How are you celebrating?! Share your own video response in the comments on YouTube! Who are the doulas in your life?

Doula.

I am a doula.

Those words, filled with so much meaning over the years, were my starting point in this birth journey I’m on. Doula is a weighty word. It’s a very different role than almost any other in birth. It encompasses so much that used to be taken for granted: that a sister, a mother, a grandmother, an auntie would be there for our births.

With our scattered society, and its driving desire to prove individual independence, that doesn’t happen as much any more. I think the rise in doulas in this country is just one sign of a shift in society’s thinking about that independence. The resurgence of old-fashioned life skills such as knitting, crocheting, quilting, canning, gardening, keeping small farm animals, bartering/trading for goods and services, and more all indicate that our society might be beginning to see the value in interdependence.

A very different concept than independence. Independence declares, “I can do it myself!” Usually in ALL CAPS. Interdependence says, “I can probably do it myself, but I would really like to have you by my side, because many hands make light work.” It’s a humble honesty that admits that we need each other, while acknowledging individual responsibility.

I like this shift in thinking. It means that each of us are needed by one another. Isn’t it a wonderful feeling to be needed?

We see it in the blog posts encouraging us to ask for help when we need it. We see it in the abundance of people who come out of the woodwork in order to sign up for meal trains. We see it in baby showers, scrapbooking parties, childbirth classes, book clubs, community gardens, homeschool groups, and knitting circles. We long for community, especially as women.

Birth is not an independent act. While it is “your” birth in one sense (individual responsibility), it is very much “our” birth in another (we need safe community in order to do it well). There are very few women who don’t need other women around them to birth, and each birth has a ripple effect on the community around it.

Enter the doula.

She brings interdependence back to birth. She encourages the mother’s individual responsibility in decision-making, while helping to meet the mother’s need for community. A doula bridges the gap between our precious, American independence, and our desire to have another woman to lean on. It is finally acceptable to need the help.

This is no bad thing, and is slowly, birth by birth, making a big impact on the way women, babies, and birth are viewed in this country.

“What’s a doula?” is a question asked less and less frequently, though we do need to keep putting the good word out there!

I am a doula.

The words still carry great weight. I have not yet burned out on standing beside women in my community while they usher new life into the world through their bodies, with the strength of Creation behind them. It is an honor, a privilege, and a blessing for me.

I am a doula.

I don’t yet know when the day will come that I utter these words for the last time, as I move forward into midwifery work. I wonder how that will feel, when it finally happens, as it surely will in the next few years.

Until then, I am a doula.

And I am grateful to be one.

Grace & Peace,
Tiffany

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

I’m beginning to wish that I had brought my camera after all. I decided to leave it home so that my husband could take pics of all the fun things he planned to do with the kids while I was gone. Turns out we have a sick kiddo, so that fun is not necessarily going to happen.

After five great, brain-busting, heart-tugging sessions, my mind is full. The theme this year is building bridges, and all the sessions so far have really given me some practical tools and advice on how to make productive, positive changes to the way I approach my clients and students.

I thought that tonight, I’d just share a few quotes that I really liked from the various sessions today, as well as a few things I learned.

1) Bridging the Nutrition Gap (Laurel Wilson IBCLC, CLE, CLD, CCCE):
The nutrition moms are able to get lay the foundation for her unborn baby for the rest of their life. Sure, we can make changes as needed as adults, but it’s far easier to make healthier choices if the foundation is already laid. Nutrition affects our epi-genome. (Google epigenetics – it’s fascinating stuff. Not going into it here, but man alive…)

2) The Accidental Parent (Tracy Wilson Peters CLD, CLE, CCCE):
I learned the H.A.L.T. principle. Never make important decisions or have important discussions with your spouse when you are Hungry, Angry, Lonely, or Tired. Makes sense!

3) Birth & Postpartum Rituals Around the World (Darla Burns CPD, CLE, CCCE):
We need to learn to value the trichotomy of father/mother/baby, not just the dichotomy of mother and baby. We all know fathers are important, but we do tend to sort of leave dads out a little in childbirth education.

4) Building Birth Bridges (Janice Banther CCCE, CLD, CD):
I learned here how to get things done, reach my goals, and fulfill the dreams I have in birth work by building communication bridges based on the interests and needs of others before myself. Super-inspiring lecture!

5) The eBirth Professional – Best Practices in Technology Use (Desirre Andrews, CLD, CLE, CCCE, Intern Midwife, Advocate):
Oh, MAN – all the stuff I learned in this session! The balance of being real, but professional. Human and accessible, but appropriately private. Developing and establishing my online presence, and finding my own voice.

Looking forward to tomorrow, so much. I can’t wait to really process all this and put it into practice!

Grace & Peace,
Tiffany

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

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!

Oh. My. Word.

How on earth am I going to narrow today’s post down to 10 things? The fact is that I must. I’m really ready for bed after a long, crazy-full day. Well, here goes nothing, and in no particular order:

#1: These sessions are jam-packed FULL of some seriously life-changing information.

#2: There have been things that I have “known,” somewhere in my gut, were true. I found out today that much of that has a biological basis, and is, in fact, TRUE. Awesome. I love that.

#3: All neural connections for the full spectrum of human emotions in an unborn baby is completed by the first week of the third trimester. In other words, the unborn child is capable of feeling anything from bliss to despair – in utero.

#4: The heart is another brain – it actually has brain cells in it. No, really.

#5: Babies feel begin to feel pain no later than twelve weeks in utero, but it’s probably earlier. However, the part of the brain that can produce analgesic effects, to help cope with pain, are not developed until much later. (I’ll have to go get the dvd of the session to double-check the age, so I won’t list it here yet. It was somewhere in toddlerhood, though.)

#6: Epigenetics are friggin’ awesome.

A few good quotes:

#7: “The foundation of emotional intelligence is emotional security.” ~Robin Grille, psychologist and author of Parenting For a Peaceful World and Heart to Heart Parenting.

#8: “Babies are not resilient, they are adaptive.” ~Bruce Perry In other words, babies don’t “bounce back,” they adapt and cope to deal with whatever comes their way in life – not always in healthy ways.

#9: “Loving eye contact is the other breastmilk.” ~Robin Grille (See #7)

#10: I haven’t danced, like I did tonight, since high school. CAPPA put together an amazing chocolate fondue party to end the night, and I hardly left the dance floor. So much good, clean fun, with women of all ages, shapes, sizes, and colors. It was a beautiful thing.

I don’t have pictures yet, since my camera battery died in my lap yesterday morning. I rue his passing. However, I have friends who promised to email me a few to share with you.

Grace & Peace,
Tiffany

After almost four years as a trained doula, and almost three as a trained childbirth educator, I have finally made it to my certifying organization’s annual conference! I am so grateful and blessed to be here, and to be part of CAPPA.

Even more, I am so glad that I didn’t have to fly out here, navigate LAX, or reserve a hotel room alone. I flew out with a new friend and associate, Kari Golyer, whose friends graciously allowed a stranger to tag along. We are both rooming with Desirre Andrews. This is going to be a unique experience!

Without much further ado, I’d like to share ten things from my day today.

#1: I wish my camera battery wasn’t nearly dead, and I wish that I had remembered my charger for it.

#2: I forgot to bring many different, fairly essential, items on this particular trip.

#3: Kari’s friend, Cari, spent her day taking us to the beach and introducing us to the most amazing Mexican restaurant I’ve ever been to. I’ve already forgotten it’s name. Something like Pablo’s or … PONCHO’S! That’s it, Poncho’s.

#4: Aforementioned Cari also took us to a sand dune used by a lot of people as a workout. The stupid thing was HUGE! Neither Kari or I thought we could do it. It glowered at us and dared us. So we did it.

#5: Six months ago, I would not have been able to do it. At all. Twenty pounds lighter, and 6 weeks into the the Couch to 5K training, I made it! I felt amazing afterward, too. My legs will be sore tomorrow, but I’m proud of myself!

#6: Tonight’s meet-n-greet turned into a wonderful series of surprises, as I met some women whose faces I’ve never seen, except on Twitter or Facebook. The most exciting face-to-face for me was to meet Janice Banther, the founder of Birth Behind Bars, an organization that provides doulas to women inmates. Something that I would like to be a part of, in my “someday dreams.”

#7: I got to see my doula trainer tonight too! I haven’t seen Ana since my training, but have been in touch online. She’s amazing, and I’m so glad to know her, even a little.

#8: Kari and I enjoyed getting out toes into the Pacific Ocean for a little while today. The weather was perfect. Absolutely perfect. That little visit brought us each a little bit of much-needed peace.

#9: I miss my kids and husband, who have graciously allowed me to come to this conference, knowing how much it will benefit me. I have the best family I could have ever asked for.

#10: I have a feeling that this is going to be a wonderful, brain-bustingly fantastic weekend. I can’t wait to share my birth-geekiness with you.

In fact, I think I just might try to share 10 new things a day that I’ve learned…it’s an idea. I make no promises. As you know, my blogging isn’t exactly consistent, but I really do delight in sharing with you when I can; and I appreciate that you care to drop by and read it.

Today’s post was quite random, but my brain needs a little more order to it before I can give you anything other than random. I certainly hope that’s alright with you!

‘Til tomorrow then (or the next day-ish)!

Grace & Peace,
Tiffany Miller, CLD

Being a childbirth (perinatal) educator is a position that affords great opportunity to positively influence women in the childbearing year and far beyond.  It is also a great responsibility that ought include: self-assessment, continuing education, evidence-based curriculum, the ability inform with discernment and the willingness not to teach a good patient course.

With all of this in mind, it is important that pregnant women choose their childbirth class wisely. There is not any one-size-fits-all class.

How does one go about choosing a childbirth class? I encourage you to go about choosing a class series in the same way you would choose a provider or birth location. Do some investigating and even interview the educator.

Off to a good search:

• Get referrals from women who have had or wanted the type of birth you are desiring.
• Check out your local birth groups and get referrals.
• Ask your provider for a referral.
• Do a web search for classes in your area. You may be surprised that there are many offerings method and philosophy based outside and within the hospital setting.
• If thinking about a hospital sponsored course, find out if it is a comprehensive series or a what happens to women once they get to our hospital class? This is otherwise known as a good patient class.
• Check out the course website then call or email the instructor to get a feel for her style and philosophy. Even a hospital based educator should be able to call you back or email you.

Before registering for a class series:

• How long is the series? A minimum of 12 hours is needed to be a comprehensive series. At least 2 different class sessions over two different weeks, but  preferably a minimum of 4 class sessions. You may find classes up to 12 sessions. Be wary of condensed one or two day classes as there is not enough time to process information and retain it well. It IS worth the investment of time.
• When is the class? Day of week and time of day needs to fit into your lifestyle. Again, I encourage your investment over a period of time versus a one-day class.
• Where is the class held? Classes may be held in like-minded businesses, in home, care provider office or hospital.
• What organization is the instructor trained and certified with? Though certification is not required, it can be very important the training and background an educator has.  Check out the organization to make sure you agree with it.
• What does the instructor’s experience involve?
• What is the instructor’s philosophy and style?
  
• What is the cost of the course? Classes can cost anywhere from free through a hospital to a few hundred dollars. It really can be a wide range. Find your comfort level. Though expect to invest in a good class. Free or low cost for everyone is often not comprehensive in nature.
• What is the course content? A comprehensive class should include a variety of topics, such as, pregnancy basics,  common terminology, normal physiologic changes, exercise, nutrition, prenatal testing, birth plans, informed consent, communication skill building, overview of spontaneous labor and birth, labor milestones with comfort and position strategies, overview of all options in labor and birth, labor partner role,  immediate postpartum, navigating first weeks postpartum, overview of infant feeding, infant norms, medications and interventions, cesarean, unexpected events, role-playing scenarios, relaxation practice and local/online resources. It is usual to expect homework on top of class time as well.
• What are the birth outcome statistics for class participants? It may be difficult though to get true data whether a philosophy-based or method-based class.
• What is expected of me as a class participant?
• What do I need to bring?
• Who may come with me?
• Is there a lending library?

I hope you find this list helpful and are able to find the just right fit. I look forward to your feedback.

I am very excited to announce the addition of  Lori Welch, BS, CCCE to the Preparing For Birth teaching team. She is a CAPPA Certified Childbirth Educator and also Lamaze trained. She has experienced both hospital and home births herself.  She has a deep calling for assisting others in their pregnancy, birth and early parenting journeys.

Beginning in May 2010, she will begin teaching and overseeing the bulk of  PFB group classes.

Class registration will remain the same. Her contact information will be lori@prepforbirth.com.

I look forward to working alongside her and expanding the available offerings for birthing families.