As a doula, I have had the privilege of witnessing so many beautiful moments during labor. From loving embraces to funny (but appropriate) jokes to lighten the mood, a woman’s birth partner can most certainly be her rock during labor. But I have also observed those moments where someone says the wrong thing or eats the wrong food that people in the Twitterverse like to call #epicfails.
It really doesn’t take much to anger or upset a laboring mama, so here are some tips to help you stay on her good side:
Above all, women in labor need love and support. When all is said and done, even if you make one thousand “mistakes,” she will remember that you supported her, and that is all that matters.
It has not been long that I've been a doula. My training is nearing completion with a few more births to be evaluated. I take great pride in my training efforts; read far more than required, watch every film and documentary, listen earnestly to other birth workers and other mothers like myself who have experienced a birth trauma, only to redeem their experience with a subsequent birth. I think I can confidently say "I know the basics" just as confidently as I can say "there is so much to be learned".
As a training doula, I often focus my learning on techniques to be used: massage, Rebozo, essential oils, memorizing positions and their uses. Important stuff, as in most descriptions of a doula these are the highlights of our work. We know how to help you cope, physically. We know the process, and believe in the process, of natural childbirth. We also know about the interventions and how to work with them so they don't fall into the "cascade" we birth workers fear will take away from the childbirth experience. Ask any lay person what a doula does, and if they know anything about us at all, they will know that we can help you deal with the pain of labor.
But despite all the wonderful uses and intentions of those techniques, I fear I have left out focus of a key factor of my work. As a doula can tell you, the most beneficial part of having a doula at your birth is the CONSTANT SUPPORT. I knew this. I believed this true. And yet I still didn't understand the extreme impact that statement has.
Not "doing it with woman", not even "helping a girl out". WITH. With? Such a simple implication of a word. Defined easily, categorized simply.
Not until the last birth I attended did I truly understand the full weight of importance of "with" in my role as labor support.
Although, I should have as I experienced it in my own birth of my second child. In my personal experience of a rather quick labor/birth (6 hrs total), I did not want coping techniques to be used on me. I was fighting off the panic of how quickly my birth approached. I holed myself up in the smallest room of my house and made a small nesting area reminiscent of the way the dogs my family bred in my childhood did. I was offered a simple, and known to be quite effective, hot water bottle; but the presences of the gentle, loving, midwife's apprentice and the trying of that physical ease made me loose focus. I did not like either, and so I stayed alone in my safe place listening to the conversations of my husband and midwife, my mother crushing ice for me in the kitchen, my father retreating to another area of the house so not to disturb the process; alone and content working internally to handle my labor.
And then, eventually, I came out of my nest because I honestly felt a little out of the loop. I wanted to be near the people. I entered the hardest of my labor there, with them. I needed them there. I did not need them to assist my labor and frankly they couldn't have anyway. No, I just needed them. After a unfavorable positional change I remember grabbing my midwife's knee suddenly as a heavy contraction hit before I was ready. Her face was shocked by my sudden grasp as I up until this point had labored within myself, not reaching out for help. And then her eyes told me what I needed to know:
"I know it's hard. I know you're working harder than you ever have. I know."
After that moment I felt a new level of trust. Not because she helped ease my pain or even because she said some scholarly fact about transition being the hardest but shortest part, but because she empathized and validated my experience..... all in a look.
Yes, a doula can offer you many helpful things to deal with your labor but not all who labor want a massage or a positional suggestion. Some just need you to be WITH them. To hear them when they cry out that they don't want to do this or that they don't think it can be done. To know they are suffering. To somehow with your presence tell them you understand. Perhaps a word of "but you are doing this" or "your work is paying off" or even "you are further than you realize and doing more wonderfully than you think" but mostly just WITH.
The last birth I attended was a mother's 3rd and first attempt at a totally natural and un-augmented childbirth. Much like my own, quickly moving. She fought her labor until she couldn't fight anymore. She voiced her retreat of intent for this birth so I could hear it, not because she really meant she wanted to give up but because someone had to know how difficult it was. And I did. I knew. It was hard and it was fast and it wasn't exactly how she pictured herself laboring. Once she had told me and I agreed that it was hard, she stopped fighting it. She danced beautifully the dance of a laboring woman, drawing her baby further through the pelvis. And when her dance was sufficient she found herself a bed to rest in. And when her rest was sufficient, she pushed the baby out in 2 waves without voicing to anyone that it was happening (in fact, in that dark hospital room, we nearly missed that the baby was being born, let alone a doctor to be present for its entirety!). Her birth was beautiful and it was hers. She was strong, even when she tried to say she wasn't. I did not help her with counter pressure or positions as I so often do. No, instead I was simply "with".
To sum up the whole, the best part, the most important part, is that I, and all the striving birth workers in our present, past and future, are WITH you, woman. Every mother that has ever been is WITH you, birthing goddess. And if you need to be validated while you work to bring your baby earth-side, just look to the woman at your birth-she is WITH you in this momentous right of passage and that, I hope, will sooth your soul.
1) Figure out what your health coverage insures. If it is slim or nothing for a home birth or midwifery care, go over your finances and consider what you can afford (keeping in mind that some midwives offer income based sliding scales as well as payment plans.).
2) Interview Midwives and Doulas:
-It is good to interview several before deciding on one. In some areas home birth midwives may be scarce so it will be easy to find their names and plenty of reviews. In other areas, there may be a lot of midwives that service the area and it is a good idea to do lots of research, read reviews, along with speaking with them in person. A good way to find positively reviewed midwives and doulas is on birth community sites that have forums for specific locations (IE: mothering.com offers “tribes” that connect you to mothers in your area of the world). Most midwives and doulas offer a free consultation before they become “yours”.
Examples of what to ask at a Midwife consultation:
- Who certifies you? Are you a CPM, CNM?
- What is your training background?
- What is your educational background?
- Why did you become a midwife?
- How long have you been in practice?
- What is your whole cost, do you offer a sliding scale?
- What is your transfer rate?
- Do you do any “routine” screenings, tests, etc and how do you process them?
- Do you have any hospital affiliation?
- For what reasons would you suggest I don’t deliver at home or need a transfer?
- What equipment do you come with to a birth (and in case of emergency)?
- Do you bring a nurse or apprentice to births?
- Do you offer birth tub rentals if I desire a water birth?
Examples of what to ask at a Doula consultation:
-Who certifies you? (CAPPA, DONA, CBI, BAI, etc)
-What techniques do you use to help me cope with labor/birth?
-How many times do we meet before/after birth?
-How long will you stay with me during/after labor/birth?
-How much is your whole cost and do you offer a sliding scale or bartering system?
-Do you have a lending library or other resource rentals (birth tub, birth balls, etc)?
-Can you help me write a birth plan?
-Do you offer any other services (placenta encapsulation or preparation, childbirth classes, Blessingway hosting, etc)
3) Prepare yourself with information as you deem appropriate. There are lots of great books and resources to help you prepare for birth. Below is a list of books that may be worth a read:
- “Ina May’s Guide To Childbirth” by Ina May Gaskin
- “The Thinking Woman’s Guide To A Better Birth” by Henci Goer
- “Childbirth Without Fear” by Dr. Grantly Dick Read
- “Gentle Birth Choices” by Barbara Harper
- “Homebirth” by Sheila Kitzinger
- “Spiritual Midwifery” by Ina May Gaskin
- “The Complete Book of Pregnancy and Childbirth” by Sheila Kitzinger
There are many, many wonderful home birth resources on the internet as well. As a pregnant woman it is best to work under the philosophy that images and words will greatly affect how you feel and view birth during this childbearing year. So, although there are plenty of things to discover on the world-wide web, discretion is always good. Some sites that I recommend are below (these sites have categorized headings so you can navigate what will be useful and what you wish to see and avoid what you wish not to see):
Consider hiring a private childbirth educator (or speak with your Doula-they often offer crash courses in childbirth for their clients) to meet you and your partner in your home for a childbirth class. (Or even split the cost with an interested or other pregnant friend!) . You could also find a class through hospitals or ask your midwife or doula if she knows and recommends any childbirth courses in your area or online.
Some find attending a natural childbirth class to be just what they need to feel comfortable with home birth while others find their own research and support of their doula and midwife to be enough to prepare. Whatever you choose to help inform yourself, do so at a level that is comfortable to you-over researching and under preparedness have both posed issues for pregnant mothers as our minds can be particularly vulnerable during this time. If you find the more you dig for information the more anxious you become (or the more tempted you are to absorb negative stories and visuals), take it down a notch, tell your support people and advert your attention back to the positive thoughts for YOUR birth.
4) Speak openly with your partner. Decide what your hopes and wishes are for who will be present at the birth of your child, what roles you hope them to play. Discuss your partners comfort levels and work together to become comfortable with your plans. Think about the possibility of having a water birth, what music you may want, anything special you wish to be used to enhance or mellow your birth environment, sit down and consider all the aspects you wish to cover in your birth plan, specifically what roles everyone will play. Enjoy this part of the planning, find common grounds with those you intend to include and make sure the people who support you believe in the process. Reading a book together or sharing helpful articles can be a nice way to bond while preparing for your home birth. If you intend to include your older children, introduce them at age appropriate levels to the idea of mommy having her baby at home. There are several children's books out there that talk about what they can expect.
5) Make an “in case of emergency” transfer plan with your midwife and inform everyone that will be present of the plan. Prepare a separate birth plan for the event of a transfer if you feel it suites to calm you. Most midwives will have you fill out a form that will include what hospital you wish to transfer to if possible, ambulance service if you are rurally located, etc.
6) Trust in the process and have faith that you picked people who will support you. This step is consuming affirmations, day-dreaming, picturing your birth, connecting with your baby, enjoying the fact that you are going to join the ranks of every mother that has ever lived(for the first or subsequent time), as well as give birth in the comfort of your home like so many generations before us. Cool, huh? Remember, you are strong, you are capable, the hands around you offer healing knowledge and support, the space around you offers peace, and your baby knows how to be born just as you know how to birth him. Allow yourself to feel the spiritual aspect of your pending home birth and enjoy every second!
To tell you the truth when I first heard the word "doula" I could only think about homebirth and mothers who totally reject anything which is in connection with hospitals. Then the more I learned from them, the more I started to believe that every woman really needs a doula before, during, and after birth. During this journey I got a lot of help from Anikó Földi; a doula who helped me create this writing with a great interview.
Note: I live in Hungary (Central Europe) where things are pretty different from the USA. A lot of women there don’t even know that doulas exist.
-- How can ’being a doula’ be defined briefly?
-- A doula is a woman who has personal birthing experience; a supporter who helps the pregnant woman when and in what way she needs the most. But she doesn’t decide anything for the mother.
-- What kind of tasks does the doula have during pregnancy, birth, and postpartum?
It depends on what the pregnant woman wants. The doula can help make head or tail of the big amount of information; help the mother make decisions based on authentic information; and help prepare her for the birth. If it is needed she is there during the labor either via phone or personally. These are all individual decisions. It can also depend on the doula to what extent she can assume helping beside her own family.
-- In case of a c-section, how can a doula help the mother? Can she enter the operating room?
Unfortunately in Hungary doulas are “persona non grata” in the hospitals, not to mention the operating rooms. Fortunately there are exceptions, for example where there is an opportunity for the father’s presence in the operating room, then a doula may also enter.
A doula can be a big help in case of a c-section, in caring for the baby, effectuating skin contact, supporting the mother physically, helping the mother spiritually and mentally, and of course every other way that the family needs.
-- In case of homebirth what is the doula’s scope? Does she have any responsibilities?
Doulas are "laymen.” During a homebirth a doula cannot take the competencies of the midwife; it is not her task or responsibility to follow the medical / physical condition of the mother and the process of labor professionally.
In Hungary during a homebirth two skilled midwives have to be present, it is regulation. The professional responsibility is theirs. The task of the doula is the same everywhere; they support the mother in what she needs: compress, massage, physical support, etc.
-- What kind of legal background do doulas have?
As the doula is a supportive person, she doesn’t have any legal or medical responsibility. Unfortunately being a doula in Hungary is not an official profession. (Although her presence should be allowed in hospitals as it is stated in the medical law of 1998 that "Every woman has the right for the presence of a major person chosen by her, during the whole birth process”)
-- Is there official doula training? How can someone learn to be a doula?
There are many schools in Hungary (MoDulE Doula Training, Dona Doula Training, Békés (Peaceful) Doula Circle). In every school training is a bit different, but it usually lasts for some days to learn about being a doula, about the birth itself and the postpartum period. You can learn from authentic lecturers and therapists. As for Anikó, this beautiful world – motherhood, childbirth, being born - opened for her after the birth of her first child. It called her with such power, and more and more information got into her way that she realized she was sitting on a MoDulE training.
-- Can a doula work as it is her main job? What kind of "salary” does a doula get?
As it is not an officially registered job in Hungary, you cannot do it as your main job. The other reason for it is the responsibility towards your own family. Beside a family a doula cannot assume more than 1-2 births in a month.
As for the compensation, every doula works with different rewards. Some are volunteer, some work for a one-time salary, and some are paid after every meeting. Anikó works for about 140 US dollars during the whole pregnancy, birth and postpartum period.
-- For whom is it recommended to hire a doula?
Mostly in those cases when the mother feels that she is looking for the best way for her; she needs authentic information and wants to make head or tail of birth. For mothers who want to be in labor and give birth in the presence of a supportive person. Anikó believes that it is the biggest wonder of a women’s life when she gives birth. Women have this special power, which cannot resemble anything in the world. It’s a special joy if it can happen in an unmedicated (untroubled) way. So Anikó can recommend a helping doula to any woman who has the desire for any of the above mentioned things.
 MODULE egyesület http://www.module.hu/index.php?option=com_content&view=article&id=111&Itemid=76
 Kovács Katalin: A dúlaságról http://www.katadula.hu/a_dulasagrol.html
 Békés dúlakör Működési szabályzata
 MODULE egyesület http://www.module.hu/index.php?option=com_content&view=article&id=111&Itemid=76
So, you think you want a doula. You’ve heard about them, maybe from a friend or on a TV show, and you think it sounds like it might be helpful to you. Maybe you’re worried that you might have to deliver alone, because your partner will be working or is absent altogether, or you don’t know how helpful they can be, or you just want someone else there. Or maybe you know you want a doula, because you’ve been reading a lot, and a lot of the more progressive books recommend them, and you want to try to have a particular kind of birth, and you know a doula can help you.
You’ve decided, so you sit down and start looking. Maybe you’re extra savvy and you know where to find us, or maybe you just do a simple Google search for doulas in your community. Then the results come up, and you find someone in your area who appears to be available—score! And then, below that, the number. Chances are, you’re having some sticker shock. You see a number that’s higher than you expected, and higher than the amount of wiggle room you have in your budget for this expense.
Despite the fact that even Suze Orman has come out and said that doulas are a need, not a want, needing something doesn’t change the fact that having a baby is already tremendously expensive, in some places more than others. You’ll hear a lot about the lifetime cost of raising a child, but the fact is that the points at the ends of that long line of expensive years are the most expensive for a lot of people. The “start-up” costs, even if you’re lucky enough to live in one of the countries where those costs don’t include $10,000 or more in medical bills, are high. For some of you, you’re not going to have another expense this big for this child piled into a single year until you start paying your child’s tuition. The endless hours of number crunching can be heartbreaking, especially if your numbers never seem to go far enough as it is. You may be fully sold on the whole doula idea, but the money just isn’t there to match the fees listed on the websites.
Wanting or even needing a doula doesn’t erase the expense if the expense is more than you have to give.
Here’s the good news: Most doulas want you to have a doula, if you want one. For many of us, it’s a major part of our mission. Doula work is also often our livelihood, however, so most of us do need to recoup some costs. We can’t offer our services without fair compensation for our training, supplies, transportation, and time. What counts as fair compensation depends on our area’s cost of living, but there may still be a gap between the going rate for doulas in your area and what you have to spare. So then what?
Don’t give up. Like Suze Orman, or Dr John Kennel (who famously said, “If a doula were a drug, it would be unethical not to use it”), I, too, believe a doula is an important part of a good birth, regardless of what that means to an individual. I believe every family welcoming a new member deserves—and needs—someone with knowledge to support them during that time, especially if their organic support network is limited. But like you, when I’ve taken a moment to sit down and price doula services, I’ve been forced to admit that I probably won’t be able to afford the listed fees of experienced doulas in my area. My household income isn’t high enough to be able to justify upwards of $1200 on anything at once, and that’s the going rate for experienced, certified professional doulas where I live.
Because I’m a doula myself, though, I now know that there are plenty of options for making a doula realistic, and I want to share them with you.
· Start early! The more time you give yourself, the more likely you are to be able to find someone who suits you and who will work with you. It also means you have more time for things like payment plans or service exchanges, as most doulas will want a portion of their compensation before they attend your birth (because they provide a portion of their services before that, too). Usually, if you start looking at around 20-25 weeks, you'll have enough time to interview several doulas and work out more payment options.
· Find some options: You want to start by finding as many options for doulas as possible, and at least two or three that seem like they're what you're looking for. The major certifying organizations (like DONA International, CAPPA, or Birth Works International, to name a few) usually have an online database of their certified doulas, and a phone number you can call to be put in touch with their non-certified members, who are usually trained and either working on certification or have held certification in the past but not renewed it. You can also consider regional organizations (in Ontario, mine is DoulaCARE), who often do the same. Other options include DoulaMatch and Doulas.com, whose listings include both certified and non-certified doulas from various organizations, searchable by service area.
Find a few doulas who you think might fit your needs. Remember that while experience is important, it’s much, much more important that you have a strong connection with your doula, because your birth is going to be a physically and emotionally challenging time and you want someone who makes you more comfortable, not less. For some, the comfort does come from knowing the doula has experience. For others, personality is much more important. Keep in mind what you need, and be prepared to interview several doulas to find the right fit for your family.
· Make Contact: Once you’ve got a list, start making contact. Explain your situation and what you’re looking for, including letting them know that you’re concerned about being able to afford a doula. Not everyone is in a position where their fees are negotiable, and that’s ok! If you truly can’t afford a doula’s fees, and they truly can’t afford to reduce them for you, that doula is just not a good fit, and that’s alright. Keep trying. If you need to expand your search area, go ahead—anyone within an hour’s travel of you and your birth location should be a reasonable bet.
There are a few extra options for making a doula more affordable, and while not all of them will work for everyone, you may find one or two that work for you. Consider:
In addition to these options, your hospital or birth center may already have a doula program, and these are often lower-cost than private doulas and may even be free for you. Ask your care provider if there is an internal or affiliate doula group. There are some special things to consider with hospital doulas, however. For some families seeking a doula, the appeal is that she’s employed by them, not the hospital. A doula employed by the hospital will be restricted by their liability policies in a way an independent doula is not. At the same time, remember that almost all doulas who regularly work in hospitals, private or not, want to have good working relationships with the medical team, and that no doula is likely to wage an independent crusade against your hospital’s policies while you’re in labor. While we can remind you that it's your choice whether or not to have a procedure or medication, we also can't directly refuse something on your behalf or argue with your doctor for you.
The other important thing to remember about hospital doulas is that they usually work in shifts, and while a doula will generally never leave you just because her shift is up, you probably won’t have the same level of prenatal and postpartum care from a hospital doula, and you also probably won’t have an opportunity to choose which of the hospital doulas is present when you are. Additionally, a hospital doula will be with you in the hospital, but won’t be able to join you at home for early labor, which can also be challenging. This may or may not be important to you, but it is something to think about.
Making Room in the Budget
If you're on a tight budget, you’re probably still going to feel a bit of a pinch somewhere if you’re trying to come up with money to pay a doula’s fees, but there are ways to make that pinch more reasonable. Here’s more good news: many doulas will accept alternative forms of payment or service exchange in addition to monetary payment. This isn’t true of everyone, but it’s true often enough to be worth mentioning! Some other things to consider:
My number one tip, if you’re going to negotiate fees, is to make sure that what you offer is a fair exchange for what you get. Consider input costs, and remember that for some doulas you’ll need to add in childcare expenses, more transportation, and sometimes costs for working in certain hospitals, among other possibilities. Remember also that experienced doulas may want more than minimum wage compensation for their time, and that’s a completely reasonable thing. The single best way to get a doula to refuse to negotiate with you is to start with an offer that devalues her work, her time, and her training. Regardless of her philosophy or her situation, she wants you to have a doula, and she wants you to be able to afford care, but she also needs to support herself and her business. Making an offer, whether in dollars or services, that is inconsiderate of that fact will often cost you an option that might otherwise have worked out for you. Be fair, and many doulas will happily negotiate something that can work for everyone.
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