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Over the years I've served many different types of clients..all who have different motivation for hiring professional birth support. It's funny, sometimes clients seem to think out loud through the hiring process, almost feeling the need to justify the reasons for it.
Obviously, I believe in doula support because it's my profession, but sometimes it's a difficult concept for people to swallow. They have supportive partners, family and OBs and feel strange bringing in outside help. They don't necessarily need education so what can a doula really do for them?
A lot of them time, I am hired because people have done some research and just want some extra guidance to avoid unwanted interventions including cesarean. Maybe they are familiar with the maternal and infant mortality statistics in the US and that the use of routine interventions are the biggest contributor to that.
ACOG and The Society for Maternal Fetal Medicine recognize this benefit and made this statement:
Most of my clients are not opposed to all interventions, they just want to cut out what isn't totally needed. Sometimes that's an epidural, or pitocin, or an episiotomy. Priorities are different for everyone. Obviously, even the best doula cannot control this and knows labor is unpredictable, but we can discuss techniques and communication tools to lessen the possibility.
On the spot education is a big comfort for lots of people. They don't want to be overwhelmed with the "possibility" of what can happen, they just want to keep their head in the game as it's happening... Maybe they didn't have time for birth classes, or just didn't want to take them. AND, no matter how comprehensive your birth class, sometimes things happen that just are not covered (or are forgotten) I'm happy to help these couples have amazing support regardless of their knowledge base leading up to birth.
Education isn't always needed during delivery. I've been hired by tons of medical professionals, including an Obstetrician, Pediatrician, Orthopedic Surgeons, Physician's Assistants, Nurse Practitioners, Chiropractors (specializing in pregnancy), Registered Nurses, physical therapists...as well as Doulas and Childbirth Educators themselves. AS a doula, I also had a doula myself.
Again, motivation was different for each one. Some of these families wanted to avoid repeats of their first births (long, difficult labors with many interventions, some planned VBAC- vaginal birth after cesarean) Some of them wanted epidurals (and I fully supported them)
I wanted doula because I KNOW the pain relieving benefits of knee presses and would have paid someone JUST to do that even with no other purpose. I don't have words to express how much it alleviated my pain. That's not something, in my opinion, that can be learned by practicing a few times. I wanted someone with real life experience who I knew would know exactly what to do and when. I can do REAL physical things to make this process less painful.
Some people are very confident about their abilities and what they want. They feel strong and capable and hare a very clear vision for what support looks like.
Some people are scared shitless and have a history of anxiety and/or depression. They know they need all the help they can get because they do NOT feel confident about the physical, mental or emotional journey they are one.
Least commonly, I have a client with a non supportive partner, who needs me to step in. Sometimes I'm working with a military family who's spouse is deployed, a partner who is out of town and even single moms... but these have been rare cases in my client load. Most clients are in supportive, loving relationships and partners are thrilled to have my guidance and support.
NOW... there are some misconceptions about doulas and the most common stereotype of doulas is usually the opposite of what clients want.
I think when people first hear of a doula, they picture a woman who comes to the side of the laboring woman and pushes other support people out of the way. A woman who firmly plants herself next to the mother, never giving anyone else a chance to participate. OR they think doulas are some variation of witches like this scene from The Back Up Plan doing nothing that is really helpful or beneficial for the mother or family.
They think that doulas only help with home birth or birth center births...or natural births... when in reality, the vast majority of the deliveries I support are in hospitals. Most of my clients are regular people with realistic expectations about birth. The last thing they want is some crazy doula running around with a drum talking about their "flower" opening up.
Birth is raw, it's painful, it can be scary. There is comfort in being able to share these feelings with your doula. It's an intimate process and it's best to find someone who respects the delicate relationships intertwined, someone you can be real with.
I support ALL families, regardless of what they want for their birth or why they choose to hire me. The decisions we make about our births are multifaceted, there are many many layers as to why people birth and parent the way they do. I can provide information about choices and communication tools to help families they way they want to be helped.
The number one question we get asked when we tell people "I'm a doula" is "What's the difference between a doula and a midwife?" OR "OH! Your'e like a midwife?".
A doula is no more like a midwife than an obstetrician. This is a simplified chart of medical duties. It doesn't begin to cover the beauitful relationships that exist between providers and clients/patients. It's basic because above all else, your midwife is there as your medical provider and a doula is NOT.
We want you to love whoever you choose to deliver your baby, and wherever you choose to give birth. It's our job to smooth the process for everyone involved...YOU, your family and your birth team. <3
MIDWIFE (or OB)
There are 2 different types of midwives
Provides prenatal testing/blood work/pap smear/pelvic exams
In Texas, a CPM can only attend deliveries outside of hospitals(at home or a birthing center)
Typically does not have any medical training but is an expert in a broad range of birthing practices
Conducts regular prenatal visits
In the event that you have to transfer to a hospital, your midwife may not be able to stay with you
Is readily available by phone/email to provide resources for pregnancy/birth/postpartum
Checks blood pressure
or continue to make decisions about your medical care. You’ll need to transfer to an OB or CNM with
Can make referrals to midwives or OB/Gyns depending on your desires
Listens to fetal heart tones
hospital privileges. A doula will transfer with you and does not leave your side, no matter who your provider
Will meet with you 1-2 times in your home birth to discuss desired support measures
Measures fundal height
is, where or how you give birth. A doula is happy to stay in the operating room for a cesarean too.
Learns what your unique emotional, physical, and educational needs are
May provide or refer you to have ultrasounds
In Texas, a CNM can work in or out of hospitals.
Helps you understand how to best communicate with your medical team
Makes medical recommendations
If you are already delivering in a hospital with a CNM,
Help you know what to expect each step of the way
Her level of involvement will vary depending on the number of patients she has at the time
[Not all midwives (or OBs) practice the same or share the same philosophy about birth. Your doula can help you find the provider who is right for you based on your desires for your labor and delivery.]
[Not all doulas practice the same. A doula’s sole purpose should be supporting the client. Her training should have a focus on non-judgemental support and helping the client to achieve her own individual goals and a cohesive (not combative) relationship with the medical team.]
Ideally gets called/you arrive when you are already in active labor
The doula never replaces your midwife or OB or nurse.
Stays in close contact before active labor ever starts
Monitors vital signs with help from a nurse or birth assistant
A doula typically has an intimate relationship with her clients,
Takes pressure off of your partner to know when "It's time."
Performs vaginal exams
She is empathetic, kind and non-judgemental
Helps you know when to go to the hospital/call your medical team based on your unique labor/signs
Makes medical decisions
She respects the intimate nature of birth and your relationship with your partner
and symptoms by observing your body language/breathing
A doula is a professional and a trained expert in birth.
Helps you find positions/natural techniques to manage pain/discomfort
A doula should not push her own philosophy about birth but should support her client’s philosophy.
Supports your decision for pain management whether natural or pharmaceutical
Performs perineal repairs (stitches)
A doula’s focus should be the well being of the client, no matter what twists and turns occur.
Stays with you during all of your labor, helping you navigate every turn as it happens
Handles medical emergencies that may arise
In an emergency, the doula is there to calm anxiety for the parents while the medical team works quickly to ensure safety
Provides 6 week follow up appointment
Provides in home postpartum visit at desired time
to check recovery and discuss birth control options
May offer additional services like breastfeeding support/postpartum doula care/placenta encapsulation
May continue well woman exams as needed
Will continue to be a resource for emotional, physical, and educational needs
My six year old daughter is a bright, engaging and energetic child. Right about a year ago she started having some real trouble processing some big changes happening in her life. We thought she would grow out of it but as time passed, we realized it wasn't getting better.
I had to cancel two of her therapy appointments in a row because I had been called to births. Today when I was able to finally get her there, I found out that I was still being charged for the appointments she missed. I cried.
It was a jolting reminder of the extra costs associated with living the #DOULALIFE
I had 3 clients due in all of December. Through some strange turn of events, I had 6 clients deliver within 2 weeks. I was there for each birth. The first couple of births kept me awake for 40 hours before I was able to climb into bed. I was not with either of them for a very long time. Another couple of those births kept me up close to 30 hours. Within that 2 week period, I was up straight once for 40 hours and once for 30 hours.
NONE of those six clients needed me for an extended period of time. This is just what is expected as a full-time professional doula. I'll do the same thing again over and over next year too.
I love what I do and I don't believe that you can be a doula if you don't love it. You'll figure out it's not sustainable and you'll drop off within 2-3 years (the average lifespan of a doula).
The quick burn out is proof that the system for sustainability is and has been flawed. Unfortunately, many of the old doula organizations (and old school doulas) condition those new doulas to think shitty business practices are actually expected IF they really care about women and birth. There is a lot of judgment and I'm over it.
I CONTINUE ON BECAUSE THE THOUGHT OF QUITTING BREAKS MY HEART.
I BELIEVE THAT AM CHOSEN TO DO THIS WORK.
In April of 2015, I trained with a new organization that makes sustainability a priority. I immediately started using ProDoula's contract which defined a period of time included in the service and anything over that period of time would be billed as overtime. For me, that period of time is currently 18 hours. For some it's 12 or 15. I have a doula friend in Ohio who states 16 hours because that's the longest shift that nurses are allowed to legally work in her area. Getting paid ovetime is not a new concept.
What happens if they go over that? Nothing changes as far as support. The doula at the birth might need to call in her partner if she needs to go to sleep for a while...maybe eat and shower. She'll need to pay that doula as well. She'll also need to sleep hard after the baby comes. If she has kids, she'll need a sitter for the following day because she'll be a zombie. She'll have added expenses for things like ordering food in. I've also gotten sick after being at births for extended periods of time. No sleep is very hard on your immune system which means you may end up missing another birth. There is a domino effect that can last for days or or longer. (This is also true for average births that happen overnight.) In the doula world we call this a "birth hangover." I'm not complaining, it's all part of the job but the point is, there ARE extra costs associated with long births. Those costs are immediate and not always accounted for when you are actually making a living as a doula.
STAY WITH ME...THIS PART IS IMPORTANT.
If you are a doula who boasts to potential clients about being at births for longer than 18-24-36 hours with no additional fee in order to land a contract, you might want to think about the power of those words. I don't ever want an client to need support for that long. I would never wish that on any family or any doula for that matter. As a client, I wouldn't want to be scared into hiring a doula.
AND as a doula, if YOU are with your clients longer than 12-18 hours other than on very isolated occasions, you need to reevaluate what you are doing. Oxytocin is the hormone that causes labor to progress and we know for a fact that women who are watched or feel waited on, have a harder time producing oxytocin and making progress. When you arrive too early in labor, it's highly possible that YOU are SLOWING her labor. So while you are including infinite hours in your contract, you may be the very reason she needs infinite hours of support.
I uplift my clients, I tell them they are very unlikely to need me for hours and hours and hours...and you know what? It's true. I believe in them and that gives them the confidence to trust themselves. They know when they really need support.
I don't want to plant a seed of fear with my words (or my contract). I want my clients to know that I have total faith that my service will give them everything they need and more. Maybe reading that contract allows them to believe that they won't ever need support longer than 18 hours because they know hardly anyone does. Maybe if they read a contract stating they'd have support for unlimited amounts of time, they will expect that they'll need you literally for days on end.
If you tell her being a good doula means you won't charge extra when her birth is 40 hours, you only have yourself to kick when it actually ends up being 40 hours. Your words have power.
Abbey is a birth and postpartum doula and placenta specialist in Dallas/Fort Worth and a mom to 4 children between the ages of 21 and 7.