of the game. For example, here in Colorado Springs, a Hep lock buys you pretty much anything you want in most of the hospitals. It helps them to see that you are reasonable, and that you understand why they do what they do. It makes them far more open to your requests and out-of-the-box needs.

DON’T: Wait until you are in labor to make your birth plan known.
It is completely unreasonable to spring a birth plan on unsuspecting staff and providers. You can’t count on appointment conversations to be remembered, simply because of the sheer volume of patients a hospital-based provider might see in any given month. Not to mention the fact that you are likely to have a care provider you’ve never met catching your baby!

DO: Discuss everything on your birth plan prentally.
Write your birth plan early, in second trimester, and tackle one issue at a time in those 7-10 minute appointments. Discuss the benefits, risks, and alternatives ahead of time, and really make sure you and your provider are on the same page. If they are willing, have them sign it–this doesn’t make it a legal document, but it proves to the staff and on-call doc that your care provider is on board with all your requests.

In short, it pays to be kind. Always be kind. You never know what kind of day your nurse or care provider has had. You have no idea what is going on in the room next to you. I am not making excuses for bad or disrespectful or hurried care. I want to remind you that everyone in scrubs is a human being, just like you. There is rarely a reason to walk into a labor and delivery ward with guns blazing. Even if you had no other choice in your care. The ones providing it are just as human as you are, and if you can leave them feeling respected and understood, you are helping to pave the way for the next woman who wants out-of-the-box care.

It may be your birth, but it has ripple effects. Whether it’s for the positive or negative is, at least in part, up to you.

How do you handle differences of opinion in your care? What are the most diplomatic ways you have used to self-advocate without a situation erupting into WWIII?

Grace & Peace,
Tiffany

Student Midwives Learning

Tuesday, March 31st, 2015

This is how we do it! My turn on the bed!

This is how we do it! My turn on the bed!

The skills needed to become a competent midwife are seemingly infinite. There doesn’t seem to be an end to what we need to learn, academically and practically speaking. The academic part is relatively easy. It comes from reading, study groups, online student midwife chats, watching videos, and good mentors. Where does the practical side come from? How do we actually learn to do what we are reading about? Book knowledge only goes so far, after all. Especially for the skills that involve a certain level of social intimacy with our clients, such as vaginal exams.

Simply put, we gain the skills through practice. Practice is a close second, and then after that, practice rounds it out.

Yet, it doesn’t seem fair to “practice” on clients. Rather, we practice on one another until we have mastered the skill, then we can transfer that practical knowledge to our clientele much more safely and professionally.

How does it look here at Preparing for Birth, among my fellow students? Our preceptor came up with a great idea to give us a chance to apply our academic skills practically. Once a month, we have a scheduled four-hour block of time to discuss, learn, and implement skills. This month, we learned to do speculum exams, PAP smears, and bimanual exams. This required some chatting and warming up first, since it’s a rather intimate skill set, then we all washed properly, gloved up, and took turns on one another. We had another midwife with us, as well as her student, so it was a sizable group.

There was a lot of laughter, affirming language, encouragement, correction, and guidance. I came away feeling confident that I have a good starting point with those skills, and I am really looking forward to practicing again, and honing the skills to a fine, sharp point. The above picture is from our skills day — a rare glimpse into the world of student midwifery. As I lay there, I could not resist the opportunity to take this shot, and share it. These women are powerhouses, and I am so glad to be a part of such a community!

We are student midwives, with our preceptors, walking an incredible and humorous road paved by generations of women who have gone before. We learn best in community. We are not islands. We are a a village. Together, we learn, we grow, we change, and we improve, all to serve women and their families a little better everyday.

Grace & Peace,
Tiffany

Homebirth: The Basics.

Monday, March 2nd, 2015

General Information

The Safety of Homebirth

Other

My Favorite Colorado Springs Midwives

A Weighty Responsibility

Monday, August 4th, 2014

Image credit: longdrivejourney.com


Finishing up a class is always bittersweet, triggering a time of self-evaluation, reflection, and a desire to do better next time.

Childbirth education is not a job where I can just show up, punch a card, and go home. It is filled with challenges as unique as each student who walks through the door. Each student requires some customization of the curriculum, and will invariably ask a question I don’t know the answer to. There will be rabbit trails every so often, and bringing class back on track in order to cover the essentials adequately is critical. It is also just as critical to know when it is time to abandon a few of my slides in order to acknowledge and travel down a rabbit trail with purpose.

It requires constant research, reading, and learning on my part. I cannot recycle the same information over and over, and expect to meet the needs of an ever-changing population. Every class series I teach, while built upon the same foundation, will be a little bit different.

As I work toward finishing my re-certification process as a CAPPA Certified Childbirth Educator, I am overwhelmed at the amount of new information permeating the atmosphere surrounding the perinatal year! I am required to choose and read ten complete studies relating to my field that were published in the last five years. I thought it would be a challenge to find new research. I was wrong. The information is out there. It is accessible, if you know where to look, and I am astonished and excited at how much I still have to learn!

I am so glad I chose to certify with an organization that has such rigorous standards for its members. If it weren’t for the constant challenge of re-certification, I think it would be too easy to fall into a rut and stay there, becoming more and more irrelevant in the community. More and more useless in effectively navigating the changing state of childbirth in this country.

When I am up front teaching, I am viewed as an expert, and even an authority on childbirth. Shame on me if I fail to strive to live up to such labels by maintaining a steadfast continuing education. While I know I can never impart everything I know to every student who walks into my classroom, it does not excuse a lack of evidence-based, current knowledge driving and directing my passion. All the passion in the world means nothing if it isn’t paired with a working knowledge of current evidence, applied realistically, and presented in a way that is easy for students to integrate into their own real-world experience.

A discerning childbirth educator changes with the times. Changes with each new group of students who choose their class. Incorporates new information into curriculum as quickly and accurately as possible, enabling students to apply the new knowledge to their own circumstances and worldviews. A wise childbirth educator strives to get a little better each day, understanding that people are making decisions based (at least in part) on what they have said in class.

It is a weighty responsibility.

And I love it.

How do you continue to learn, grown, and change in your own work? What drives you to keep reaching for the next step?

Grace & Peace,
Tiffany

7 Symptoms Every Pregnant Woman Should Know

Monday, May 19th, 2014

Pregnancy is weird. There is no denying that. It often comes with all kinds of odd symptoms as the hormones of pregnancy do not limit their effect to the uterus and growing baby. Everything from morning sickness to hemorrhoids to indigestion can be a normal part of pregnancy. These things are not often a cause for concern, but sometimes, these symptoms wander outside the range of normal, and it’s important to understand what that looks like.

There is a reason your care provider has you pee in a cup, takes your blood pressure, and asks about headaches, vision changes, and other symptoms. It’s best not to stay in the dark about why.

I don’t share this information to scare you, or to make you paranoid, but to bring a sense of awareness. When in doubt, it never hurts to call your provider. Peace of mind and good health are more important than feeling a little foolish. Take a minute to watch this video, and just tuck it away in an easily accessible corner of your mind.

Grace & Peace,
Tiffany

Preparing For Birth Has Moved!

Monday, May 12th, 2014

We are still at the same address, but we have moved upstairs into a new, more spacious office suite. We are now in Suite 201, just at the top of the stairs. The very first door. We now have three midwives working out of this office, and five doulas, all of whom are a joy to work with. Classroom space is bigger, too, which excites me to no end!

As I grow in my business, I am learning so much, and I am grateful to be a part of Preparing For Birth as it grows to better serve our community with more options for women during the perinatal period. From Early Pregnancy classes, to Essentials for Childbirth, to Life With Baby, Pregnancy Fitness, and Breastfeeding classes, we really are covering a wider range of needs at an affordable price.

Stay tuned for more information!

Grace & Peace,
Tiffany

How To Find Moolah For a Doula.

Saturday, October 19th, 2013

Image credit: primecoordination.wordpress.com


So, you’ve read the literature, or seen the infographics on the measurable benefits to having continuous, trained labor support in the form of a doula. (You haven’t? Oh. Well, then. Click HERE to read the best, most recent evidence, then come back here and finish this post.)

Based on that measurable evidence, you’ve decided that you need a doula, but are wondering how on earth you can afford one. You’ve seen that doulas are worth every penny they charge, but it doesn’t matter if you don’t have the pennies, right? Right. I know that feeling! I think we all do, in this current economic climate.

As I mentioned in my last post, doulas in the Colorado Springs area charge anywhere from about $300 up to $650 at the moment. Of course, insurance doesn’t consistently cover us yet, though there are reports of some insurances doing just that after claims are submitted by clients. It’s slowly, but surely happening. Still, that upfront cost is still there.

To start, I would like to cover the basics of what you must have for a newborn. (Stick with me, I’m going somewhere with this.)

  • Boobs. With milk in them.
  • Something to cover & clean their behinds.
  • Maybe two weeks’ worth of clothes, depending on how often you do laundry, and how often your baby blurfs on you, or has poopsplosions.
  • Car seat. Must-have, if you ever need to go out and buy food or something.
  • Some sort of barrier between spit-up and your clothing.
  • Some sort of well-made babywearing device.
  • Small diaper bag.

Really, everything after that is gravy. Sure, there are a lot of very handy devices, contraptions, and doo-hickeys, but most of those are luxury items, that add up very quickly to hundreds of dollars or more. Of course, many of these items are covered by the ubiquitous Baby Shower. Everyone is eager to pick up your Target registry list and go crazy!

There are…

  • fancy nursery sets
  • cribs
  • high chairs
  • various swings
  • pack n’ plays
  • child-proofing devices
  • baby gates
  • teething rings
  • toys
  • floor mats
  • wall decals
  • strollers
  • blankets
  • socks
  • hats
  • specialized bath tubs
  • giant diaper bags
  • SO MANY THINGS!!!

Do you really need all of that? No. Most of those are created needs. They come in handy, certainly, but most aren’t needed in those newborn days before six to eight weeks postpartum. Oftentimes, it makes sense to put off getting most of these items until you know for sure it’s something you will use. Time will tell very quickly in that case.

So, instead of creating a registry for SO MANY THINGS! for your baby shower, might I suggest: Have a simple money tree, or card box set up, and ask people to contribute what they would have spent on stuff to your Doula Fund. Most people tend to be as generous as they can toward new mothers and babies, and will be happy to do just that.

In lieu of all the stuff, you will likely end up with plenty of money to pay the doula you would like to hire. You may even have some left over to pick up one or two items that you find you really would like to have. It’s a win-win!

Of course, that’s not the only way to go about it. I just think it’s often the easiest way. Still, there are other options.

Some other ideas to help you pay the doula you’ve chosen:

  • Bartering. Many doulas have need of the skills you or your partner possess. Offer a dollar-for-dollar trade, up to a certain amount, then pay cash for the balance.
  • Sell some stuff. Maybe you’ve already had a baby, and found you didn’t need that $400 jogging stroller, and barely used it. Perhaps your garage needs to be cleaned out. You may be able to scrape together enough to afford the doula you’d like to hire.
  • Make and sell some stuff. Do you sew at all? Crochet or knit? Make fabulous cakes? Jewelry? Do you paint? Photography? Put those skills to good use!

When all else fails, and you honestly can’t pull together the entire balance…

  • Hire a training, or newer doula, and work with her to pay her what you can afford.
  • Ask for a discount. Be specific. “I can’t afford x, but I can afford y. Can you do that?”
  • Ask for a payment plan. Again, be specific. “I can make payments of x amount, over 6 months.”

Most doulas are willing to work within certain parameters, as long as a client is upfront, honest, and is willing to put a financial agreement in writing. We hate to say no to someone in need, and most doulas will bend over backwards to help you make it work. We know that we have measurable benefits. We know that doulas are much more of a need than a luxury, especially in the current birth climate in this country. We want to help, but communication runs two ways.

You only have to ask.

It’s almost always feasible to afford a doula – you just have to get creative, be flexible, and find a doula that can work with you in your particular circumstances. Remember, you are trying to secure evidence-based, customized, continuity of care for yourself and your baby. It’s more than worth it. You will likely never regret spending money on a doula, because you are really investing in yourself and your care.

What ideas do you have for raising moolah for a doula? What have you done in the past — either as the doula or the client — to make it work?

Grace & Peace,
Tiffany

Nuts & Bolts: What exactly am I paying my doula for?

Monday, October 14th, 2013

Image credit: shipulski.com

Next to finding a good personality fit in a doula, financial concerns are probably the biggest factor in choosing which doula to hire, and many potential clients ask me exactly what the fee covers. In some ways, that’s an easy question to answer: “My fee covers x number of prenatals,  labor, birth, and immediate postpartum, and x number of postpartum visits, as well as unlimited phone/text/email support.”

In other ways, not so much. Doulas have to strike a balance between affordability for clients, and maintaining a sustainable practice. This can be tricky sometimes, and often takes a lot of time (and mistakes) for a doula to figure out how to structure her individual fee. Finding that happy medium is essential: 1) to prevent burnout from being constantly on-call, and 2) to reach the widest economic base they can.

Basically, a doula is going to base her fee on a combination of a few factors. Her experience, how many births she can take on in a month, and her business expenses are all part of the equation.

Now, no doula enters this profession thinking, “I’m going to make it rich doing this!” No, indeed! Doulas are all heart, and do this work because they can’t not do it. Beyond their hearts, though, a doula does have to consider the financial part of the equation, because it would be unwise not to. After all, just because she had a light month, as far as births go, doesn’t mean her rent won’t come due.

That said, I would like to explain, as simply as possible, what a doula’s fee covers–both for the client, and for the doula herself.

Nuts and Bolts–What the fee covers for the Client:

  • 2-3 prenatal visits.
  • Labor, birth, and 2-4 hrs. postpartum.
  • 2-3 postpartum visits.
  • The tools in her birth bag.
  • Unlimited phone/text/email access. A doula’s time spent just communicating with her clients can quickly add up to several hours a week in order to make sure the client has all the emotional and informational support she needs.
  • Usually four full weeks of on-call availabilty, during which she cannot leave the area, must take her own car everywhere, and cannot make any firm commitments.
  • Objective help writing a custom-tailored birth plan.
  • Continuity of care throughout pregnancy, labor, birth, & postpartum period.
  • A walking birth encyclopedia.
  • Someone dedicated to keeping the environment peaceful.
  • A skilled communicator that helps create positive dialog among members of the birth team.
  • Specific to the doulas here at Preparing for Birth: Guaranteed back-up doulas, and continuous access for the doula to an experienced mentor when things get “interesting.”
  • A professional person with an emotional investment in each client’s care, who answers only to the client–not to hospital staff, doctors, or other family members.
  • If you’ve had a doula in the past, what might you add to this list that your doula did for you?

Balanced with the above are the doula’s financial needs. In order to do such demanding work, doulas need to charge enough that they can take enough births to meet those needs, but not so many that they burn out. Let’s face it: Living on-call nearly 24/7 most of the year can get exhausting for anyone–no matter their profession. Below is a basic explanation of where the doula will put her fee to good use.

Nuts & Bolts–What the Doula needs the fee to cover so she can keep working:

  • Childcare, if she has children too young to stay home alone. Most doulas pay their childcare person by the hour, and if a birth is long enough, that can add up to a significant portion of her fee. It’s probably the single biggest cost factor in this work.
  • Her time. Probably the second-biggest cost factor when setting a fee.
  • A back-up doula, on the off-chance she can’t make the birth.
  • Phone & internet bill, including website fees.
  • Gas money & mileage on a personal car.
  • Office space, even if it’s in her home.
  • Basic business supplies (paper, printer ink, files, etc…)
  • Business checking account
  • Certification Fees
  • Taxes and state business fees
  • Birth bag tools, some of which are costly, and all of which need to be replaced periodically.
  • Promotional materials and marketing.
  • Continuing education.
  • Professional memberships.

Most doulas spend a minimum of four to eight hours with their clients prenatally, as well as another two to four during the postpartum period–not including phone calls, emails, or texts. When the time spent with a client during her labor and birth is factored in, many doulas will need their fee to cover anywhere from 16 up to 36 hours or more of time, in total. If that were the only factor to consider, let’s take a look at what a Colorado Springs doula “brings home.”

Doulas in Colorado Springs charge anywhere from about $300 up to $650, which is actually somewhat less than other cities in the U.S. of similar population size. Doula’s fees range from $500 up to $850 or more (some go higher than $1,000) in other comparable cities (based on an informal poll I took in a birth professionals group).

So, if hours were the only factor, a Colorado Springs doula grosses about $19.00 to $40.00 per hour, for each client, at the minimum amount of hours she might work. This is before any of the other listed factors come into play. When those are factored in, what’s left for her time is often less than minimum wage.

Do you know what? It’s worth it for doulas! It’s enough for many just to be there, in that sacred birth space, participating with a family the way they do. Quietly going about their doula business caring for and nurturing a new family in the moment of its expansion, melting into the background, and holding space for the mother-baby unit to hold their focus. There is nothing like that moment when a woman looks up at her partner, that wet baby held tight to her chest, with tears in her eyes, saying “I did it!”

Doulas love what they do, and they share that love and passion with each family they serve.

Taking all this into consideration, hiring a doula is probably one of the most valuable things a mother can do for herself. Forget the fancy nursery decorations, stroller, and extra stuff. Instead, a mother can invest in customized, top-of-the-line, evidence-based care by hiring a doula–and get the best deal of her life for one of the most important times in her life!

Wondering how to afford a doula? Keep an eye out for my next post, with tips on how to get creative with finances to do just that!

I had a lot of help in putting this post together, and I just want to give a shout-out to my fellow doulas at Preparing for Birth: Sarah York, Christin Yorty, Rachel Madrigal, and Jamie Nyseth. Each of these women serve as wonderful peers and fresh perspectives, and I am privileged to work with them. Click HERE to visit each of their profiles.

Grace & Peace,
Tiffany

This Is Hard.

Friday, May 31st, 2013

I can no longer describe myself as a stay-at-home-mom. Of course, I am still home the majority of the time, but I am definitely working more now.

Slowly, my business is building and increasing. I have at least one client a month through July, and a few births a month with Desirre as her assistant. Also, I am still teaching as the only educator at Preparing for Birth. That work will have some relief soon, as one of our other doulas is pursuing her childbirth education certification too. She’s student teaching under me right now.

Needless to say, I’m officially a Really Busy Mom. Adding work hours has been tough. Tougher than we thought it would be as a family, but we’re working out the logistics pretty well. I am so grateful that my husband is not just grudgingly supportive, but encouragingly so. He has really stepped up to help on the days I have to go in to work, or get called to a birth.

In addition, with my mom living here for now, we have had some welcome relief. She cannot help but pitch in and do things that need doing around here. She is a beautiful gift. She would make a great postpartum doula.

I know that I am called to this work. When doubts creep in, someone always comes along to remind me of the truth of my calling in birth work. They usually don’t know that’s what they’re doing, but it is.

God is faithful, and is holding me up in this journey.

This is hard, but I am glad I am here.

What has been worth it in your life, in spite of difficulty? Why?

Grace & Peace,
Tiffany

Announcing Something Cool

Tuesday, July 17th, 2012

Just a moment ago, I signed a doula contract with Preparing For Birth. Though I will be retaining my business name as a doula (Birth In Joy), I will be working exclusively with Preparing For Birth.

As a result, my fee structure will be changing.

Watch for the upcoming changes on my website, and hop over to Preparing for Birth to take a look at all we offer as a group.

Being part of a growing organization like PFB this past year has been exciting and filled with opportunity to learn, and I am so ready to change and grow and learn even more!

Grace & Peace,
Tiffany