The almighty calendar calls today. I am more than halfway through 2019, and I already find myself looking to 2020 with a desire to order my days, set goals, and make a plan to move productively toward the growth of my life. I find that mid-year is just as good a time to face the calendar as January is. 

As a midwife and homeschool mom, it has become critical that I plan our year 12 months at a time. Then, I can reevaluate every six months. It’s pretty simple, but not always easy.

If I don’t do this, my family has no way of knowing if and when I will be off-call. To live on-call 24/7 is stressful enough. To make it 365 days a year is entirely too much. It is unfair to ask my husband and kids to live on-call along with me. They are entitled to a wife and mother who prioritizes their needs. I have learned the hard way what it looks like when I allow my family to take a backseat year round.  

It looks like taking June and July off completely could be my best option for the next several years. With four school age kids, it makes more sense to take time off when we are taking time off of school already. Our family can be free to really enjoy summer vacation together in whatever way we would like. 

That freedom sounds glorious to me right now, in these final years with the kids at home. My youngest turns 12 this year, and I really want to have as many adventures as our time and budget allow in the next six years.

Family comes first, and even my work calendar must reflect that. Otherwise, I cannot be the wife, mother, or midwife I strive to be. 

So, here’s to the almighty calendar! Dictator of days, goals, and seasons! May it reflect my values truthfully and clearly throughout the year.

And if you are due any time after early September 2019, I still have several spots open for homebirth clients! Let me know when you would like to meet.

PS: One of my favorite planning tools is my bullet journal. It has saved me a lot of headaches!

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?

Image credit: bbburkefineart.com (Click for original source)

You can never be quite sure of who this tiny human is going to be after he or she emerges from your womb.

We often expect an image like this one (Artist: Brenda Burke). Mom and baby awash in the sweetness of new motherhood. You picture the days snuggling away in quiet and coos, with only occasional crying.

The reality is usually different. The vast majority of us have to soothe an intensely crying baby at more than one point. Everything can be difficult to navigate when you are sleep deprived, and your postpartum hormones are in full swing.

However, if you have a baby who seems to have a more than usually intense personality, and a higher than normal demand for all things Mother, you may have a high needs baby.

That said, there are a lot of simple tools that can be helpful when you find yourself facing a high needs baby. Here are five good starting places:

1. Get help yesterday. My top advice would be to hire a postpartum doula, who will be able to assess the situation, and make good recommendations. She will know a lot of tips to help soothe your crying baby, and many postpartum doulas do overnight work, so you can get some much-needed sleep, and tackle the issues with a clearer head.

2. Relax as much as possible. (I know that sounds crazy.) I’m not talking about spa visits, necessarily. I’m talking about learning basic relaxation techniques. Remember the breathing lessons from your childbirth class? Those are life skills, and you will need them as you manage the stress of parenting a high needs baby. It can be as simple as stimulating a yawn, or putting baby in a safe place while you take a shower.

3. Learn about a baby’s normal development. I have found that this one factor can make all those mountains seem like molehills again! When you know what normal looks like, it is much easier to recognize what isn’t normal, and therefore get specific help.

4. Visit a chiropractor within baby’s first few weeks of life. Find one who specializes in care for women and their children, if possible. Many high needs babies fare better after a few adjustments, especially if their birth was very fast or very slow.

5. Learn about babywearing, which can be a lifesaver (sometimes literally). Babies who are worn, or at least held often, cry less, because their needs are met more quickly, and they have less chance to get worked up.

Now, these are very basic, ground zero strategies. These are not going to solve all your problems. They are only a springboard to get you started. Pick one, and give it a try!

What would you add? Have you had a high needs baby? What worked for you and your family? Why? Where did you turn for help?

Grace & Peace,
Tiffany

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