Archive for the ‘Doulas’ Category

The Professional Doula: Maintain Your Role!

Calling all doulas- aspiring and experienced alike! Welcome to Part 3 of a short series on developing professionally as a birth doula. The goal of this series is to help you learn how to better serve the mother, work with care providers, and develop a good rapport while you’re at it. Be sure to visit the other parts of the series:

Part 1: Dress the Part

Part 2: L & D Ettiquette

The last installment of my short series is going to be brief and to the point. (Sorry it took me so long to write it!)

Doulas, what is your role? We’ve all heard many versions of the answer to the question “what is a doula?”, but generally they are all pretty similar. Here’s my own definition:

A doula is a non-medical, trained labor assistant who provides physical, emotional, and informational support to families before, during and after childbirth.

You may have your own variant on this definition, but one thing that almost everyone unanimously agrees on is that a doula is not a medical caregiver (unless she is a medical caregiver already who is simply acting as a doula at the time).

And yet, it seems that far too many doulas have a very difficult time restraining themselves when it comes to giving medical opinions, “cheating” at births by sneaking in food, etc., and other “infringements” on the non-medical restriction on our job. So how do you avoid the temptation and stay within your realm?

1) Give women information- not advice. If we really do believe that we stand behind evidence based care, then wouldn’t it make sense to let that evidence speak for itself? Give women resources and information to inspire them to do their own research. Always encourage them to come to an informed decision together with their caregivers.

2) Don’t argue with a doctor during a birth. Ask questions instead. As I said in Part 2 of this series, you need to keep your cool during a birth, even if you are in direct disagreement with a doctor. Phrase your disagreement as a question.

For example, instead of: “This mother doesn’t need pitocin! Her water has only been broken for an hour,” try something like, “How long after the waters are broken does the risk of infection increase dramatically?” Even if you already know the answer, starting with a question opens the doors to suggesting that the parents and doctor (not you!) can perhaps come to a decision on how long they feel comfortable waiting before beginning pitocin. 

3) Learn  policies & ask questions about them beforehand. Don’t be the one to break them. Your job during a birth is to provide informational, physical, and emotional support to the mother. It is not to disregard the hospital policies that the birthing family has already agreed to by choosing to birth there. Of course, you can encourage the families to ask for exceptions to the rules, but don’t blow them off. You don’t have the training, the authority, or in most cases, the financial resources to take on this sort of liability during a birth.

Remember, I am all for helping to change the face of birth in America. However, this should be done outside of your role as a doula through various methods of advocacy. When you are a doula, stick to the support you should be giving the family to ensure a job well done from all perspectives.

How do you maintain your role during a birth? What suggestions would you add to this list? How do you walk the fine line of doula and birth advocate?

The Professional Doula: L & D Etiquette

hands labor

Calling all doulas- aspiring and experienced alike! Welcome to Part 2 of a short series on developing professionally as a birth doula. The goal of this series is to help you learn how to better serve the mother, work with care providers, and develop a good rapport while you’re at it. Be sure to visit the other parts of the series:

Part 1: Dress the Part

Far too often I have overheard hospital staff talking about “the nerve” of other doulas, or listened to doctors talking about doulas getting in the way. Don’t be that doula! It’s still possible to serve the mother well while also cooperating with the staff. Here are some quick tips to having good etiquette in L& D.

1) Introduce Yourself. You are aiming to form pleasant relationships with the staff for the duration of the mother’s labor. Be friendly. Act professionally. Don’t be a standoff.

2) Ask questions. Show genuine interest in the staff & their activities. Make conversation as appropriate- obviously remembering that the mother is your first priority. Ask them how long they’ve been at this hospital. Ask if they have children. Ask if the day was busy for them. You’d be surprised how earnest and pleasant small talk can soften staff members that have a poor preconception of doulas.

3) Ask permission. Yes, ultimately, the mother should be able to get what she needs to labor comfortably. But the best way to do this is not by recklessly raiding the cupboards. The supplies are still the hospital’s, not yours. Just pop your head out to the nurses’ station and say, “Hey, do you mind if I grab a washcloth out of the cabinet?” or, “I know you’re busy right now, but when you get a chance could you point me in the direction of the extra blankets?”

Better yet, ask the nurses when you first arrive if they mind if you grab what you need as you need itDoing so ensures that you won’t be stuck in a hard place when the mother is in transition and needs you there almost constantly.

4) Think ahead. For that matter, try to ask a little bit ahead of time about as much as possible. It helps keep stress levels down and leaves everyone feeling prepared. For example, try to gently remind the staff about the couple’s desire for delayed cord clamping in between pushes, rather than right as the baby is being born.

5) Keep your cool. If you are faced with opposition, be polite. Don’t be mean-spirited in your replies. I understand that many of us are very passionate about birth issues. However, starting a fight in the labor room doesn’t help the mother or yourself. If there is disagreement over a procedure or policy, you need to stand behind the couple’s desires while still upholding respect for the staff. I would suggest the following format for your conversations with staff when a conflict arises:

  • I understand there is a disagreement over [such and such a procedure].
  • When the couple and I spoke prenatally, I know they were hoping for [such and such an alternative].
  • Would you be willing to present your concerns with the couple and discuss possible options with them? (Provided this is not an emergency, of course.) Perhaps a compromise can be reached.
  • Thank you for your understanding. I know this may not be your standard protocol, but as long as mom and baby are both healthy, I know they would really appreciate your flexibility in this matter.

Maintaining your professionalism will help your client’s case, not hurt it. And it will help you to develop rapport at the hospital while you’re at it.

6) Let the staff do their job. There are certain times in which you need to allow the hospital staff to take center stage. You should not have a problem allowing them to do what they need to do in these situations. Here are three examples:

  • They won’t want you near the doctor’s instrument table during pushing. Make sure you are not in the way.
  • If the baby needs resuscitation, you will not be allowed to hover over the baby until he or she is stable. Respect this.
  • If there is a true emergency, staff may need to move quickly. Step back and allow them to do so.

7) Say thank you. The hospital staff works very hard for a lot of women. They are usually on 12 hour shifts, on their feet for much of it, and are often being snapped at by stressed families. Many times they are left un-thanked for their work. Even if you weren’t particularly fond of a particular nurse or doctor, make sure you tell them thank you for their hard work! They deserve it!

Okay, experienced doulas… what have you learned over your time working in hospitals? Share your wisdom in the comments section!

Photo Credit

//

The Professional Doula: Dress the Part

Calling all doulas- aspiring and experienced alike! Welcome to Part 1 of a short series on developing professionally as a birth doula. Come back in the following weeks to read more on how to better serve the mother, work with care providers, and develop a good rapport while you’re at it.

Part 1 of our series deals with how you should dress when you attend a birth. I’ll be the first to tell you that appearance isn’t everything, but it certainly can either help you or do a great deal of damage to your professional image.

Remember that every single job, whether it’s in a kitchen or a business office, requires its employees to dress in a certain way. Even if you have a strong sense of fashion, work may not be the time to express it fully. As self-employed doulas, we don’t have any boss to give us hints on our clothing, but that doesn’t mean you should just wear whatever you want. Let’s start with a couple of big no-no’s.

earthmother

Into natural birth, real food, and “green” living? Me too. But please make sure your apparel doesn’t reflect your inner hippie too much. As much as I resent it, showing up to a birth with long unkempt hair and a t-shirt with a “believe in birth” slogan will earn you nothing but disrespect and being talked about at the nurses’ station.

businesswoman2

On the other hand, you probably don’t want to arrive at a birth in a blouse and business suit. You will be doing hard, sweaty work that often goes for odd and long hours. So don’t try to impress anybody too much with fancy clothes. Now is not the time, and the staff understands that.

When you attend a birth, do not:

  • Wear ripped up, old, or torn clothes.
  • Wear heels or uncomfortably dressy clothing
  • Wear a dress or skirt. This will be rather difficult to work in.
  • Show cleavage.
  • Wear t-shirts or sloppy jeans.
  • Wear anything that would confuse you with staff- scrubs, etc. You are not medical and should not give that impression.

Please do:

  • Wear well-kept & neat clothing.
  • Bring extra hair ties. It’s nice to be able to get it back out of your face when you need to.
  • Wear shoes that stay comfortable for hours.
  • Bring a toothbrush and a full change of clothes. Face wash is always nice too. If it’s a long birth, you may need to freshen up at some point.

While there is no strict dress code for doulas, I find it best to maintain a well-kempt, clean & comfortable appearance. Usually for me this means comfortable dress slacks on bottom (easy to do when they have a maternity top!), or a pair of “dressy” black yoga-style pants. I have been known to wear nice jeans or khakis when I’m in a rush to get to a birth, but so far I haven’t had any complaints with that. On top, I usually wear a sweater, tunic, or casual blouse that will hold up to long hours of wear. Again, look nice, but stay comfortable.

Fellow doulas, let me hear from you! What do you wear? If you’re a member on hospital staff, what do you usually see doulas wearing to a birth?

Photo Credits: Mother Earth Photo

Businesswoman in Conference Room

//

What Goes Into a Doula’s Fee?

When people see a doula’s fee that is several hundred dollars, or even going into the thousands, they often wonder what in the world could cost so much about “supporting” them through labor and birth!

So what exactly are you paying for when you hire a doula? Your money goes towards…

  • Her training.
  • Her level of experience.
  • Her knowledge of pregnancy, physiologic labor, natural childbirth, medicated childbirth, breastfeeding, and newborn care.
  • Her constant stream of informational support throughout your time working together.
  • Her emotional encouragement and sensitivity.
  • Her physical support in assisting with comfort means during labor. (This can actually be fairly difficult physical labor for the doula- though granted, not as hard as the mother’s work.)
  • Her unbiased assessment of your labor and presentation of options.
  • Her unflagging commitment to help protect your birth plan, and her flexibility to help you in a new direction if you change your mind or need medical intervention.
  • An extra set of hands to take care of small jobs so you and your partner can focus on the birth.
  • Her communication skills- with you, your other support team members, and with your care providers.
  • Her time at prenatal & postpartum visits.
  • Her on-call availability 24/7, for 4-6 weeks, during your “due window.”
  • Her phone and email availability during your entire contracted time period.
  • Her hours of behind-the-scenes research on your behalf.
  • Her hours at your birth- often without any limits or breaks.
  • Possible prevention of other costly and undesirable interventions through use of natural comfort means, physiologic tricks for labor, and constant encouragement.
  • Her gas expenses in getting to and from appointments and your birth.
  • Her babysitting expenses if she has children of her own.
  • Her food expenses while she is at your birth.
  • Any supplies she brings for you and your family.

Although a flat rate charge of several hundred dollars can seem intimidating to you at first when shopping for a doula, remember that she can save you thousands more in other interventions- and more importantly, she can help you to make your birth what you hope it will be- a positive, calm, and blessed experience.

Many women are surprised to find that their doulas actually aren’t making much money at all. When I break down my fee into hours worked for a single family, I’ve made as little as $2.50/hour, and have never made more than minimum wage. (Granted, my fee is pretty cheap, but still- it gives you an idea of what many doulas are making.)

It really should never be about the money for a doula…  It should be about respecting your intelligence and ability to make informed decisions for you and your baby. It should be about giving you the tools you need to have the birth that you want. It should be about protecting the parents’ desires and the mother’s dignity. It should be about supporting and ministering to a family during a life-changing event in their lives.

It should be about all the love she brings to her work, and to you and your family. Period.

Photo Credit

A Doula’s Best Instructor

What does one have to do to become a doula? To become a certified, you must generally attend lectures and/or workshops, read a variety of books on birth/breastfeeding/newborn care/etc., complete writings in relation to coursework, and of course, fulfill practicum requirements by actually attending births. Each one of these requirements has taught me so much about my work with moms, birth, and babies. But who have been my best teachers?

Moms.

It’s funny how we as doulas always herald phrases like, “watch the mom, not the monitor,” and “follow mom’s lead..” and still- in a moment of fear or stress, I’ve found myself racking my brain for advice I could offer instead of asking my client how she’s feeling.

If you are a doula, what about you? Have you caught yourself flipping through birth books for ideas, or watching the EFM print-out for contractions on the rise, or making irrelevant suggestions, or asking the mother to move to your favorite pushing position (instead of her own)? Have you found yourself worried because mom’s labor slowed, and tried to get it started again without thinking through why it may have slowed? Are you more satisfied in telling the mother how to labor than you are in seeing how she does it herself?

I’m not saying that we shouldn’t take advantage of our resources, or that we shouldn’t make suggestions. There is a time and place for these actions. For example, a mom might be caught in a moment of panic and need her doula to ground her. Or she might not know what to expect next and needs explanation. Or maybe staff and/or family members place emotional or physical stresses on the mother that make it difficult for her to focus. Sometimes necessary medical treatments can interfere with mothers’ natural coping measures and the doula needs to help her find her “ritual” again. Sometimes societal expectations cause a mother to be hesitant to try what feels right to her because she feels embarrassed or frightened, and she needs the doula to be sensitive to her desires and encourage them.

However, with each birth I attend I learn more and more that each mom, when left free to labor as she pleases, instinctively knows works for her as she births her own baby.

As much material as a doula may know, she doesn’t know exactly what and how the mom is feeling during labor. She should observe, listen, and ask the mother:

  • How is she feeling emotionally? Emotional needs must be considered during labor, sometimes even more than physical ones. Is the mom frightened? Discouraged? Angry? Panicked? All of these feelings can and often do affect her labor greatly. 
  • How is she feeling physically? Is there any cause for extra pain? Is she as comfortable as she can possibly be? Is she exhausted? Don’t make her walk 2 hours if she’s been laboring all night and needs to rest. Pay attention to her cues and follow her lead.
  • Is what she’s doing working for her, or does something need to change? “If it ain’t broke, don’t fix it.” If mom is handling her pain well already, jump in and support what she’s doing in whatever way you can. Don’t interrupt her with unnecessary suggestions. If what she is doing isn’t working, this is when you can try different ideas that might help her.
  • Are all of her needs being met? Check, check, and triple check. (Maybe not out loud- that could get obnoxious!) Does she have everything she’d like, such as extra pillows, water, a light snack, a cool cloth? Watch to make sure that everything she needs is filled, turned, fluffed, wet-down, readily available- whatever it is- make sure it’s right! And if you can, be like a good waitress and refill her water (etc.,etc.) BEFORE she asks for it.

In all things, follow the mother’s lead. Support her in her groove instead of taking her out of it. Pay attention to her needs and desires- not what you think you would want. In all situations, be sensitive.

Mothers can teach those around them a lot- if they are allowed to do so. Sometimes mothers can surprise you with a natural resource you never would have thought of, or come up with more strength than you could have offered. Sometimes their choices may be different from your own, but they make those choices for their own reasons. Every birth is unique, and I have learned something new from every mother I have had the privilege of serving.

Thank you, moms, for allowing me the honor of serving you, but also for being my very best teachers.

Should You Become a Doula?

To many, the idea of being a birth doula is very romantic. Your client calls you, saying she’s in labor and she needs your help- you rush to her aid, guide her gently and confidently through her labor, develop a great rapport with the hospotal staff, witness a beautiful natural birth, and then go home happy to your soft warm bed. (All within about a 12 hour time period, right?)

Unfortunately, not all doula gigs go as smoothly as this one. Many times, being a doula means last minute phone calls for back-up childcare, 2-3 nights of minimal to zero sleep, hard physical work, and putting your own preferences aside to support mom, regardless of her birth choices. Don’t get me wrong- I love doula-ing (even though I’m still very new at it), and it’s extremely rewarding. But before you become a doula, think through these questions:

  • Can I be on call any time of the day or night? Do you have another job? Regular pressing commitments? Are you out of town frequently? If you have a lot of other commitments that can’t easily be let go, then being a doula might not be the best job for you.
  • Do I have childcare available to be on call any time of the day or night? If you have children, then guess what- you’ve got to have someone watch your kids! For many women, hiring an on-call babysitter is too costly to justify the time away from your children to doula. For my situation, however, it works out quite nicely. My husband is home by 4 pm most weekdays, so he is my “on-call sitter” for evenings, nights, and weekends. From 7 am to 4 pm, I have my mother (who works part time and adores time with her grandchild), sister in law (who stays at home with her own little one), and two other stay-at-home moms who are willing to help out, depending on their schedules. It is very important that you have back-up childcare, and even back-up for your back-up. You don’t want to be at a birth and find out that no one is available to watch your children in an hour.
  • Do you have a back-up doula who is on call any time of the day or night? Find another doula in your area and play back-up for each other. This is essential for any time that your client might not be able to get ahold of you, or if you have been at a birth for 72 hours and need a 6 hour reprieve for sleep, or if you have a family emergency. Again, you need a back-up for your back-up, just in case. I work with two back-up doulas in my area.
  • Do you have business skills, or can you learn them? I highly recommend browsing The Doula Business Guide by Patty Brennan before opening your doula business. There’s a ton to learn! I am still studying up in this area.
  • Can you communicate well?  See my post on Communication in Birth Work. Communicating with expectant families and their caregivers requires a lot of listening and thinking before you speak.  If you have a hard time holding back your opinion while you listen, you may need to work on taming your tongue before you start doula-ing.
  • Are you physically fit for long hours of hard labor? True, the mother is definitely the one doing the hardest work. But the doula is also in for the long haul. Try doing counter-pressure on the mother’s sacrum for every contraction for 3 hours. Or supporting her in the dangle through an hour of pushing. Or doing belly-lifts from the base of her hospital bed while the mother lies on her back (unconventional, I know!) throughout early labor. Your back is going to be hurting too after all that. But it’s not about you- it’s about the mother.
  • Can you keep your cool in the face of opposition? During a birth is not the time to try to change hospital policies. You must be able to develop the art of maintaining a sincere, pleasant relationship with the staff, but also firmly holding to the mother’s preferences. You must learn to mediate gracefully and tastefully. 
  • Can you support the mother even when her wishes are different from yours? Remember- the mother did NOT hire you to have you try to convince her out of an epidural. She hired you to give her comfort measures, to stay with her, to talk her through everything, to help her have the best and most physiologic birth possible. It’s your job to do everything within your power to support mom’s preferences and then do your job within her framework, not yours.
  • Can you stay within your scope of practice? Doulas are not medical caregivers. Do not offer medical advice. I repeat, do not offer medical advice. As Patty Brennan said in The Doula Business Guide, you are not getting paid enough to take this kind of risk. You do not know enough to take on this kind of risk. You did not go for years of schooling to take on this kind of risk. Your scope is continuous emotional, physical, and informational support to the mother and her family. If you cannot restrain yourself, go become a midwife, nurse, or OB.
  • Do you feel “called” to this work? Doulas typically get very little financially in return for their hours. If you are looking for a lucrative business, go someplace else. Doulas aren’t in the work for recognition- if you are looking to be a hero in the labor room, you have the wrong motives. If you want to be a doula for the fun of it, maybe you should consider a different job. (It is wonderful to doula, but it’s a lot of hard work too!) You have to truly love supporting mamas and babies to doula. I consider doula-ing to be a ministry to blossoming families. I have an opportunity to serve them at a very vulnerable, personal, and spiritually open time in their lives. I pray that I would take my role seriously and serve families humbly and with grace.
  • Does your family support your decision to doula? I consider this item to be very important. Doulas spend long hours away from their families for very little pay. If your family doesn’t support this work, then it is not worth the stress to your home to continue in it. Supporting new families is a very special role, but not at the cost of your neglecting your own family. Make sure you are fostering your own home life first and foremost.

Hopefully these questions will help you as you consider whether or not you should be a doula. If you’ve thought through the issues thoroughly and feel prepared to jump in, then go for it! Overall, I highly recommend the work. I find that I haven’t experienced anything quite as humbling and beautiful as being able to serve a mama as she brings her child into the world.

My husband’s first taste of a doula’s role.

Doula Services in Northeast Pennsylvania

Are you in Pennsylvania and interested in having doula support at your birth, or do you know someone who might be interested? Here is my shameless self promotion for my doula services in NEPA. Check out BeneBelly Doula Services for more information. 🙂 Thanks for stopping by!

P.S. You can also stop by and hit “like” on BeneBelly’s Facebook Page, or even follow @BeneBelly on Twitter. Thanks so much friends!