Ornament

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Ornament

Doula's Notes

Why women shouldn't fear home birth
by Mayim Bialik, Ph.D.
This short essay is humorous, honest, insightful and inspiring.

See also:

Subsections on this page:



Caution for Doulas



Many lay people are confused about the difference between a doula and a midwife, and they may sometimes expect their doula to make specific clinical recommendations regarding prenatal herbs, position for breeches, Group B Strep, and a variety of other complicated topics.  They simply don't understand the difference between a three-year midwifery program that prepares a midwife to handle life-and-death emergencies and a weekend doula program that prepares a doula to comfort and reassure laboring women about normal labor.

I guess it's a good thing that lay people understand that both midwives and doulas contribute to a better birth experience, lower rates of interventions, and successful breastfeeding and mothering, but a doula can feel very conflicted when she's asked a clinical question.

Naturally, a doula wants to help and support her clients, and she has also naturally learned quite a lot about the clinical aspects of maternity care.  She may have doula friends who have also studied herbalism or homeopathy, and they may share some information with her, and she may feel that she knows the answers to some important questions.

But there is much more to making clinical recommendations than knowing SOME answers to important questions.  Here a midwife responded to a doula's question about recommending Evening Primrose Oil (EPO) to her client.  This is a great summary of the thought process that needs to be taking place in the mind of someone making clinical recommendations.  If you find that your thought process is simpler, such as, "Well, I've heard that EPO softens the cervix", then you're doing your client a dis-service to pass this along and leave her thinking that she has received a sound clinical recommendation from someone who knows her medical history and understands the subtle nuances of how this might affect her individually.

I don't know if you are a certified Doula and if you are what scope of practice your certifying group has but with what training, experience or education are you recommending EPO?  I know how easy it is to read in a book or on the internet how great such and such is but I wonder how profound your understanding of EPO is.

What are your reasons for thinking this supplement is needed or necessary? What are your expectations?

Additionally, what are your recommendations for usage? Oral vs vaginal? Dosage?

What responsibility are you willing to accept for this suggestion?

I am not throwing stones either. I have made my way to midwifery via the childbirth educator and Doula route too.


Difference Between a Midwife and a Doula

A midwife has the equivalent of 3 years of specialized training to provide comprehensive prenatal, birth and postpartum and newborn care.  Midwives have exactly the same clinical skills and responsibilities that an OB would have for a normal birth. Midwives have an obligation to provide care in line with the local obstetric standard of care, although their clients have the option to decline treatment.

Midwifery training tends to focus on facilitating a normal birth, correcting minor problems before they become major.  Midwives are obligated to recommend a transfer of care for cases that deviate from normal to the extent that they require a physician's care.  And, of course, midwifery training includes a heavy emphasis on handling unpredictable  mergencies, such as shoulder dystocia, postpartum hemorrhage, and neonatal resuscitation.

A doula's training may be no more than a weekend workshop, and they don't provide any clinical care; their focus is on comfort measures.  It's actually problematic that some doulas give the impression that they're qualified and licensed to advise women on clinical choices, which they're not.  They can give information about what is currently known generally, but they cannot make a specific clinical diagnosis or recommendation.

The similarities are that they are usually women, and they are a key part of an optimal birth experience.

This paper from DONA gives a good description of what a doula does.  And here's a good description from the UK about midwives.

Some women hire midwives as "doulas" because they want clinical midwifery care while laboring at home, and they want a birth advocate who is qualified to make clinical recommendations.

Some midwives are trained as both and practice as both, although DONA asks them not to call themselves doulas if they are providing clinical care.  So you may see the word "monitrice" used to describe someone providing clinical midwifery care during labor, with a transfer of care to another provider as the birth attendant.

Midwifery care does NOT include doula training, and many midwives are actually lousy doulas.



Resources



Doula Mailing Lists

doula@fensende.com

http:


doulabirthconnection Yahoo! group is to connect newly trained birth doulas with pregnant women seeking free or low cost doula services.


Looking to nature, doula Penny Simkin practices the art of delivery - beautiful article about her work.


Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient's Perspective [Full text]
Papagni, Karla; Buckner, Ellen
Journal of Perinatal Education, Volume 15, Number 1, Winter 2006, pp. 11-18(8)


BirthSource.com has a fabulous collection of doula supplies (plus a great selection of childbirth education materials).  They have one of the best dilation charts I've seen; they really show the changes in effacement along with dilation, for a first baby.


Labor Support Initiative from the Maternity Center Association


The Doula School will come to your area.  510-728-8513


Doula Trainings International - "We are committed to providing novice and seasoned doulas with the tools needed to having a long lasting professional career as a certified birth and postpartum doula."

Advanced Online Doula Training, free when you join BirthLove, which is well worth the modest subscription fee. [Ed: birthlove.com is not available at this time.]


Operation Doula Care has been formed in response to the events of September 11th, 2001. Doulas all over the United States have come together to form America's first ever "Doula Reserve". Our mission is to provide, FREE of charge, birth doula support to the pregnant wives of U.S. Military men (Active Duty, Reservists, National Guard, Coast Guard) that have been called up, deployed, injured or have become deceased as a direct result of any military actions relating to the war against terrorism.


Night Doula Care - a website that lists *just women that work at night* as a night doula or baby nurse


Certified Perinatal Support Specialist (CPSS) - an apparent invention of Birth Wisdom, expanding the role of the doula.


Labor Support Initiative - a detailed online guide to help pregnant women understand the benefits or labor support, options for labor support, and how to make arrangements for such support from maternitywise.org. Continuous Support for Women During Childbirth, a new Cochrane Review, presents the benefits of continuous labor support based on the experiences of nearly 13,000 women who participated in 15 randomized controlled trials.


Birth Empowerment Support Team (B*E*S*T) Doula Service is a group of qualified birth and postpartum doulas serving childbearing families throughout the greater Los Angeles area.  Their web pages offer comprehensive information for and about doulas, including a great set of handouts.


Postpartum AyurDoula Care - Tonic Ayurvedic Care for Mother and Baby - This woman is out of New Mexico and trains postpartum doulas in the Indian traditions of postpartum care including massage for  mom and infant.  She has an email list
perinatalayurveda@yahoogroups.com.


A Child is Born offers a variety of workshops in the US and Mexico: Doula Certification Workshop, Advanced Doula Certification Workshop, Childbirth Educator Training, Childbirth Educator Apprenticeship


Polly Perez' Cutting Edge Press - lots of doula resources!


Frequently Asked Questions About Doulas/Childbirth Assistants


Mother-Friendly Nurse Recognition - from www.anacs.org - A certificate to print out to recognize L&D nurses for a job well done . . . to acknowledge a nurse for going the extra mile to help a woman have a good birth, that is part of a movement to recognize that the nurse's attitude really impacts birth outcomes.



Doula Organizations



DONA - Doulas of North America


ALACE HAS GIVEN BIRTH TO TWO NEW ORGANIZATIONS. THE FOLLOWING ORGANIZATIONS WILL BE OFFERING THE LABOR ASSISTANT/DOULA PROGRAM AND THE CHILDBIRTH EDUCATION PROGRAM BASED ON THE EXCELLENT ALACE PROGRAMS AND PHILOSOPHY

The Birth Doula/Labor Assistant Training is now being offered by: toLabor - The Organization of Labor Assistants for Birth Options & Resources

The ALACE Childbirth Educator Training and Certification Program will now be offered by The International Birth and Wellness Project. Please contact them by phone at 1-877-334-4297 or through the web page.


Doulas Make A Difference! ®

A Student Doula Birth Experience Program is under construction through Doulas Make A Difference! ®.  In the near future, you may be able to come to Southern Oregon and stay for 2-3 weeks and receive birth experience at the local hospital. For more information call (541) 732-0548

Space will be extremely limited in the birth experience program.  If you are interested, it is highly suggested that you call now and reserve a space to ensure that you will be able to get in.



Benefits of Doula Care/Good Labor Support



Cochrane Review on effects of "Continuous Support for Women During Childbirth" (click for PDF file).

Read full review

Labor Support from childbirthconnection.org

A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates.
SK McGrath and JH Kennell
Birth, June 1, 2008; 35(2): 92-7.

CONCLUSIONS: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula.


If I told you today about a new medication that would reduce fetal asphyxia by 2/3, cut labor length by 1/2 and enhance mother-infant interaction after delivery, I expect there would be a stampede to obtain this medication, no matter what the cost. Just because the supportive companion (Doula) makes common sense does not decrease its importance.

-- John Kennel, author of Birth, Interaction and Attachment


"If a doula were a drug, it would be unethical not to use it" attributed to John Kennell and/or Marshall Klaus.



Doula Studies - "Doulas came about because a researcher sent women in to record information about typical labors, and the researcher became aware that the presence of the women in the room drastically changed the labor outcomes."  My favorite statistics are about Satisfaction with Partner at 6 weeks.  Every relationship needs a doula!

Nervous dads-to-be worsen cesarean pain

"As birthing partners can improve the experience of women giving birth, Dr Keogh suggested: "Rather than removing them from the operating theatre altogether, it would be better to target the emotional well-being of the birth partner to help reduce the anxiety and fear experienced by the mother."

This study is about cesareans, but most people would agree that it applies to all births.  Doulas sometimes help moms by helping the dads.

Psychosocial influences on women's experience of planned elective cesarean section.
Keogh E, Hughes S, Ellery D, Daniel C, Holdcroft A.
Psychosom Med. 2006 Jan-Feb;68(1):167-74.

CONCLUSIONS: Maternal fear during cesarean section not only fluctuates, but may be influenced by psychosocial factors, including their birth partner. Psychosocial factors were also important predictors of postoperative experiences. Interventions that appropriately manage psychological and social factors during cesarean delivery may facilitate a more positive experience for mothers.


Doulas Can Improve the Health of Both Mother and Newborn - This is a great summary of doula benefits!


Fathers 'a pain' during childbirth [1/25/06]

Many pregnant women will tell you their partners can be a pain during childbirth, but scientists have now discovered they're right. Anxious men pass on their fears to mothers giving birth by Caesarean, researchers from the University of Bath and Imperial College London found.  [Ed. Here's a case where a doula's calming the dad helps the mom.  And many birth attendants would bet that this effect carries over into all of labor and birth.]
from the Journal Psychosomatic Medicine


The obstetrical and postpartum benefits of continuous support during childbirth.
Scott KD, Klaus PH, Klaus MH.
J Womens Health Gend Based Med 1999 Dec;8(10):1257-64

"The results of these 12 trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor."


Continuous emotional support during labor in a US hospital. A randomized controlled trial.
Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C.
JAMA 1991 May 1;265(17):2197-201

50% reduction in the cesarean rate
25% shorter labor
60% reduction in epidural requests
40% reduction in oxytocin use
30% reduction in analgesia use
40% reduction in forceps delivery


Female Comforter During Labor Benefits Both Mother and Infant [Medscape registration is free]  [Obsolete link - please e-mail me if you find this article anywhere online.  Thanks.]


A comparison of intermittent and continuous support during labor: A meta-analysis.
 Scott KD, Berkowitz G, Klaus M
Am J Obstet Gynecol 1999 May;180(5):1054-1059

A recent study contrasted the influence of intermittent and continuous support provided by doulas during labor and delivery on five childbirth outcomes. Data were aggregated across 11 clinical trials by means of meta-analytic techniques. Continuous support, when compared with no doula support, was significantly associated with shorter labors (weighted mean difference -1.64 hours, 95% confidence interval -2.3 to -.96) and decreased need for the use of any analgesia (odds ratio .64, 95% confidence interval .49 to .85), forceps (odds ratio .43, 95% confidence interval .28 to .65), and cesarean sections (odds ratio .49, 95% confidence interval .37 to .65). Intermittent support was not significantly associated with any of the outcomes. Odds ratios differed between the two groups of studies for each outcome. Continuous support appears to have a greater beneficial impact on the five outcomes than intermittent support. Future clinical trials, however, will need to control for possible confounding influences. Implications for labor management are discussed.


Doula: A woman trained and experienced in childbirth who provides continuous physical, emotional, and informational support to a woman during labor, birth and the immediate postpartum period. Postpartum doulas care for new families in the first weeks after birth providing household help, advice with newborn care and feeding, and emotional support.

Effects on birth outcomes: Eleven studies showed the following effects of doula support: shorter labors, fewer complications, reduced cesarean rates, less need for oxytocin to speed up labor, reduced use of forceps, fewer requests for pain medication and epidurals.

Effects on the mother: greater satisfaction with childbirth, more positive assessments of their babies, less postpartum depression

Effects on the baby: shorter hospital stays and fewer admissions to special care nurseries, babies breastfeed more easily, mothers are more affectionate with their babies postpartum

Effects on the healthcare system: dramatically reduced cost of obstetrical care, women are pleased with the personalized care doulas offer

Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement. -Hodnett, E. D. "Support from caregivers during childbirth." (Cochrane Review) in Cochrane Library, Issue 2. Oxford Update Software, 1998. Updated quarterly.

Facing unprecedented pressures to reduce expenses, many hospitals are targeting the largest single budget item--labor costs . . . . [An] unintended consequence of nursing cutbacks may be an increased cesarean rate; the inability of pared down nursing staff to provide continuous coverage to laboring mothers [has been] shown to increase the chance of cesarean . . . . Doulas clearly improve clinical and service quality; they provide an absolutely safe way to reduce cesareans and other invasive birthing interventions. -[Coming to Term: Innovations in Safely Reducing Cesarean Rates. Medical Leadership Council, Washington DC. 1996. ]

The continuous availability of a caregiver to provide psychological support and comfort should be a key component of all intrapartum care programs which should be designed for the effective prevention and treatment of dystocia (non-progressive labor).  [Guidelines on Dystocia. Society of Obstetricians and Gynaecologists of Canada, 1995.]


Doulas improve perceptions of labor, reduce epidural use

WESTPORT, Mar 02 (Reuters Health) - Doulas, women who provide praise, reassurance and coaching to pregnant women during labor, can reduce the use of epidural anesthesia and improve postpartum perceptions about the birth process.

Dr. Nancy P. Gordon and others at Kaiser Permanente in Oakland, California, examined the effects of providing hospital-based doulas to pregnant women in labor in a randomized study. They used medical records and an interview conducted 4 to 6 weeks after delivery to compare epidural use and perceptions of the labor experience in 149 women who had doulas during labor and 165 who received usual care.

Women who had doulas were significantly less likely than others to have epidural anesthesia during labor, according to a report in the March issue of Obstetrics and Gynecology. Rates of other medical nterventions, on the other hand, were similar in the two groups.

Doulas also appeared to improve women's perceptions of the birthing process, Dr. Gordon and colleagues say. The birth experience was rated as good by 82.5% of women with doulas and 67.4% of those without doulas during labor. Women who used doulas were also significantly more likely than others "...to feel they coped very well with labor...and to feel that labor had a verypositive effect on their feelings as women...and perception of their bodies' strength and performance."

"What didn't show up was an effect on self-esteem or depression," co-author Eileen McAdam told Reuters Health. She explained that prior studies had indicated that doulas would have positive effects on both of these outcomes.

Most "...women who had doulas were very enthusiastic about them," the investigators report, "...and even women who did not have doulas thought they would like to have one if they had another baby." The findings support further examination of the use of doulas in the delivery room, Dr. Gordon and her team conclude.

McAdam said in an interview that physicians and others interested in more information on doulas should consult the meta-analyses, cited in the report and published in 1996 in Obstetrics and Gynecology, volume 88, pages 739-744.

Obstet Gynecol 1999;93:422-426


Doulas of North America Position Paper: The Doula's Contribution to Modern Maternity Care from the DONA Web pages.  This article has a lot of good statistics at the end.


Benefits of Assistant for Childbirth Go Far Beyond the Birthing Room By SUSAN GILBERT
New York Times - May 19, 1998


Assistance of a `Doula' May Reduce Childbirth Complications


Someone recently mentioned that there was a study done that showed that even with one on one nurses to moms they only spent 6 % of their time with the moms.


From Vol. 3No.3 (Sept/Oct 1995) of The International Doula.

McNiven, P.; Hodnett, E.; O'Brien-Pallas, L.L. "Supporting women in labor: a work sampling study of the activities of labor and delivery nurses." BIRTH (1992 Mar)19(1):3-8; discussion 8-9

....This study piloted a work sampling method that was adapted to determine the proportion of time the average intrapartum nurse at a Toronto teaching hospital spends in supportive care activities. Supportive care was operationally defined within four categories of activities: emotional support, physical comfort measures, instruction/information, and advocacy. Work sampling was an effective method of measuring support as a specific aspect of direct ntrapartum care. The proportion of time that nurses spent in supportive versus all other activities was 9.9% percent (95% confidence interval 7.5% and 12%), based on a sample of 616 random observations of 18 nurses. ...


About Labor & Delivery Nurses Not Providing Labor Support


Why aren't they paid to labor support? I see them sitting at the desk, true that isn't true in all places but here sometimes there is only 1 or a couple in labor, they get no more time, yet I see them sitting , smoking and drinking coffee at the nurses stations and many times there are several there. I don't think that more labor nurses want to get personal, I work with a CNM who said that when she was a labor nurse they discouraged it.


I have to respond to this, although I have been content to sit on the sidelines for this discussion. I have now been drawn into it from the above message. I have worked as a labor and delivery nurse in one of the hospitals in Great Falls, and I do not believe I ever said that the nurses were discouraged from providing labor support. Rather, we were often assigned a patient load that made it difficult to be one-to-one with the laboring woman. I must strongly object to the assertion that labor and delivery nurses do not want to get personal with their clients. Let's be careful to comment only on what we know for a fact, not speculation, rumor or misinterpretation of someone else's comments.


Doula Participating in Study at Kaiser



Doula Collectives




I've worked in a doula collective and in single-doula or "private" doula practices.  The collective had both its positives and its negatives. It's great for the new doula needing experience, and also for someone who doesn't want to be on call all the time. You know which days you work and when you need child care. It's also great for the Mom who can't afford a 'private' doula. But the reason I hesitate to refer anyone to you is because I don't believe that it provides women with best that a doula can offer, which is the continuity of care from one person and the benefits of the relationship that is developed between doula and Mom.

What I and the other doulas in our collective found was that the 'collective' doula was underpaid for the time spent and it made the 'private' doulas look bad. Also, since the Mom was not as invested in the doula attending (because she didn't know who would be there--it could be 1 of 7 doulas), she herself was not as invested in the experience or outcome (i.e.: more interventions were used).

Again, this is based on my experience with the 'collective' and I'm not saying your business or idea is bad or will be bad. It just that it goes against my doula philosophy as a 'private' doula.



When I did work for a hospital that had 24/7 Doula's on call that were paid by the hospital I think it was well worth it for the clients, but many of them, if they knew before that they would have a doula, only had an intake prior to labor and had no expectation of who would be their doula, not even a meet and greet. The shifts were 16 hours and so often a doula would switch off with another. The connection was made during the labor, which let me say, is VERY difficult to make an instant connection while someone is already in active labor, in a gown connected to machines and already had some form of intervention. The follow up postpartums would just be done on rounds for the days that they were in the hospital. It definitely was a step in the right direction because the L&D floors eventually became entirely ran by Midwives and Doula's. 1 doctor on call for 24 hours that would pretty much be asleep in the on call room unless needed for only medically necessary sections that were very last resort or for orders-and 1 anesthesiologist. It took lobbying for this, as a cost cutting measure at the state level of congress. As L&D floors are unnecessarily expensive with the gross amount of sections that happen in California and that ob/gyn's are surgeons by nature and that there are tons of other surgeries that women need that can be done during the 9-5 hours.

the Doula program provided a chance for everyone to have emotional and physical support who would not otherwise have the opportunity. Including many times, young, teenage, single mothers.  It was paid for by all insurance carriers that worked with the hospital and by medicaid and because the cut costs SO much on the labor and delivery floors it allowed top of the line prenatal care, perinatal services, and postpartum/lactation services to be paid for by medicaid as well.

When I moved here, I hoped that someday, a push like this would start to happen, or people would gather to start making this happen, especially during the extreme budget cuts to social services due to the deficit in California. But this was a public service for people who did not hire a private doula.

I don't mean to offend. But we all have our own style's of doula'ing so to speak. Even birth doula's know their clients enough who to refer as a good match for a postpartum doula for their client as it's a relationship that is nurtured throughout the pregnancy. It's a sacred trust. Websites, advertising, all that may get you a phone call but really referrals are what get you the job, because the clients trust you. Even looking for a backup doula (like I am about to for a certain client) I scrutinize people to make sure that this is going to be a perfect fit for a certain client, which is why I don't have 1 certain backup.  I don't think you guys have a bad idea, I think you have a good idea to take as a formulated one that you can get referrals for new doula's and people looking for low cost doula's and etc.. I also think that if you are interested in lobbying for maternal change in hospitals your set up, as a business plan is one that is good to go to the  state house and start talking to people during an election year.

I wish you all well, I come from the experience that you all are embarking upon and say that it is VERY hard to establish a trust and a rapport with a couple, a client while they are laboring. But it's a marketable idea to really push for in maternal health in California. It's needed.



Doulas and Dads/Partners



How Dads and Doulas Work Together - A Help for Fathers During the Labor and Birth of Their Child


Female Comforter During Labor Benefits Both Mother and Infant [Medscape registration is free]

Studies show that the father-to-be provides support to 80% of laboring women in the United States. To study whether the father eliminates the benefits of a doula, 555 healthy women were randomly assigned to be attended by the baby's father and a doula or only by the father. Among women assisted only by a male partner, 22.5% required cesarean delivery, Dr. Kennell said, compared with only 14.2% of those assisted by the father and the doula.

Moreover, doula-supported mothers bond more quickly to their new baby — 2.9 days versus 9.8 days for non-doula mothers — and spend less time away from them. They are also more likely to rate their baby as better than the average baby, Dr. Kennell said.

Exactly why doulas are helpful is unknown, but touch may play a role. While support from the father-to-be is rated highly by new mothers, systematic observations show that fathers tend to touch their partners less during late labor compared with a doula, Dr. Kennell said. Fathers also routinely leave their place at their laboring partner's side when hospital personnel enter the room for any reason.


My Experience With a Doula During Childbirth by Dana H. Glazer - A new Dad writes about his experience with a doula


Brochure - Nurses, Midwives, Dads and Doulas


Myths about Dads & Doulas


Doulas & Dads


My husband read "The Birth Partner" and talked to a man whose wife had a natural birth .  He came home and told me HE wanted a doula.  He did not want to be responsible for remembering everything, knowing what positions were helpful when, etc. etc.  He wanted to be my husband and the daddy.  I frequently tell dads that their job is to love the mom and baby, my job is to think.  I always get the husband as involved as possible. For example, suggesting a position change, then letting him do the massage etc.  I also manage the details--run for drinks and snacks, adjust the lights, get wet rags all that stuff.  Dads like to be able to go for a walk and pee during labor.  Doulas let them do that without leaving the mom.

A good doula makes the dad look like a hero.


As a doula, part of the work that I do is fostering the relationship that the couple has.  Part of the beauty of this work is that we can really help the dads to have a better birth experience too and also give them the opportunity to support his partner is his own way, whether that be right in there in the thick of it all, or in a more back of the scenes way.  The moms don't have to get mad at their partners when he just doesn't seem to know what to do because we are there guiding him while we serve both of them.  I don't think the dads are giving over their role at all.  I do find, however, that at some point during labor even the most actively supportive dads step back just a bit into a more protective role and allow the "women's work of birth" to take over.  Most of the time when this happens it is as labor becomes very active, just before full dilation when it can get very intense. They always come right back to it when she is pushing.  There was some study done, maybe by Klaus and Kennell showing that moms who have doulas and their spouses with them feel closer to their spouses after the birth than those who don't have doulas.


This is how I share information with dads/partners and other family birth supporters - I have a sheet of paper which is mostly blank, except, along the left hand side I have:

Dad, Mom, Doula, Other, each as its own section with lots of blank space.  I give a copy to each person and ask them to fill out on their own what they feel each person's role is. We then get together and discuss this and work towards each of us being in sync with each other's wishes.


How To Help Dads Keep From Fainting

I just wanted to offer some tricks of the trade to keep from fainting in the OR during a C/S, or during pushing, helps the dad too.
Always eat something before you go into the ER and before the pushing starts. I eat luna bars.
Always have an alcohol swab handy and rub it under you nose if you feel nauseous.


Doula Business and Fees



Economics of A Doula's Fees - How are fees set?


In my quest as a Doula and a business professional I have been guilty of charging less for my time.  We all know the importance of the work we do... treating  it as such sometimes means applying a material value that translates to others as "an important" service.

In today's society our exchange of energy with others takes the form of  money.  By understanding that the energy we give as Doulas is equal/worth a  valuable exchange might help others to know its value.


Free or Low-Cost Doula for New Doulas

I am a doula in training looking to attend a couple of births free of charge! I am in the process of completing my DONA certification and don't feel it is right to charge while doing so. In exchange for the free service I would simply need a few evaluation/feedback forms filled out.

Welcome to the amazing world of birth and our awesome community!  I just want to give you and any other new doula a little word of caution…often, people who don't pay for a service don't see value in it.  Even though you have not been to a birth before, I'd still advise you to charge- even if it's only $50 or $100.  It would be such a huge disappointment to put time in with a new mama, see her for prenatals, limit your own life while you are on call, only to hear she had the baby without you!  I caution you because it has happened *many* times before.  You can simply to tell couples you are asking for a small fee to cover your expenses- gas, food, etc.  When they put a little money out, they are more invested in your service.  Good luck!


And get the payment IN FULL before her due date or at the last prenatal.  I've had that happen too (not been called for the birth after all the time I've put in w/ prenatals, etc. and waiting for days on call with the labor putzing along) and then have them not want to pay me the agreed upon amount because I didn't attend the birth (which was only due to the fact that they changed plans at the last minute and didn't call me!).  Not only did I have the disappointment of not getting to go to the birth that I had invested so much time and heart in, but then the disrespect of my time and not being paid for my time and energy.  Then if they don't call you, you are still at least honored for your time and expertise, and the agreement with you kept.  Although you will still have the disappointment of not getting to go to the birth, at least their last minute change of plans will be their financial loss not yours.


Even at an average rate of $800-$1600 ish, we all know that Doula work does not make for a "living wage," at a safe max of 4 clients per month.  And we all know it breaks down into an incredibly low hourly wage in most cases - especially considering it is pre-tax and does not include health or any other benefits.  We also know how taxing it is on the doula and her family.

Even a doula-in-training is working and pouring her energy, skill, and heart into the work, often relying on others for her own childcare for extended and unpredictable lengths of time, and should be asked to be compensated.  Families have tight finances, and we do this work because we want so much to help, and don't want someone to not get a doula due to $, but doulas have tight family finances, too.

What happens when we constantly drop our prices even further below a living wage, is that birthing families are able to persist in undervaluing what it is we do.  They never learn that it is an expense they need to plan and budget for (like their beautiful new crib set or other items), and our rates stay low year after year after year, so doulas work for a few years, burn out and/or lose the support of family/partner, and go on to get another job to actually pay the bills.

I absolutely believe that we all reserve the right to do an occasional pro-bono or reduced-fee birth, as a service, because some expectant parents couldn't produce more money for a doula even with the best planning and prioritization,...
AND I strongly encourage all doulas to be careful about undercharging, even from the beginning.  It pulls the wages of all doulas down, parents tell other parents they can get a doula for $300-$600 or less, and keeps everyone from charging what they need for the valuable service and time they are providing.


Yes, I have also told potential clients (with whom I felt particularly connected and really wanted to work) that if the cost is the only obstacle to hiring me to let me know.  Most do not, they work it out or choose someone else.

I offered to do my 1st birth on a volunteer basis.  They wanted to pay me anyway and I left it up to them.
After that one, having experienced the amount of energy the whole process required, I took my 2nd client when she was 40 wks (her primary doula was leaving town), and charged $300, knowing there was almost no prenatal time involved.
After that one, I charged $600.
It's just too much real work and real energy and WE BRING VALUE - by our presence, our training, our focus, our intention, and our love.

After my 4th or 5th birth, I used a sliding scale, but a very intentional and careful one, and I believe it was the best thing for all involved.

My scale starts at the base I would charge if I were charging a flat fee -- NOT BELOW IT.
Then it extends up another $400 or so.
They do not need to commit to their price before-hand, and I do not ask for financial records or get involved in assessing ability to pay in any way.  Many, many factors contribute to a person's financial pressures, including their partner's spending habits, partner's perspective, mortgages or car loans they are already stuck in, etc, so I have no interest in being involved in that aspect.
A deposit of a little over a third of the base is due upon contract/hire.
A second payment of almost the full rest of the base (almost) is due at 38 weeks.
The rest (something like $100-500) is due by 2 weeks after the birth.

This way, I'm not dropping below my needed standard -- minimum to feel good & fine, not bare minimum.
And the parents get to break up the payments over time in most cases.  AND, they don't decide their full payment amount until after their birth, when they know best how much time was involved and what it meant to them.  If the birth was quick and easy, great! They can feel okay sticking on the lower end, or pay more because they are thrilled with the whole world!  If it was long or complicated or whatever, they now have a full grasp of what it really means.

I understand the appeal of standardizing rates across doulas, but my own feeling is that it may not be practical, since we each need to autonomy to decide what feels and is worth it for our own time and energy.  Some doulas may have only attended 3 births as a doula, but may already be a massage therapist, or counselor, or prenatal yoga specialist, or have exceptional personal skills/qualification/personality for the job, or be pouring her energy into reading and training and learning.  We are just too individual.


I don't ever want someone NOT to hire me because they truly can't afford my fee and I do say that.  But that said, I want to know that it is a situation of not being able to TRULY afford it.  I have offered a sliding scale to folks who have said that, only to show up at their house with 50" flat screens and BMW's in the driveway.  I'm on a budget is very different than truly in need.  This is where a volunteer doula program is really needed.


There is a big difference when then can't afford you ...Or ....they don't want to pay your full fee. Everyone wants a bargain.....We are in a world where if you want it you will find a way to pay for it. Whether you go into credit card debt or do it the old fashion way...and save your money.
I can tell if people truly are struggling...they are the ones who don't ask for the discount they just ask when they need to get you the money.


I totally agree with everyone on this topic and I get very bummed when my colleagues undervalue their own work


How A Doula Got TV Coverage



Doula Contract



You can find my contract on my WWW site.

This address will take you directly to my contract. I made up my contract from 2 examples given in Cheri Grant's "Labor Support Forms: A Guide to Doula Charting." I do not consider it copyrighted, since I combined and changed what she had presented. Actually, that's what I've done with most of the forms in that book, but they sure were a great place to start!


Doulas of East Central Indiana - Contract/Letter of Agreement and Description of Doula Services



Doula Liability Insurance



ICAN offers liability insurance for doulas and CBEs


 I am covered for postpartum work; I am not sure if they cover birth doulas but I would be surprised if they did not.

CM&F Group, Inc.
151 William Street
New York, NY 10038
1-800-221-4904.
info@cmfgroup.com


[Feb, 2000] We have a market for doulas who are dually licensed (e.g. also as RN, massage therapist, accupunturist, etc.). We have also received approval to insure doulas/CBE's/Lamaze/Monitrice  for policy limits of $1,000,000 each claim/$3,000,000 annual aggregate for annual premium of $236.93, regardless of number of hours worked (full or part time). Program details will be  finalized within thirty days. Thanks! Ann Geisler/Dean Insurance 800/721-3326 ageisler@deania.com


I carry Postpartum Care Provider Professional Liability Insurance from National Union Fire Insurance Company of Pittsburgh, PA an authorized Representative of Cotterell, Mitchell & Fifer, Inc. out of New York # (800) 221-4904. This does cover all you Doula Services birth and pp. It's about $ 50. a year. I haven' t checked out any other options so I would welcome any feed back. Another Doula out of New Orleans gave me the # a couple of years ago.


I recently followed-up on a post that gave the name and number of an insurance company which offers liability insurance to doulas.

My finding is: National Union Fire Insurance Co. offers doula services coverage -- for birth and post partum work -- for an annual fee of $47.00 for $1 million of coverage and $79.00 for $3 million dollars of coverage. The insurance co.'s number is 800-221-4904.


National Union Fire Insurance Company offers liability insurance for BIRTH doulas. $1M is $47/yr. $3M - $79/yr. 1-800-221-4904


I contacted the National Union people a few months ago when I returned home from my doula training workshop. Liability is a big issue around here (the Philadelphia suburbs). The people that I reached were in Louisiana, had no idea what a doula was, and said they couldn't cover me anyway because I was in Pennsylvania - I don't know if it was that I was out of state, or the particular state I am in that made the difference.

At any rate, I was under the impression that the coverage was for PP doulas only anyway?



Doulas and VBACs



I think that it is *very* important for us (doulas) to remember when taking on VBAC clients, that they are relying on us to really be there for them.  The VBAC moms that I have worked with over the years have pored over information, gone to great lengths to make the best choice in their care providers, educated themselves in every way they could, and very often not had the support of their families and occasionally their partners.  All of this so that they could have the very best shot at a vaginal birth.

As doulas, when we tell our clients that we will give them "continuous support", we better do just that.  Because sometimes we are the only ones that they feel are really and truly on their side.  They rely on us to be next to them on their path, sometimes literally holding their hand.  Continuous support does not mean that we can leave them if they get an epidural.  It does not mean that we can leave them if they are sleeping.  We are taught in our training that continuous support means just that - we stay by their side at all times.  And if we can't, we call in a back-up.

For many of these women, the point in their first labor when they got an epidural and/or pitocin was the point in which they felt that the downhill slide began that led to their cesarean.  So if those things come up in their labors the second time, that is the time we need to hold their hands tighter, guard their space more ferociously, and pour more love from our hearts.  It is certainly NOT the time for us to leave to get sleep, or to eat, or to run errands until they need us.  I feel that when we leave their side, we might as well be saying to them that we do not believe in their ability to have this VBAC.

I encourage all of the doulas on this list to remember the guidelines that we work by, whether or not you are a certified doula or not.  Yes, the majority of us make money doing this work but is that really why you do it?  Or do you do this work to fully support women in this pivotal moment in their lives?


While Doulas can help a lot, they can not do everything and expectations are extremely important for all Mamas but especially VBAC Mamas.  As an aside, not all women go into their VBAC making good choices in care provider or facility due to fear or insurance reasons.  Despite the information we offer...not all women are receptive and have unrealistic expectations (in either direction...low or high).  As a result, these Mamas require a LOT more patience and effort on the part of the Doula.  However, even if the care provider rocks this time, these Mamas will still need a lot of reassurance and energy from their support team.  If you ask many of the VBAC Mamas about why they did not like their first birth experience...you will find:

1.  They did not know their options.
2.  They were not heard.
3.  They were not involved in any of the decision making.

1, 2 & 3 = NO empowerment

This means they need these things in spades the second time around from all of their care providers.  Sometimes it is only the doula that actually offers them since care providers & partners are not always on board.  This is double/triple duty for Doulas and if you can't provide this, then please think again before agreeing to Doula them.  If anyone takes on a VBAC Mama, they really need to understand the psychology & listening skills needed to work with them properly so they can gain their confidence back regardless of the outcome.  Then when labor begins, we really need to be there for them.  These labors are often longer than usual and the commitment needs to be there on the Doula's part up front or another Doula needs to be in place to assist (one they have met before and feel good about participating).  I have worked with our local ICAN chapter lead directly about these issues in the past and have attended similar ICAN meetings that have really helped me to gain a broader understanding of what is needed to help VBAC Mamas.  The more we know, the better support we can provide to improve outcomes...whatever they are :)


I most frequently hear about difficulties around when the doula actually goes to be with the laboring woman.  Many women wanted the help sooner, but due to the physiology/psychology of labor, they were unable or unwilling to push for that if their doula tells them over the phone (even if well-meaning and also giving helpful suggestions for comfort) that they should call back when the contractions get to ___.

This may come up even more frequently with vbac mamas, since they know from experience how the lack of emotional and physical  support can undermine their labor hormones and sense of safety.  It is certainly reasonable for a doula to have boundaries around how early she will go to begin the labor support -- and it will best serve the doula and the mama if she is sure those are clearly communicated to the parents before being hired.

In addition, I feel it is also important for doulas to be careful not to SEEM to be saying that "if you want a vbac (or unmedicated labor, or whatever), you need to have a doula" in a way that implies that having a doula will somehow ensure the vaginal birth.

Yes, many of us agree that without that support and educated suggestion of comfort measures, etc, the likelihood of vbac may go down.  But some moms hear that statement as saying that having a doula will almost guarantee their vbac.

Many of these women are extremely emotionally tied to the goal of a vbac (since it actually requires that kind of emotional investment to even try for one in this environment!), so they may be more likely than some to hope that their choices of provider, location, and doula will ensure that outcome they want.

With enough experience, we know that we, as doulas, are not a promise of an unmedicated or vaginal or uncomplicated labor or birth in general, but some parents can be tempted to view it that way, and many doulas can inadvertently reinforce that mistaken idea that that's what we're FOR.

We are there to provide CONTINUOUS SUPPORT -- which in many cases helps to REDUCE THE LIKELIHOOD OF needing or wanting certain medical assistance or procedures, but that should be seen as a side-effect, NOT the intended goal of having a doula.  I think it is important that we are up front about addressing that issue with expectant parents and not allow that misconception to be what "scares" them into hiring a doula.

If we play into that temptation when trying to encourage someone to hire a doula, we will feel like failures too often, and we set our clients up for giving away their power and responsibility over to others -- and it's not any better for them to give power to a doula than to a midwife or a doctor -- it still produces dis-empowered new mamas who don't trust themselves.

My personal feeling is that we best serve mamas when we encourage them to identify and access the help they may want, rather than encouraging them to feel helpless without the assistance of others.


One thing I find that has worked well for me and my clients, when asked the inevitable question "when will you come?"  My answer (and promise) is "Whenever you feel you need my help."  I also remind them that it will take me XX minutes to get there (weather it is home or hospital).

It might be a good idea to have a (some) SBBC meeting topic(s) on a doula's role and responsibility and to share ideas of what helps and what hinders a good experience - regardless of interventions and birth route.


I think it is easier to negotiate when to come if you know you're being paid by the hour.  When you offer a package deal, you are taking on the client's responsibility to do a lot of the inner work she needs to do in order to be able to have a VBAC.



 



Doulas at Homebirth



I think midwives are as puzzled as the parents about the purpose of a doula at a homebirth.


I have only been to a few births with doulas and they all have the same thread of the doula thinking things are _really_ cooking along, and we end up being there for days. I believe strongly that women need to only give labor as much energy as it demands, and when they get the pretty music out and the candles in early labor, and feel like this is the real things, it ends up epic!

I do think, however, that at a hospital birth, doulas are  essential!!!


I think that sometimes doulas at a homebirth want to badly to impress the midwife so they'll get a lot more referrals to other homebirth clients that they pull out all the stops with the music, and the "active birth" and really working the labor.  This higher adrenaline level inevitably brings a level of dysfunctionality to the labor.  Sigh.


Most doulas are trained to assist at hospital births and have most (or all?) of their training there.  Something that is very different at homebirths is the timing  and the pacing.  Many homebirth midwives don't rush things along  the way they do in hospitals.  It is important for doulas to understand and respect that this is what the mother has chosen.


As a doula, I've felt pushed away from homebirth midwives as well...which is a shame, because if anything I feel inspired by them and would love to learn from them.


If you view attending homebirths as a learning opportunity that you're especially eager for, you could make your services more attractive to homebirth clients by offering those clients a discount.

I wonder if you aren't expecting much more from a homebirth midwife than you expect from hospital birth attendants?  Are you expecting her also to be a midwife to your hopes and dreams? Are you expecting her to teach you and nurture you in ways that you wouldn't expect in a hospital?

I don't know, but I keep hearing these very personal responses to what is essentially an impersonal, role-based relationship between a birthing woman's midwife and her doula.  Sometimes I wonder if doulas are expecting the midwife to protect and nurture them and their experience at the birth in the same way they protect and nurture the birthing woman?

The bottom line is that if your doula services improve things for a birthing woman (and subsequently her midwife), then the midwife is going to want you there, if she has any sense. I don't discount the possibility that there are irrational or neurotic midwives, just as irrational and neurotic people can be found among the ranks of doulas, hospital midwives and OBs.  But most midwives are quite happy to have their lives made easier and their outcomes improved.

So, to doulas in general, if you haven't had an opportunity to "prove your worth" to your local homebirth midwives, make them an offer they can't refuse.  Every midwife at one time or another has a client who will obviously benefit from professional labor support.  If you're especially looking for opportunities to attend homebirths, offer your favorite midwife a special deal for her clients, or for the first client you help or whatever.  Then, if you do a terrific job, she'll obviously be recommending you to her other clients as well if they ask.

It may be that there are some midwives that you get along with better than others; it seems sensible to work harder to build a relationship with the midwives you like.  If it turns out that you don't like any of the midwives or don't get along with any of them, well, maybe your community is in desperate need of midwives and you might want to consider becoming one yourself.  Then you can treat doulas the way you wish you were treated.  (This isn't exactly how I became a midwife, but I was a doula first.)


I LOVE the idea of doulas and labor support.... I'll take any extra help mom can get. And I love it when clients ask questions and want to discuss things. I even like it when the doula wants to discuss things..... but a doula who contradicts and challenges the midwife is a different situation.

If as a midwife, I think it best for mom to go to sleep in early labor, but her doula decides mom should walk to stimulate labor --- then what happens? Some doulas are so used to managing labors in hospital (where they often ARE the only one present iwth the laboring mom) that they forget there is midwife/client relationship which  might be damaged when they suggest something contrary to the midwife's advice.

I would love to have doulas available who are supportive of -- and trained in -- midwifery style homebirth, but it's out of my hands. Parents hire someone from the phone book to doula at their births and the expectations at home are very different from the expectations at hospital.

At a hospital, I imagine folks would be shocked if the doula cleaned the room and helped change the bed and mopped the floor. At home -- this is simply part of labor support (or should be). A doula used to hospital wouldn't expect to spend the next four to six hours after birth to help the mom --- the mom doesn't need it. There is a whole staff of folks doing the things mom needs. But not at home.

So when a family pays as much as $500 for a doula to come to a home birth, there are conflicting expectations. If all mom is getting is labor support and no home care or postpartum help, then it's a lot of money to pay -- especialy considering most moms are getting labor support from thier husbands, freinds, family or the midwive's themselves.

On the other hand --- a doula in hospital can save a mom a world of interventions -- she is greatly needed and is a wise investment.

If  expectations are clear from the outset, then that;'s fine.

Homebirth is just a different scene from hospital birth, that's all. I think -- in a perfect world -- the doula role should be different too. But people should know what is expected --- I rememer one doula looking at me like I was nuts when I asked if she would take the birthbed sheets to the laundry room!

So I think it is partly my own expectations which are to blame. I have a hard time thinking of my role at a homebirth as being just the woman who catches the baby -- and by default -- does all the cleanup afterwards -- while a doula does the labor sitting, labor support,  and "labor management". Conversely, it's probably frustrating for a doula who attends a homebirth and finds the midwife doing the things the doula is trained to do -- and then being asked to do maid's work after the birth!

It's worth taking time to discuss these roles all  before labor begins. My mistake was that I have seldom met a doula before mom goes into labor.  should insist on it so we can talk and get to know each other first.


As for homebirth doulas, I welcome them in my practice.  Our geographical area is tight so I know most of the birth attendants here.  If a client expresses a desire to have a doula, I don't try to talk them out of it.  I will recommend a few names if they so desire.  More times than not they will opt for labor support from my assistants.  But if they are married to the idea of a professional doula, I say go for it.  I  always meet with the doula during a prenatal so that we have a clear understanding of responsibilities.  I know where they're coming from and vice versa.  All of my assistants/apprentices are required to be doulas and learn the very patient art of labor sitting...not to mention clean up, cooking, babysitting, etc.  Everything is a learning experience. I have had only one occasion in which I had a difference of opinion with a doula...and as luck would have it, so did my client!  So the doula didn't make it to the birth.  She was a rather pushy newbie-doula with a trunkful of oils, candles, toys, etc. that literally intimidated my client to distraction.  I believe the heart of the problem may be that a paid doula (and not ALL of them by any means!) feel the need to earn their $$$ by performing and intervening.


I agree, most hospital based doulas do not know how to doula at home. More often than not, the support is redundant for homebirth clients. I am a doula and a midwifery student, and I LOVE to attend homebirths. I don't feel out of place, but I have had 5 homebirths of my own and feel comfortable in that setting; it takes more for me to be comfortable in the hospital!   Unfortunately, doulas are a product of their environment as we all are. If they have only seen hospital birth and the complications that ensue from intervention, they may not feel safe with homebirth. They may think it sounds groovy, but deep down (or even on the surface) they don't trust the process and they are afraid. Birth is so much more an intimate sexual act at home, it can be tricky, as you all know, to blend. Personally, I would not choose a doula for a homebirth whose knowledge base was obtained predominately from hospital births. Now, if I knew I was going to have a hospital birth, I would want those skills and someone who was familiar with the turf and sights and staff.

I did have a doula for my first (home) birth, 17 years ago. She was called a "labor sitter" back then, the term "doula" hadn't been coined. She was my angel! She became my mentor for motherhood, she was like a knowledgeable big sister, and during my labor, she wiped by brow, emptied my barf bucket, reminded my mother and young husband that this was birth looked like, that I was doing it perfectly. All this before I had reached 3 cms - (smile)
So her example was set for me, and later, when she was a MW herself, she helped me have my next baby. That set me on my way.

It is a completely different role at a homebirth. If someone is going in with only the tools they have for hospital birth, they are going to be lost. Most homebirth clients don't need a written birth plan to avoid interventions, or have worries about being able to wear their own clothes or not having a hep lock, they don't need someone going to bat for them, or body guarding for them, or holding space for them.


I have been privileged to work with doulas for years, both in hospital and home birth settings, and overall, my impression has been positive.  Many of my home birth assistants (I am in solo practice) are doulas, and their devotion to the normalcy of birth and these families is exceptional.  Never have I seen a doula fail to respond to any request for assistance or support from either the family or me.  Some of these doulas are midwife wannabes who just cannot take the time/energy/money to pursue education at this time, and some of them are perfectly content to be a support person for either home or hospital births.  But I have never been disappointed with their skills (they have taught me tricks too!!), and their devotion is impressive.  I have done what I could to further their education, and accepted their assistance gratefully.

In the local hospital, they have taken their faith in the normalcy of birth into the labor room, and in their calm and peaceful support of women, enabled the hospital staff to once again revere birth for the intimate experience that it is.  Although personally, as doulas, they sometimes would much rather be at a home birth than the hospital one, their skills are much more necessary in that interventionist environment and the clients need their assistance!!!

I have the utmost respect for these ladies and their calling.


Doulas need to be aware that the midwife isn't midwifing to support the doula in her role or her personal path.  I am in agreement with the laboring couple to have at their birth anyone they choose.  That labor support will stand or fall on their own.  I have a job to do and I do it and am mindless of anyone other than the couple and that babe.


It saddens me that this type of talk that feels like "there is no place for doula's" is happening.  Isn't that what so many midwives have to contend with???!!!  Yes, Some doulas in a home setting would feel and maybe act like a fish out of water.  Guide them, teach them, assuming of course they are willing and so are you.  But please, don't place the burden of bad experiences on the backs of all of us.  We have worked as hard as you to learn and to define our place within birth.  Yes, maybe some fall short, but don't characterize all on limited experience.  As midwives, it burns you to be characterized on the basis of hospital stats, or someone's bad outcome, or just because you are trained unconventionally.  This is the same type of talk/attitude that can and does pull the birthing community apart.  It really is not constructive, but destructive. It is not supportive of your doula sisters.  Midwives ask for support, deserve support, as a choice for America's birthing women.  Doulas deserve no less.


Doulas are supposed to be the labor support that you spoke of - intelligent, caring, compassionate, giving NO MEDICAL ADVICE OR INTERPRETATION, but supporting the couple and their choices.  Unfortunately, I've worked with some who had their own agendas.  They seemed to figure that if being a midwife was just waiting for the process to unfold, well there couldn't be much to it.  One doula decided that an hour of serious pushing was a clear indication for a cesarean.  We transported for other reasons.  I was driving my own car, with all my equipment in case we had a birth en route.  During the ride, the doula convinced the mom that she needed an immediate cesarean, and then the doula did everything she could upon arrival at the hospital to make sure that a cesarean happened ASAP.  It made no sense to me until I got the big picture; immediately after the mom was wheeled into the surgery suite, the doula took off to catch a flight to a family reunion.  What treachery!


OK, that's a pretty extreme example.  I would think any doula would be embarrassed to show her face at a birth after that.  But that doesn't mean all doulas are like that!


We try and stress to the moms who have doulas or family members acting as doulas that they need to stay with them beyond the time we do (which averages 2 hours postpartum).  It's really frustrating to find that the doula has left before we have.


I don't know if I agree with this; it implies that the doula is working for the midwife, rather than for the client family.  I treat client-hired doulas as one of their family/friend circle, and who am I to say when they should arrive or leave?  (And, still, I must admit, it wouldn't earn that doula any extra brownie points in my book!)


i work as a doula in the homebirth setting quite often.  it has worked quite well, as i am just another part of the team but someone who is not focused on any of the medical aspects of it.  sometimes i am the gofer and will be the person to make smoothies for the mom, get the shower ready, tub, etc. but usually it is just like in the hospital that i am with the mom continually.  i usually come before the midwife, but not always.  i still work for the birthing couple so when there is a problem (ie 'overdue') and maybe the midwife wants the mom to do something and the mom isn't sure, i will still help her make an educated decision. also, when there is a transfer, that can be where you are really needed to help the mom stay connected to her baby and make the transition from home to hospital go as smoothly as possible, as that can be a very difficult time for most people.



Doula at a Homebirth Transport



A few weeks ago, I requested feedback about communicating with doulas at a homebirth about possible transport situations.

Thank you all so much for contributing your thoughts on this issue. It has all helped me to realize that most doulas have a somewhat hazy idea of the politics involved in homebirth transports.

I'm sure you've all seen situations where the nature of communication with hospital staff has affected the type of care provided to the mother and her baby.  If you don't understand the issues involved in homebirth transport, then you can't know how to modulate your communications with hospital staff for the benefit of the mother and baby.

Christina said many helpful things about the delicate nature of homebirth transports, especially with regard to the midwife's exposure to arrest, investigation and possible loss of license.  In our area, this applies to all midwives attending homebirth, regardless of type of midwife license.  However, my concerns were more about protecting the mother and baby from punitive actions in response to prejudice against homebirth.

I'll admit I was fairly baffled by some of the responses.  Anybody who hears the phrases "homebirth transport" and "delicate situation" together and thinks I'm talking about a conflict between the midwife and doula doesn't understand the politics of homebirth transports, at least in this area.

I find myself both laughing and crying at the interpretation of my concerns as a power play.  Quite frankly, if I transported a mom in and she was being well cared for, and she turned to me and said, "Ronnie, you've been up with me for 48 hours straight now - why don't you go home and get some sleep; my doula will make sure my comfort needs are met.", I would not be worrying that the doula would somehow be alienating the affections of my client.  Birthing women need all the support they can get, and good support from a doula lessens the demands on the midwife.

It saddens me to hear of situations where doulas find themselves at odds with midwives, which was implied in many of the responses.  Is this because you believe that the midwife isn't acting in the best interests of the mother and the baby?

It has been especially helpful to be reminded that a professional doula will not be discussing clinical issues with hospital staff, which is what I was concerned about.  (In my work as a doula, I routinely perform clinical monitoring at home, including vaginal exams, and I do report this information to the hospital staff when we phone in or arrive at the hospital.  It makes sense that non-clinical doulas wouldn't be discussing clinical issues.)

Given what I've seen of the responses here, I don't think I can take for granted that a doula would necessarily understand the politics of a homebirth transport.  It probably makes most sense for me to require that the doula come to a prenatal meeting with the clients so we can all discuss what needs to happen in the event of a transport to get the best possible care.

Or . . . I've put together a brief handout - does this seem to hit the highlights?  I've written this for family members as well, since I do recognize that the woman's doula has the same "standing" as any of her own family members she has chosen to attend her labor and birth.

****************************************

Dear Homebirth Support People:

In the event that it becomes necessary to transport into the hospital for medical care, there are a few things to keep in mind:

Please do not try to communicate the clinical situation to hospital staff.  If they ask you any questions about this, please refer them to me so I can get accurate information from the charts.  This can be vitally important in getting the best possible care for the mother and baby.

Unless the mother requests otherwise, please leave the advocacy role to me.  Even though my legal responsibility for care is greatly reduced once we transport into the hospital, I still have some very strong ethical responsibilities regarding the outcome.  Obviously, I would be happy if you reminded me about the details of the birth plan if there is any confusion about this, but the situation may not always allow me to explain my recommendations in the moment.

Many hospitals limit the number of support people who are allowed into the birth room; our party is likely to exceed that limit.  Hospital staff are more likely to be OK with that if we keep a lower profile.



Doula Controversies



Wall Street Journal Article - Doula Controversy - As 'Doulas' Enter Delivery Rooms, Conflicts Arise Hired to Help in Childbirth, They Sometimes Clash With Doctors and Nurses [January 19, 2004]


CIMS responds to Wall Street Journal article on Birth Doulas [main page for CIMS Coalition for Improving Maternity Services (CIMS)]


This article brings up some good points that deserve some good discussion.

-Doula's are not medically trained.
-Doula's should not be giving medical advice or assessing the well being of the mother or baby, even if they have a medical background.  This is not the role of a Doula.

-The Doula's role is to support the choices of the birthing woman.  Included in this could be to provide pros and cons of the suggested medical procedure to help her make her choices, but should always default to what feels right to the birthing woman. However, I must say that when I first started my journey as a Doula, I don't know that I would feel comfortable enough with my knowledge base or experience to adequately comment in the best interest of the woman and her baby.

-Doula's are to have no personal agenda as should anyone else.  We are hypocrites if we expect the Doctors, Nurses and hospitals to abstain from personal agenda if we do not do the same.

-Sometimes medical intervention is what is best.

Additionally however, there are a multitude of holes in this story.

-A Doulas role is not adequately described
-The Doctor does not state that she witnessed the Doula advising the woman to decline Pitocin.
-It is not revealed if there was evidence that the baby was in jeopardy, such as, maternal fever, GBS, or accelerated HR.
-If the Doctor felt so strongly about the baby's well being why did she not employ the help of the Doula, with her powerful influence on the mother, to recognize the baby's well being was evidence based.
-If there was no Doula in attendance and the same scenario presented, would the Doctor state that the woman was to blame and ban pregnant women from her practice?
-If the woman never questioned or denied the recommendation and the baby's outcome were the same would she ban herself from treating other pregnant women?

The real issue that stands out to me is - Why was the Doctor/patient relationship such that the woman did not trust her recommendations?

This is an issue that deserves more consideration from the medical community as well as the media.



First, let me don my asbestos suit, as I know I'm going to catch hell on this one.  :)   Also, let me assure everyone that my comments below in no way negate the fact that I am a huge natural childbirth advocate and doula advocate/proponent.

Now, I read the article from the paper about doulas, and want to address a point or two.

I think that the article was, in general, biased as all get out.  It included the usual scare stories and misconceptions about doulas.  I also imagine that all of the stories included components that we were not privy to in the interest of editing.

However, I think that we as a community have got to admit that we do have some members whose dogmatic views on birth tend to get in the way of their ability to support women in the most effective way possible.  I am sure that there have been doulas who plowed over women's wishes and caregivers' medical advice in favor of their own agenda.  I also do not doubt that there have been doulas who gave rather dubious birthing and nursing advice that was barely disguised medical advice.

In the rush to condemn an article as totally unfair, we must admit to the shortcomings of some of our colleagues, and work to help all doulas achieve balance in this area.  Can we let ourselves be walked over and not acknowledged in the birth room?  Absolutely not!  The fact that some of the powers-that-be are getting so mightily pissed off means that we are a growing force in the birth world, and are providing a necessary link to the birthing woman.  I really do take it as a good sign most of the time.

But some of the doulas in this world are taking big time issues into the birth room with them, either as the result of reading, personal experience as a doula or their own past birth experiences.  (I think this would make for an interesting topic at the DONA conference.)  I know I have to let go of my preconceived notions about childbirth every time I step into a birth room.  I'm there for HER, not for me or my own birth high.

Now (and it's a big now), I will also add that the doula community is hardly alone in the birth world as dispensing bits of rather icky advice at times.  OB's, family practice docs, midwives/medwives, lay midwives, lactation consultants, League leaders et al. have all been known to have some really bad days.  Using the experiences of a few people to color the entire profession is wholly unfair.  But let's be fair to ourselves and remember to address our issues.  It will be a most beneficial step toward advancing ourselves as a professional cause and organized movement.


No need for the suit here.  I agree with you.  But the two things about the article that bothered me so much were:

1) I saw nothing that showed that the doula was even the problem.  It may have been her and it may not.  I've had times where I wanted to scream, "I hope you don't think I put her up to this cause I didn't even know she felt this way".

2) That they were all kicked out instead of this one doula being dealt with.

Can you imagine if a doctor or nurse was a big problem at a hospital (and it happens all the time) and because of it *all* doctors or nurses were kicked out?  Not gonna happen!  It's hard to get a bad doctor or nurse dealt with never mind that one kicked out!!!



When Baby Comes Faster than the Midwife - Unplanned, Unassisted Homebirth



I'm curious as to what the standard of care is for a doula in the following situation:

She's working at home with a family who is planning a hospital birth, and the baby comes so quickly it's clear they're not going to make it to the hospital in time.

Do you call 911 right away?

Do you wait and see how things are going and only call 911 if there's a clear emergency? 


Call 911 no matter what. I know it can seem like a bummer, but doulas are not medically trained, like a midwife, and even if they are, they are not licensed to do anything other than 'good samaritan' type stuff, which means calling 911. Doula certification requires this, and we have to respect our role and it's limitations. If we want to do otherwise, we should pursue and complete midwifery training.

Certainly most births do not need the EMTs rushing in, but you simply cannot risk waiting to see if there will be a bit of retained placenta, bleeding, or whatever else.  It's not that that dangers are always lurking, it's that it is simply not our role to make that assessment.

Depending on when it became obvious that the baby was COMING, the doula may still be the one to catch, and do the best she can at assessing maternal and neonatal status, and may even need to do neonatal resuscitation (hopefully she took that training), but this should always be covered by having made every effort to notify a medical practitioner, again, since these hypothetical parents were planning a hospital birth, so medical assistance is at least on its way, and she did what she could and in a timely manner.

In a risk-benefit analysis, the down-side of calling 911 is minimal, for a family who was planning a hospital birth.  The potential for harm is small compared to the risks of not calling, even if they are rare.

When mom and baby are well, in the majority of cases, the EMTs arrive to a healthy, happy family, and can proceed in whatever way the parents dictate. 


I'm glad that it seems like most doulas would call 911.

Honestly, even with all my years of experience as a licensed, homebirth midwife, if I were visiting somewhere without my equipment and medications, I would call 911.  I'd want to have suction and ventilation equipment on hand, and it would be nice to have some O2 and postpartum meds, too. I hope all doulas understand that even though most births would go just fine without any intervention, there are births where immediate action is required to save lives. You cannot predict which births these will be, and sometimes they look low risk until they look life threatening. For out-of-hospital birth, there should ideally be at least one person in the room who has successfully managed a gnarly shoulder dystocia, resuscitated a compromised baby, and managed a partial placental separation.

 I assume you all know that you can't rely on your cell phone to get through to 911 from all locations?  It might be something useful to ask the family on their intake form.  It's kind of scary that some families don't have any landlines in their home. 


Those second babies can come really fast.  I won't accept doula clients who want to labor at home "as long as possible" unless it's a first baby or a VBAC.  That's just asking to have an unplanned homebirth.  Honestly, if I do my job right, they could have that baby in about 20 minutes at home.  The irony is that the labor tends to be more dysfunctional in the hospital, so it ends up taking so much longer.  I'm hearing from a lot of moms that their hospital births for a second baby were 9 hours.  I figure they've probably got an epidural in place, and the nursing staff is just waiting for the morning before calling the doctor in to catch the baby!  :-)



When A Client Wants an Epidural



Here's my two cents about clients who are angry or feel betrayed because they didn't get an epidural when they asked for one, or when it was too late.

I was also somewhat stunned the first time I had a doula client complain about not getting "her" epidural.  It was because it was a second baby coming pretty fast, and anesthesia wasn't available for the half hour of labor we were there before the birth.

In my mind, it didn't even make sense that she was upset, because the epidural would hardly have taken effect before her baby came. And the fact that anesthesia wasn't available made the nurses very sympathetic and supportive of her laboring in the shower until the last five minutes or so.  So, from my point of view, it was a great labor and birth.

But she was very unhappy and had a very negative view of her birth. I never quite understood her particular issues, but since then I've come to understand a bit why some women can get so upset.  For some of them, it's the simple feeling that their wishes weren't respected or that "the system" wasn't there for them when they needed it. For people who have these kinds of emotional wounds, they tend to hurt even more when they happen during labor.  And for some women, they project the lack of support forward into their mothering days, so they can feel very discouraged by this as well.

And then there's the whole class of women who have known or unknown sexual abuse issues.  For the women who know about it and are comfortable discussing it with me, we can have a good conversation about how their best possible birth experience might include getting an epidural for the last couple of hours and for pushing.  And I always emphasize that in my experience, having an epidural for four hours is unlikely to have much effect on the baby or on breastfeeding because there just isn't enough time for the drugs to be absorbed from the tissues into the bloodstream.  These women can have a great birth experience with a well-timed epidural.

For the women who aren't conscious of an abuse history or aren't comfortable talking about it, they may just have a vague sense that they really need an epidural, even though they can't articulate "why".

When I first started doing doula work, I was very zealous about natural childbirth and assumed that any woman would prefer not to have a needle the size of a house nail inserted near her spine.  It took me a while to come around to a full respect for the woman's wishes and needs.

For my homebirth clients, it's not such an issue because they know we don't do epidurals at home, and they're not likely to choose homebirth without wanting natural childbirth.  (There are exceptions, of course; sometimes the husband or other family make it subtly clear to the woman that anything other than homebirth or natural childbirth isn't acceptable. That's when we can see some pretty funky "complications" that necessitate a transfer of care to the hospital, where she gets an epidural.)

Still, my "birth plan" form has a full page about this.  I really like to have these discussions well before labor starts.  For a woman who really, really wants an epidural, I consider it part of my job to be aware of the staffing issues around how quickly she'll be able to get an epidural when she wants it, how long they like to have an IV going beforehand, etc.  I want to be able to help her get an epidural as quickly as possible when she makes that decision.

Also, there are women who go quiet when they feel they're being abused or disrespected, and if you try to dissuade them from an epidural, you may never hear another request, even though they're dying inside.  I want to understand this before labor starts.

So, after MANY years and MANY mis-steps, here's the section from my doula questionnaire about pain relief:

Do you know your care provider's/hospital's policy regarding the timing of epidural administration?  Is it ever "too early" or "too late" in labor to get an epidural?  Do they require blood to be drawn in labor and processed by the lab before you can get an epidural?  If so, is it possible to have this done before labor?

In terms of your plans for pain relief, where does your choice fall on the following spectrum?

Natural if At All Possible

Pain Drugs if It's More Difficult Than I Expect

Planning on Drugs But Hoping to Delay Them as Long as Possible

Planning on Drugs As Soon As I Can Get Them

What are your reasons for making this choice about pharmaceutical pain relief?

For women who want pain relief drugs during labor, I recommend an epidural rather than IV narcotics for several reasons: epidurals provide superior pain relief; smaller doses of drugs are used; there’s a time delay between the administration of the epidural and the time when the drugs get to the baby so that epidurals administered just a few hours before birth don’t seem to affect the baby much.  Is an epidural also your preference for pain relief drugs or would you like to talk more about this?

Often, even women who are dedicated to natural childbirth will reach a point in labor where they may say they can't do it anymore.  This is typically when they are in transition and nearing the end of labor and the beginning of the pushing stage.  Often, they just need to know that the labor won't be this intense for much longer.  Or it may mean that they simply need increased labor support.  Some women have issues with past experiences where their needs or requests were ignored, and they may especially need me not to question their request for an epidural.  How would you like your labor support team to respond if you request an epidural?

Some common answers - please mark all that apply:

I'd like to be reassured that I'm making good progress and it won't be much longer.

I want to be reminded of my reasons for wanting to avoid or delay pharmaceutical pain relief.

I'd like you to work with me through another _____ contractions or for another _____ minutes, and if I still want an epidural, I'll ask again.

I have a safe word to use with my partner - if I say this word, I really mean it - please don't bargain with me

If I ask for an epidural, I really mean it.  Please just try to get me an epidural as quickly as possible.

Any additional thoughts about this?

And here are some excerpts from my homebirth "birth plan" form:

Metaphysical Challenges

Labor and birth are technically physiological functions, but as humans, we bring all our mental, emotional and psychospiritual  baggage along with us.  Occasionally, a laboring woman will come up against a metaphysical block that causes her to feel some panic and prevents her from going forward in her labor.  Sometimes this is the intensity of labor or the feeling of being out of control as the energy of labor increases.  Sometimes this is a shaking of your fundamental beliefs as you come up against childhood messages about your self-worth, your power, your ability to give birth, or about homebirth in particular.  Sometimes this is a direct physical recall of past traumas involving your genitals or sexuality.

If you are able to articulate metaphysical blocks that might come up for you, it's a really good idea to discuss them with your birth support team so that at least one person will be in a position to help you according to your wishes if a block does come up for you.  In particular, you may come to a point where a metaphysical block feels so scary to you that you want to dissociate from your body, and you may request transport to the hospital for an epidural so that you don't have to feel the intensity of labor and the physical experience of a baby coming through your body.

It is really helpful to think about these things in advance, and to help give me the clearest possible guidance as to how you would like me to help you.  It's my nature not to intrude upon your personal boundaries, but birth is a special opportunity for empowerment and personal transformation that I would like to help you take advantage of, if this is what you want.  I do not "play the edge" when it comes to homebirth safety on the physical level, but I am willing to work through metaphysical blocks with you if you want.  In attending to your physical body, I am also obligated to attend to your metaphysical being, so that I do not generally differentiate between these duties.

If there seems to be some kind of block to your labor, first I look for the obvious physical reasons and try to correct any physical blocks.  If the blocks seem to be metaphysical in nature, I try to look for signals or implicit permission to help me know how to help you.  You may feel a resistance to progress, and we may need to do some emotional work that is uncomfortable for you.  Unless you specifically request otherwise, I will let you know if I am sensing some blocks that have nothing to do with the physical situation. If you want me to restrict my practice to the physical/clinical level, I am requesting that clarity now.

Do you have a sense of any metaphysical blocks that might come up for you?
 

How would you like me to respond if you request transport to the hospital for a metaphysical reason, even though everything looks fine on the physical level?  (Please choose one or improvise.)

• Don't ask any questions, please just get me to an epidural as quickly as possible

• Please explain to me that everything looks fine on the physical level and that you think you're seeing a metaphysical block that we can work through.  Then respect my request to go to the hospital if I still feel that I want an epidural.

• Please help me see what is going on and start working with me to try to get through the metaphysical block.  I'll repeat my request if I truly want to transport for an epidural.

• Please do whatever you can to help me transform this panicky feeling into an empowering birth experience.  I want to transport only for physical reasons.

The bottom line is that I would not ignore repeated requests for transport under any circumstance unless you and your partner make this crystal clear ahead of time in writing, but this helps me to know which direction to take if the situation arises. Please add any additional information about metaphysical blocks that will help me help you.



What Doulas Carry in Their Bags



The things I like are: (and are the things that I include in a labor support kit in my catalog)

Birth ball; Heat pack ( not a sock. It has a removable washable flannel cover and covers a larger area) Lavender scented massage oil, Anti-nausea wrist bands (for those women who get so nauseated that they cannot drink enough fluids to ward off an I.V. {if that's their goal} ) Relaxation music (Transitions(tm) cassette with womb sounds and soft meditative harmonies)


I would like to include a carrier/bag for the birth ball with my kit, (because I'm tired of lugging it or kicking it through hospitals!) but haven't found one reasonable enough to include) Feel free to e-mail me if you have a suggestion.

I don't carry those "universal ice packs" because they are expensive and the hospital can provide a baggie of ice (I don't think I'd want ice anywhere else but right at "that spot" in my back, so the large size of the pack doesn't impress me)

I've recently learned about magnets that help alleviate pain safely (kind of like a tens unit would) but they are expensive.

Also, there is a "childbirth kit" with cards of different pictures to focus on depending on the stage of labor. I personally passed on carrying these because I am a Bradley teacher and teach to focus inward for the most part. It might be fine for some parts of labor, but I feel only as an alternative when other things aren't working (totally my humble opinion. . . I mention it because it's a great product for those who work with distraction methods. Very interesting pictures! Perhaps just the right thing for some transitions)


I typically carry the following:

  1. birth ball
  2. sock with dry rice in it
  3. seabands
  4. CD's (Canyon Trilogy by Carlos Nakai, some Bach, Music to be Born By etc.) and a portable tape/CD player if I know there isn't one at the hospital I'm going to.
  5. lavender essential oil (it is nice on a damp washcloth)
  6. massage oil
  7. The Birth Partner
  8. a couple cans of ginger ale
  9. paper / pencil / pen
  10. camera with film in it
  11. extra film
  12. water bottle
  13. snacks / tea
  14. toothbrush / toothpaste

I've found a backpack to be an effective birth bag, that way I can easily carry the birth ball too. I have yet to find the perfect bag though--a backpack can be hard to find things in.


1) What is in your doula bag?

big hand mirror (for Mom to see baby emerging)
food for me
some food to share
money for more food ;)
mints and gum
pads and tampons (always start it if I'm anywhere near it!)
toothpaste, toothbrush, hairbrush, lipstick, deoderant,
2 clean washcloths
hair ties (several)
bottle of hand sanitizer
lip balm for me and a new one for Mom
at least one complete change of clothes
2 books:
Optimal Foetal Postitioning and
Labor Progress Handbook
clipboard/pen/paper
client folder
massage oil
couple of massage tools
tennis balls
music
essential oils on washclothes in ziploc bags
2 bottles of water for me
2 rice socks

> 2) What items do you find absolutely necessary?

....honestly?  None of it usually!  I so rarely get out most of these things.

I know you will hear this again..but my hands, brain and heart are my best and most useful tools.

Generally what will come out is the food and often some massage oil.....if things go long the personal toiletries can give me a whole new outlook on life!


I bring almost all you have listed but I also include my camera (no music they bring that) also Tylenol  I wish I could down size but I don't know how plus like I said I use it all especially the food, my favorite is miso soup in packages from trader Joe's it is the best!!!!  altoids are a must



Rice Packs



They are men's tube socks that you fill with rice and lavender(that is a relaxing scent). I get white and dye them pink or blue, then fill them and sew the top. You heat them in the microwave for 3 min then it lasts for 15-20 minutes. It feels great, the heat is almost a moist heat....the sock lets it fit under the belly or folded in 1/2 for the back. I use mine for my neck....and cramps when I wasn't preggers. I give them to my moms when we do our prenatal appt(for labor support). We went to our local saving whse and bought 12pr socks and 25lb of rice (not expensive). I have also used baby diapers that I put together and made a pillow of sorts. Haven't used that style in labor yet.


About the rice packs, I don't use socks for three reasons, 1) the sock shape, especially if overfilled, is too hard and firm for a mom to lean against or to form to the mom's body, 2) the sock packs are not washable, therefore should be replaced for each new client, and 3) The cheap, affordable socks are usually acrylic, and I cannot imagine anything yuckier than hot acrylic on my skin. IMO, YMMV.

Sooooo, what do I do? I make a three chambered (lengthwise) muslin sack, about 8 inches by 20 inches, fill it up about half way, and fold it down from the top and sew it closed. This makes a nice, flat shape, and the channels keep the rice evenly distributed. Then I make covers, like little pillowcases, for them out of cotton velvet and cotton flannel. The covers are washed after each client in HOT water. Sometimes I give them as gifts. These are so easy to make. BTW, I use the short grain white (sticky) rice because of it's smooth oval shape, but any grain would probably work. I like the weight of rice.

Can someone tell me why the dry rice, when heated, feels like moist heat? I'm stumped. BTW, I use rice packs on my belly for cramps, and on my neck, shoulders, and low back for aches and muscle pains. Everyone in my family got one for Christmas.


I  read the package of one of the tube socks and guess what an ingredient is on some socks???  Latex!!  I never would have guessed.  So, needless to say I will be very careful from now on with so many people having latex allergies.  Buyer beware!!


Good Point. I always just make rice packs out of cute flannel that I find on the dollar per yard table in Walmart. I give them as gifts to my clients. The flannel works great. Just cut out two 10 x 5 inch rectangles with pinking shears, sew around three edges, fill with rice and whip-stitch closed. So easy and greatly appreciated by clients. If your client has a favorite scent, you can stir some essential oils in the rice to customize. My faves for labor are lavender & nutmeg combo.


Another easy way to avoid latex is to get cotton stockinette material from any medical supplies place - 3" or 4" makes a nice tube.  You can leave really long tails on it so you can wrap it around the mom's belly and tie it in back.  If you do it just right, the knots will put pressure on the sacral area, which can feel really good.



Oatmeal Sock



I have never tried making them with barley, but I have made them with oatmeal. When you fill the sock with oatmeal it is much lighter and some people prefer the smell to the rice. The rice smells a little "pasty" when it is heated. Both can be heated over and over again provided you don't get them wet (they get moist when you heat them anyway.) I make mine sooo inexpensively. I buy tube socks in bulk at Kmart or Walmart or wherever. I get the long, over the knee kind and I fill them and tie a knot in the end.

It's so simple I never mess with the sewing machine (I hate to sew). I add a few drops of lavender essence or dried lavender either works well. I just do it till it smells good to me, but keep in mind that laboring Mom's senses are heightened. I carry a scented and unscented one with me as some Mom's I've worked with actually didn't like the lavender scent. I put it in a plastic bag when I heat it up...especially if I am using the hospital's microwave...that keeps the sock from picking up odors in the microwave and keeps your microwave from smelling like lavender. You could fill any kind of sock or pocket with rice or oatmeal to make any size warm compresses you want. I think this is one of the most important items in my birth bag. My rice socks cost me about $1.50 each so I just let Moms keep them after the birth and they really appreciate it.


How to Respond to Bad Hospital Treatment



Labyrinths



I was intrigued by the mention of walking a labyrinth during labor as a birth ritual.  This was mentioned in the "International Doula", Spring 2001 issue, on p. 22 in the "Birth Rituals" article.  Where can I find such a thing?


The following are online resources for full-size labyrinths.

There is a company here in Baltimore that makes portable labyrinths: http: They are gorgeous, but very expensive -  $700 and up depending on size and whether they are sketched or painted).  [They offer a Personal Sacred Space six-foot square canvas for only $199!]

This site has an online "labyrinth locator":  - You might be able to find a stationary public labyrinth close enough to take a mom there to walk.   Garden labyrinths are amazingly peaceful places, even when many other people are there walking with you.

This site has an instruction booklet for sale ($10.00) on how to draw your own labyrinth: http:

Another portable labyrinth maker:  http: Again, very expensive to purchase ($1800 + shipping).

More portable labyrinths for sale: http: Astronomically expensive (several thousand $).

I haven't found any portable labyrinths that are not severely cost prohibitive, except for the "doormats" you mentioned,  which are very pretty and decorative, but not terribly practical for walking, particularly for someone who can't see her own feet.  :-)

http: More links to labyrinth resources (where to find them, how they are used, etc.)



Postpartum Doula Work



This web page is primarily about birth doulas, because I have only worked as a birth doula.  But here is some information that focuses on postpartum doula work.  Please do look through the other parts of this web page, though, for other relevant information.


Postpartum AyurDoula Care - lots of helpful information about postpartum rejuvenation

 




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