Not only does evidence tell us a doula can have measurable benefits for both mothers and their babies, but their intangible benefits are also felt every day by those who hire them for their expert support.

Doulas are fast becoming standard-of-care, as they should. Women have always surrounded women in their childbearing year, from girlhood on up. We know that new mothers in America are too isolated. Society leaves us alone to manage a never-ending list of “shoulds” between hectic schedules, separation of families, and age segregation. 

People often ask me if home birthing families really need a doula. My answer is nuanced. I don’t believe every family “needs” a doula. Some families have support and help. Their own extended family, their religious community, or a close-knit community of friends may provide the needed community. Those families may not “need” a doula.

However, I do believe that every family would benefit from a doula. This is because a good doula will always add to the experience what is needed, and guard the space from that which is not. Even in a home birth setting. 

Additionally, if a family lacks anything in the way of support, then a doula is absolutely a necessity! She is worth every penny you pay her, and more. A doula’s positive influence cannot be overstated. I am overjoyed when I hear that a mother has chosen to add a doula to her support network.

Here are 5 good reasons to hire a doula if you are planning a midwife-attended home birth:

1: You are a first-time parent or a VBAC client.

A first-time mom’s labor is likely to take longer than a woman has labored before. If you have had a cesarean, there may be some additional emotional blockages related to your prior experience that you need to overcome in labor. There is nothing wrong with either of those things. We don’t worry a bit about longish labors. As long as you and your baby are laboring well together, we are content to wait.

However, we often will not come to stay until active labor is well-established. There are a couple of reasons for this. One is because we need to be as well-rested as possible in order to maintain you and your baby’s health and safety during the labor and birth process. Our choice will often be to sleep while we can. This allows us to maintain our ability to make critical decisions that require a clear head. 

The other reason we don’t want to arrive too early in labor is that your uterus may not want us there! Your body knows when your care provider is watching, and it may get very shy–slowing or even stopping the process until the nosy midwife is out of sight and mind. I have seen it several times, both in my years as a doula and as a midwife. 

This is where doulas save the day! They are much more able to come in early labor and stay. They will help you relax, rest, eat, drink, stay distracted and let your labor unfold in its own good time. Doulas are experts in peer support, and as such, their presence rarely interferes with the natural labor process, and we often see much more efficient early labors in mothers who have doulas. 

2: Doulas are kind of a birth fairy.

They come into the birth space, read the room, and are able to fit themselves in wherever they are needed. Perhaps your partner feels bit overwhelmed trying to get the pool set up while supporting you, so your doula takes over pool duty so your partner can focus on you. One of the kids wakes up, so your doula is able to stay with you while your partner comforts a child and puts them back to sleep (or vice versa). You and your partner are rocking your labor just fine, and your doula snaps a few intimate photos. Sometimes, she walks the dog, feeds a child, updates the family phone chain, and updates the midwife. Whatever the need is, your doula will have a magical ability to fill it intuitively. 

3: Doulas can read your labor like a book.

Sometimes parents have a hard time deciding when to call the midwife to come in labor. Especially if they are first-time parents, have had a previous hospital birth (or cesarean), or were induced in a previous labor. No matter how much we discuss those “when to call” moments prenatally, some parents will doubt their ability to assess what warrants a phone call or will be so absorbed in labor, they no longer think about it. You can assign your doula the task of updating the midwife as needed, so you don’t have to break your concentration to do it. Plus, doulas know the clinical lingo and can communicate in concrete terms that your midwife will easily understand and acknowledge.

4: Comfort. Comfort. Comfort.

As a midwife, I do care about your comfort in labor, because I understand its correlation with health, well-being, and safety on multiple levels. However, I think more about how long it’s been since I listened to heart tones, rather than whether or not you need your hips squeezed. Not to mention charting. (Oh! the paperwork! *dramatic faint*) Midwives offer as much comfort as we can in the context of our primary responsibilities, but doulas are all about comfort. All the comfort. All the time. Comfort for the sake of comfort, in a very uncomfortable process! Comfort is a doula’s primary responsibility. You really can’t beat that.

5: Community Support.

As another midwife so aptly pointed out, your choices in midwives may be much more limited than your choices in doulas. Whether you are a woman of color, from a faith community, LGBT, or some other minority group, finding a doula who aligns more closely with your values and needs can help round out your care and make your experience much better than it otherwise would have been.

Pretty much any experienced midwife is going to have the skill set and competence you need in order to stay low-risk, healthy, empowered, and safe. Your community doula can help you create a beautiful, meaningful experience around your childbearing year through comfort, education, and learning to speak your needs effectively to your midwife (who will be learning right alongside you). The more trust that can be built among the members of your chosen support network, the better off you and your baby will be, and community doulas are key to this for many families.

Birth local. Hire a midwife. Then, hire a doula. 

You won’t regret it.

Did you hire a doula for your home birth? Why or why not? What was your experience?

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.

Join the #doulaparty on Twitter or follow along at DesirreAndrews.com, June 22nd 6pm PT/9pm ET to kick off summer birth work with something extra special!

I am very excited that Earth Mama Angel Baby is sponsoring this weeks live chat. EMAB has amazing products for all types of birth professionals and families.

A note from the EMAB Team:

Are you a midwife, doula, nurse or obstetrician looking for pure, safe products to comfort postpartum mamas and brand new babies? You’ve come to the right place! Earth Mama Angel Baby offers safe alternatives for your clients who are concerned with detergents, parabens, 1,4-Dioxane, artificial fragrance, dyes, preservatives, emulsifiers and other toxins. Earth Mama products are used in hospitals, even on the most fragile NICU babies, and they all rate a zero on the Skin Deep toxin database, the best rating a product can receive. Earth Mama only uses the highest-quality, certified-organic or organically grown herbs and oils for our teas, bath herbs, gentle handmade soaps, salves, lotions and massage oils.

Earth Mama now offers a Birth Pro Cart for wholesale pricing available for birth support professionals! Join Earth Mama Angel Baby on the #doulaparty chat Friday June 22 to talk about their new shopping cart plus answer any questions you may have. Earth Mama will be giving away Postpartum Bath Herbs and Monthly Comfort Tea, Mama Bottom Balm, Mama Bottom Spray, and a grand prize of their new Travel Birth & Baby Kit!

Get your pregnancy, birth or postpartum story heard!

I am looking to interview several mothers/families who have been positively changed, supported or impacted emotionally, physically, socially, educationally and/or spiritually during the perinatal (pregnancy, labor, childbirth, postpartum) and/or into the first year of mothering/processing birth outcomes through the use of/participation in social media outlets (Twitter, Facebook, Google+, Forums, Message Boards, etc.).

Purpose: Information will be used to complete a speaking session about birth and social media, as well as, material for additional writing, educational sharing opportunities.

If you are interested, please email me by October 31, 2011 with your contact information, when due if pregnant, how old your baby is if in the postpartum period and how you were affected by social media.

Contact: Desirre Andrews – Owner of Preparing For Birth LLC, birth professional, blogger, mentor, healthy birth advocate and social media enthusiast. Site: www.prepforbirth.com

Email: desirre@prepforbirth.com

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!

Being an active participant in your pregnancy and birth journey begins with choosing your provider. You can begin the search for the right provider fit prior to becoming pregnant, in early pregnancy or anytime before your baby is born. So much of how your pregnancy and birth unfold are directly related to your care provider so this is really a key element. Every provider is not the right fit for every mother and vice verse. If you already have an established provider relationship, these questions can be used as a re-interview tool.

When asking these questions, take care to really listen to the answers. If a provider will not meet with you prior to you becoming a patient, that can be a red flag.

______________________________________________________________________

Begin by expressing your overall idea of what your best pregnancy, labor and birth looks like to provider.

• What are your core beliefs, training, experience surrounding pregnancy and birth?
• Why did you choose this line of work?
• What sets you apart from other maternity providers?
• How can you help me attain my vision for pregnancy, labor and birth?
• If I have a question, will you answer over the phone, by email or other avenue outside of prenatal appointments?
• How much time will you spend with me during each appointment?
• What routine tests are utilized during pregnancy? What if I decline these tests?
• What is the average birth experience of first time mothers in your practice?
• How do you approach the due date? What do you consider full term and when would I be considered overdue?
• What are your patient 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 are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water? How often do patients deliver in positions other than reclined or McRoberts positions?
• How do you feel about me having a birth plan?
• What if I hire a doula? Do you have an interest in who I work with or restrictions? If yes, why?
• Do you have an opinion on the type of childbirth or breastfeeding class I take? If so, what and why?
• Are you part of on call rotation or do you attend your own  overall? Will the 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 in labor or post birth, how will that be viewed?
• When will I see you during labor?
• What postpartum care or support do you offer?
• Will I be able to get questions answered or be seen before the 6 week postpartum visit?

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?
• Were there red flags or white flags?
• 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?

I wonder if most of us really know what the scopes of practice are for the providers we may choose  for pregnancy, birth, postpartum, and for the baby.  Keep reading to see if you really know what the jobs encompass.

As you go through the list I would like you to think about the language used, descriptors, and purpose of each type of provider. When we are approaching health care decisions especially who will care for us from pregnancy through birth, postpartum and for our babies, we need to make sure we are choosing the appropriate care for our individual needs and situation.

If anything strikes you or you would like me to add any provider types, please leave me a comment!

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OBSTETRICS AND GYNECOLOGY (OB/GYN)

Obstetrics and gynecology is a discipline dedicated to the broad, integrated medical and surgical care of women’s health throughout their lifespan. The combined discipline of obstetrics and gynecology requires extensive study and understanding of reproductive physiology, including the physiologic, social, cultural, environmental and genetic factors that influence disease in women. This study and understanding of the reproductive physiology of women gives obstetricians and gynecologists a unique perspective in addressing gender-specific health care issues.

Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages.

Obstetricians and gynecologists may choose a scope of practice ranging from primary ambulatory health care to concentration in a focused area of specialization.   – from ACOG

Certified Nurse-Midwife

Midwifery as practiced by Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) encompasses primary care for women across the lifespan from adolescence beyond menopause, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. Midwives perform comprehensive physical exams, prescribe medications including contraceptive methods, order laboratory and other diagnostic tests, and provide health and wellness education and counseling. The scope of practice for CNMs and CMs also includes treatment of male partners for sexually transmitted infections, and care of the normal newborn during the first 28 days of life. -from ACNM

Certified Professional Midwife

Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other health care providers when necessary. The key elements of this education, monitoring, and decision making process are based onEvidenced-Based Practice and Informed Consent. – from MANA

Direct Entry Midwife (including Licensed Midwife)

• Not required to be nurses.
• Multiple routes of education (apprenticeship, workshops, formal classes or programs, etc., usually a combination).
• May or may not have a college degree.
• May or may not be certified by a state or national organization.
• Legal status varies according to state.
• Licensed or regulated in 21 states.
• In most states licensed midwives are not required to have any practice agreement with a doctor.
• Educational background requirements and licensing requirements vary by state.
• By and large maintain autonomous practices outside of institutions.
• Train and practice most often in home or out-of-hospital birth center settings.
  

To learn more detail about all types of midwives go to Citizens For Midwifery

Nurse Practitioner

Nurse practitioners (NPs) are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute health care services to individuals of all ages. Today, NPs complete graduate-level education preparation that leads to a master’s degree. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed.

NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. Nurse practitioners perform services as authorized by a state’s nurse practice act.  These nurse practice acts vary state-to-state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician. -from ACNP

Family Practitioner

AAFP defines a family physician as, “a physician who is educated and trained in family medicine–a broadly encompassing medical specialty.”

Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources. – from AAFP

Labor Doula

The labor doula assists the woman and her family before, during, and after birth by providing emotional, physical, and informational support. It is not within the labor doula’s scope of practice to offer medical advice or perform any medical or clinical procedure.

During pregnancy, the labor doula’s role is to assist families in preparing a birth plan, to provide information about birth options and resources, and to provide emotional support.

During labor and birth, the labor doula facilitates communication between the family and the caregivers. She supports the mother and her partner with the use of physical, emotional, and informational support.

During the postpartum period, the doula assists the mother in talking through her birth experience, answering questions about newborn care and breastfeeding within our scope of practice, and referring the family to appropriate resources as needed. – from CAPPA

Postpartum Doula

The postpartum doula provides informational and educational information to the family. Medical advice is not given; referrals to appropriate studies and published books are within the postpartum doula’s scope. The postpartum doula will determine ahead of time what duties she feels comfortable with performing for the postpartum family and she will share this information with the family prior to accepting a position with them.

CAPPA members do not perform clinical or medical care on mother or baby such as taking blood pressure or temperature, vaginal exams or postpartum clinical care. CAPPA standards and certification apply to emotional, physical and informational support only. CAPPA members who are also health care professionals may provide these services within the scope and standard of their professions but only after making it clear that they are not functioning as a labor doula, postpartum doula, or childbirth educator at the time of the care. For needs beyond the scope of the postpartum doula’s expertise, referrals are made to the appropriate resources.

CAPPA strongly recommends that members do not drive mother or baby unless there is a life-threatening emergency and an ambulance could not get to the family quick enough. – from CAPPA

Lactation Educator

Lactation educators fill an important function in educating and supporting families interested in learning about breastfeeding. This education may take place in the public, hospital, clinical or private setting. Lactation educators provide informational, emotional and practical support of breastfeeding. They may provide this service exclusively as breastfeeding educators, or may use their training to augment their support in other professions, in the cases of doulas, childbirth educators, nurses, dieticians, and postnatal or parenting educators. In addition to providing breastfeeding information, lactation educators offer encouragement, companionship, an experienced point of view, and foster confidence and a commitment to breastfeeding.

Breastfeeding education is not restricted to new families, but applies to the general public and medical staff as well. Due to the limited breastfeeding information given in standard medical and nursing training, and the rampant misinformation about breastfeeding that is so prevalent in our society, the breastfeeding educator serves as a resource for accurate, evidence-based information to the public and health care providers, as well as to childbearing families.

CAPPA does not issue Certified Lactation Consultant status, nor does the lactation educator program qualify a member to dispense medical advice, diagnose or prescribe medication. However, lactation educators provide a wealth of information about how and why to breastfeed; establishing a breastfeeding-friendly environment; basic breastfeeding anatomy and physiology; the normal process of lactation; deviations from normal; physical, emotional and sociological barriers to breastfeeding; overcoming challenges; and resources available (including medical referrals) for the breastfeeding family. They can also be a source of vital support, guidance and encouragement throughout the duration of breastfeeding. -from CAPPA

IBCLC (Lactation Consultant)

International Board Certified Lactation Consultants (IBCLCs) have demonstrated specialized knowledge and clinical expertise in breastfeeding and human lactation and are certified by the International Board of Lactation Consultant Examiners (IBLCE).

This Scope of Practice encompasses the activities for which IBCLCs are educated and in which they are authorized to engage. The aim of this Scope of Practice is to protect the public by ensuring that all IBCLCs provide safe, competent and evidence-based care. As this is an international credential, this Scope of Practice is applicable in any country or setting where IBCLCs practice.

IBCLCs have the duty to uphold the standards of the IBCLC profession by:
• working within the framework defined by the IBLCE Code of Ethics, the Clinical Competencies for IBCLC Practice, and the International Lactation Consultant Association (ILCA) Standards of Practice for IBCLCs
• integrating knowledge and evidence when providing care for breastfeeding families from the disciplines defined in the IBLCE Exam Blueprint
• working within the legal framework of the respective geopolitical regions or settings
• maintaining knowledge and skills through regular continuing education

IBCLCs have the duty to protect, promote and support breastfeeding by:
• educating women, families, health professionals and the community about breastfeeding and human lactation
• facilitating the development of policies which protect, promote and support breastfeeding
• acting as an advocate for breastfeeding as the child-feeding norm
• providing holistic, evidence-based breastfeeding support and care, from preconception to weaning, for women and their families
• using principles of adult education when teaching clients, health care providers and others in the community
• complying with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolution -from IBCLE

Pediatrician

A pediatrician is a child’s physician who provides:

• preventive health maintenance for healthy children.
• medical care for children who are acutely or chronically ill.

Pediatricians manage the physical, mental, and emotional well-being of their patients, in every stage of development — in good health or in illness.

Generally, pediatricians focus on babies, children, adolescents, and young adults from birth to age 21 years to:

• reduce infant and child mortality
• control infectious disease
• foster healthy lifestyles
• ease the difficulties of children and adolescents with chronic conditions

Click here for more information about the Physicians and Staff at the University of Maryland Children’s Hospital.

Pediatricians diagnose and treat:

• infections
• injuries
• genetic defects
• malignancies
• organic diseases and dysfunctions

But, pediatricians are concerned with more than physical well-being. They also are involved with the prevention, early detection, and management of other problems that affect children and adolescents, including:

• behavioral difficulties
• developmental disorders
• functional problems
• social stresses
• depression or anxiety disorders

Pediatrics is a collaborative specialty — pediatricians work with other medical specialists and healthcare professionals to provide for the health and emotional needs of children. – from UMM (I could find no concise scope of practice definition on the AAP website but here is their Scope of Practice Issues in the Delivery of Pediatric Health Care)

Doctors of Chiropractic

Since human function is neurologically integrated, Doctors of Chiropractic evaluate and facilitate biomechanical and neuro-biological function and integrity through the use of appropriate conservative, diagnostic and chiropractic care procedures.

Therefore, direct access chiropractic care is integral to everyone’s health care regimen.

A. DIAGNOSTIC

Doctors of Chiropractic, as primary contact health care providers, employ the education, knowledge, diagnostic skill, and clinical judgment necessary to determine appropriate chiropractic care and management.

Doctors of Chiropractic have access to diagnostic procedures and /or referral resources as required.

B. CASE MANAGEMENT

Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to other health care providers.

C. HEALTH PROMOTION

Doctors of Chiropractic advise and educate patients and communities in structural and spinal hygiene and healthful living practices.

-from ACC

It has occurred to me through my time with doula clients and students,  that many care providers serving hospital birthing mothers do not ask any questions of their pregnant patients during the 7-10 minute prenatal visits that lead to a substantive working relationship.

I have also learned that too often the pregnant “patient” does not know to tell her provider anything about what is going on in her life or pregnancy since she is not queried first.

Thinking there must be a way to better bridge this very real separation to solid patient-provider relationship building, I am drawing from my work as a midwife assistant in the making of this tip list.

Pregnant mothers your provider needs to know so much more about you and your pregnancy than blood pressure, weight, fundal height and fetal heart tones. I encourage you to freely offer the below information at every appointment to grow personalized care, advisement and support.

1) Appetite/Diet/Supplements – tell your provider if your appetite has increased or decreased between visits. Do you have food aversions? Are you taking any supplements or want to take supplements?

2) Sleep habits – tell your provider how you are or are not sleeping.  For example, are you having trouble falling asleep, falling back to sleep or staying asleep.

3) Nausea – Do you continue to have nausea? When? How often? Does it correlate with anything in particular?

4) Hemorrhoids – if you have them or not. What you are doing for them.

5) Varicose veins –  Are there veins sticking out or causing issue anywhere in your body?

6) Bowel habits – Are you experiencing normal or abnormal bowel habits?

7) Exercise – What have you been doing? Do changes need to be made?

8) Stress – Is there anything in your life that is really stressing you? Stress can impact pregnancy health. Important to discuss.

9) Related Providers – Are you going to any pregnancy related providers (such as chiropractor, acupuncturist, yoga, etc.)?

10) General  – Are you feeling well or not. Do you need more information or referrals?

There is so much more to you than a pregnant uterus. You are a holistic person who needs to be treated as such. I would venture that something much more individualized can come out of your care with simple sharing!

Here’s to whole care!

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.

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.