Personal Connection

Your doula should definitely be someone you and your partner feel comfortable with as she will be involved in one of the most personal aspects of your life. In most instances, she will be by your side throughout your labor. Your doula will be walking you and your partner through some of the most difficult and exhilarating moments of your life. During the initial interview process, it’s important to make sure your personalities are a good fit. For example, is your doula is overbearing? Do you find her personality and demeanor calming?  Does she get along with your partner? Does she respect your wishes and opinion or is she more concerned with expressing her own point of view? While it is perfectly ok for you and your doula to have differing opinions, her primary role is to support YOU. These are just a few of the questions you need to ask yourself before making a decision about which doula you should hire.

Support before Labor

When you are pregnant, it is important to surround yourself with a good support system. Ideally, some of the people in your support system will have experienced pregnancy & labor. They will be an invaluable resource in answering questions, addressing concerns, or just giving you the emotional support you need during the more difficult stretches. The more recent their pregnancy, the better chances they will remember more, but either way, it is still comforting to feel supported. Your doula will also be able to provide support prior to the start of your labor. For this reason it’s a good idea to go through the interviewing and hiring process early in your pregnancy.

Support During Labor

Whether you are planning a home birth or want to remain at home for your initial stages of labor then head to the hospital, your doula can be by your side. She can provide invaluable support to you and your partner when you need it most. She will have a wealth of information on positions for your comfort as well as to help labor progress, she can help you keep your breathing calm and relaxed, provide a massage, emotional support and even help you keep your birth plan on track.

Health Care

Another good determiner to the question should I hire a doula is how complicated your pregnancy is expected to be. There is significant statistical evidence that demonstrates the benefits of hiring a doula for your birth. Are you having twins? Are you an older mother? Are you a single mother? A doula can provide the extra care and support that is needed. Maybe you would like postpartum care? Does you healthcare provider allow for doula services? One of a doula’s roles is to provide unbiased support in the form of information. She will help to make sure you are asking your midwife or physician the right questions which in the end, means you are making informed decisions.

Availability & Cost

It is highly recommended that you work with a local doula that lives relatively near to your home. This will help to facilitate your visits and make it easy for her to get to your side as soon as you feel you need labor support. What is the cost of your doula’s services and can you afford it? Most doulas charge a fixed fee. Typically a labor doula will charge between $500 and $1000 for a birth. However this almost always includes 1-2 prenatal meetings, a few telephone calls and labor support followed by breastfeeding assistance and a postpartum visit.  I have never met a doula who became a doula for the money. For most, it truly is a labor of love. If cost is an issue you may find that your doula is willing to accept payments over a short period of time.

Birth Experience

Give some consideration to your doula’s experience. Often, new doulas will work alongside an experienced doula until they are comfortable taking on their own clients. While you doula doesn’t need years of experience, it’s nice to know that she has a few birth under her belt. Ask about how many births your doula has attended. Is she is part of a doula practice? Does she have formal training?  Another great indicator of experience or skill is positive feedback from previous clients, friends or family who have had the opportunity to work with your doula.

The Importance Of A Personal Connection With Your Doula

This topic deserves some reinforcement. My experience in the past has been that when a mother is asking, should I hire a doula, the primary concern usually centers around the fit. You will always be better off with a moderately experienced doula where your personalities are a great fit as opposed to a very experienced doula with a poor fit. Take a solid hour or two and interview your potential doula over a cup of tea. You should have a warm feeling that indicates whether or not you are comfortable working with her in a very personal setting. If you or your partner feel hesitant, take the time to interview another doula. You can also read a great article that touches on some of the common concerns that couples experience about sharing their birth experience.

On Feb. 4^th 2004, my second son was born at Lion’s Gate Hospital. This experience was quite heavenly when compared with the birth of my first son on May 5^th, 2002. By the very nature of the compressed birth dates, you can probably already understand that I was well on the way towards a solid hair loss adventure.

Our First Birth Experience

My wife and I went through a rather harrowing first labor experience, where a philosophical difference between my wife and her G.P exposed its ugly head in the “11th hour”. We had done all of the reading and I (being in the health care profession) thought we had a pretty good understanding of things. Nothing could have been farther from the truth. The emotional involvement for me, seeing for the first time, my life partner in the most uncomfortable scenario possible……..is devastating. During the birth procedure (with our first child, “procedure” was more descriptive than “experience”), things occurred that we could not predict. Emotions heightened, rational thought dissipates and with a healthy dose of sleep deprivation, the fringe becomes less distinguishable. Ultimately, my wife’s birth “procedure” was not pleasant and was only really eradicated by the “experience” of our second son’s birth. We thought we were prepared for it but in retrospect we had just stuck to what most do…renovate the house, finish the nursery for the new member of the family and hope for a healthy child.

Our Decision To Hire a Doula

Our initial hesitation on involving an “outsider” in something so intensely personal was quite an issue. We are not folks that would ever think of inviting in-laws and parents or other children in to watch the “birthing experience”. The educational aspects aside, we were just both a little more private. My wife really didn’t want students in the room and respectfully requested that just the people who HAD to attend be in the room.

Our decision to involve a doula in the birth of our second son was made on several fronts. I knew our doula on a professional basis and talked to my wife about her and what I thought would be the benefits. The other aspects involved in the decision making were truthfully based on “anything to make it a better experience”.

As a male who wanted to be as involved as any male can in the labour room, I did have concerns that my involvement might be eclipsed by the presence of a doula. Part of the doula’s job is to accommodate the “partner” and incorporate the couple’s thoughts, desires, fears and wishes into the overall birthing plan. Accommodating the “male who wants to be there” is part of this.

Dad and Doula Working Together

I was overwhelmed with how well the process went. This was not a family member there to assist and possibly offend or pass judgment. This was not a Midwife. This was not a medical person there to provide cold details about the birthing procedure or how well or not it was going. This was not a birthing experience marketing person suggesting candles and jungle music. This was a synthesized “two heads are better than one” emotional birth plan tracking system. She was a shoulder to lean on for mother or partner. She was a break from the emotional exhaustion that the partner experiences but feels they should not show as they have to be “strong” for the woman in labor. This was an advocate for what you and your partner believe in. This was the best move that we made.

I don’t know how to convince a couple heading down the avenue of their birth experience that having a doula is a “good thing”. All I can say is that I wish a close friend had strongly suggested it for the birth of our first son in order to make an unpredictable and “haven’t experienced this sort of thing before” event a little more in control. The experience of our second son’s birth with doula assistance has made us talk about a third. Just talk…..that’s it.

Have an experience you would like to share? If you have an story relating to Dads and Doulas that you would like to share, please let us know!

The first thing to do is to find a midwife who is willing to perform a home birth. Not all midwives are comfortable performing a home or home water birth. Therefore, you need to make sure that you have spoken with the midwives at your chosen practice to make sure that one or all of them will be willing to perform a home water birth for you.

Another thing to consider when planning for the birth is the supplies & equipment that you need to have available in your home. You want to make sure you get a supply list from your midwife so that you know exactly what is needed to make the birth go as smoothly as possible. There are a wide variety of supplies required and you also need to be prepared for medical emergencies, no matter how unlikely they are to occur

The next thing you need to do is to make sure that the tub you order is going to work for you, no matter what happens. There are many different styles of birthing tubs. Some have steps that walk you up and into the tub; Others have a door on the side of the tub; Some simply require you to step over the side railing. Each one fills differently, and sometimes they can be difficult to get into when you are in labor. Ask your midwives for any referrals they may be able to provide. Call around and talk to suppliers or local doulas who often rent birth tubs. Also be sure to ask for references once you feel that you have found someone who rents the style of tub you are looking for.

Having been through two home water birth, here are some tips to help the process flow smoothly:

•  Plan ahead! Set-up and test the birth tub well in advance of labor beginning. Make sure your partner or the person responsible for setting up the tub can do it without your help.
• Make sure things like the water heater are functioning properly. Check for leaks!
• Lay a good quality tarp out underneath the tub and have plenty of towels around.
• Don’t hesitate to fill your tub at the first sign that labor may be starting. Worst case scenario, you may have to empty it and start again. There is nothing worse than birthing in a tub that is not yet full of water or that has not had adequate time to heat up.
• Consider where you are setting up your birth tub. Is the floor structurally sound and capable of supporting the tub full of water, you, baby and your entire team?
• Have an alternate plan! Unforeseen events happen and you you want to make sure you have planned for an alternate birthing location should your home water birth not go as planned.
• Keep some warm towels spinning in the dryer. When you and baby get out of the water, it’s important to keep warm.

What Is a Postpartum Doula’s Primary Role?

A professional doula serves to enhance childbearing by counseling and supporting mothers and their families. This support often continues into the postpartum period as mothers needing information and emotional support while learning how to breastfeed. The role of the doula can make a difference. The additional support of a doula has shown that pregnant women and mothers who are in labour who receive assistance can better access prenatal care, develop a birth plan, have greater success with breastfeeding and a lower incidence of postpartum depression. These same mothers also have a lower incident of emergency cesarean-section, a shorter labor with fewer complications and report being more confident about giving birth and caring for their baby. They also feel more secure and cared for.

Labor is an experience that affects both baby, mother and their partner. The coaching provided by a doula to both parents allows for the partners to better experience the joy of the birthing process and feel both supporting and supportive. This positive experience can help shape the attitudes and expectations during the postpartum period.

For many fee is a consideration. Some may feel they can not afford a doula. The service and benefits provided in almost all cases, greatly outweigh the cost. The service not only affects the birth, it also affects the parents feelings related to the the birth process and the choices made.

The average price in North America is $600 to $800 with the price differing based on both locale and experience. Some insurance companies cover a doula’s services. Some hospitals will provide doula support free of charge for teenagers or of those below a certain income threshold. Many doulas, realizing the value that their service provides, offer a sliding scale fee.

Some specific ways in which a doula can support a mother through labour are assisting with proper breathing technique, massage, various relaxation techniques, comfort measures such as a TENS machine as well as a wide variety of birthing positions. A doula can also assist a mother or couple in clearly communicating their wishes to medical staff as well as helping to make sure they are making informed decisions.

Once the baby has been born, a doula can assist with additional relaxation techniques as well as provide ongoing breastfeeding education and support. One of the most important tasks a few weeks after the baby has been born involves a “debriefing” with either the mother or couple. Openly discussing the feelings surrounding a birth are an important part of the process.

1. Babies love to nurse. It feels natural to them, it tastes good, and it makes them feel good.
2. Breast milk is the most healthy food for your baby. Your body produces the exact food that your baby needs, and formula can never match all the components that are in breast milk.
3. I’ve often heard that breast milk provides immunities: whenever the mother encounters a virus, her body makes immunities to that specific virus and passes on those immunities in the milk. My daughter has gotten sick only about three times since she was born, even though I’ve gotten sick many more times than that.
4. Breastfeeding brings comfort to your baby.
5. Breastfeeding is an instant pain reliever for babies. When your baby falls down or slams her finger in the drawer, you don’t have to helplessly sit by, waiting for drugs to work while your baby screams in pain. Instead, pop out a boob and let the breast milk’s magic calm your baby and relieve his pain.
6. Breastfeeding helps babies fall asleep.
7. You get more sleep when you combine breastfeeding with co-sleeping, because when your baby wakes up at night, you can just roll over, offer your nipple, and fall back asleep. No need to get out of bed to get your baby back to sleep.
8. The baby’s poop won’t stink until you introduce solid foods. And if you use cloth diapers, you can throw the breastfed-only baby’s poopy diapers in the laundry with the other diapers without needing to do extra cleaning first.
9. Breastfeeding builds the attachment between you and your baby.
10. It gives you a good excuse to pause and be with your baby, and no one can take that well-deserved rest away from you.
11. You don’t have to worry about setting up feeding schedules and keeping track of how much and how often your baby eats. Just let your baby nurse whenever she lets you know she’s ready. You’ll pick up on her signals fast. If you don’t, she’ll cry to let you know she’s hungry.
12. You get to eat more. Guilt free.
13. It’s far more convenient. Your baby will always have plenty of food, and you don’t have to wash bottles and worry about germs.
14. In an emergency, you can just grab your baby and go. Even if you don’t have food, your body will prioritize food for your baby so your baby doesn’t have to go hungry even if you do.
15. Breastfeeding is often all it takes to change a baby’s fussy mood to a happy one.
16. Nursing gives a baby a positive psychological outlook. It makes a baby feel secure and like everything is right. This sense of well-being is vital for the newest members of our society and can help your child have a positive psychological outlook on life. Many adults today struggle to overcome problems that began as an infant. Through breastfeeding, you can give your baby the best possible start in life.
17. Breastfeeding helps prevent breast cancer.
18. Your husband will appreciate your larger breasts. (And if he’s too demanding, you can use nursing as an excuse to keep him away.)
19. It feels empowering to be able to feed your baby from your own body.
20. You can be a counter culture person who helps to set a new standard of normal in our society. By breastfeeding, you apply positive peer pressure to other mothers that can help them make the same good choice for their babies.

These reasons to breastfeed don’t magically disappear when the baby turns one. Mothers in many cultures nurse their children until they’re six years old or older, and the World Health Organization recommends babies nurse until at least two years of age (http://www.who.int/topics/breastfeeding/en/). If breastfeeding is working for you and your baby, please consider continuing as long as you can, hopefully until your child naturally weans.

Scope of Practice and Liability

If there is only one specific action that you choose to take as a doula to reduce your risk of liability, it should be maintaining the Standards of Practice for Birth Doulas as outlined by DONA International. Alternatively, if you chose to become certified through CAPPA, you could follow the CAPPA Scope of Practice guidelines. Both sets of guidelines clearly specify that as a doula, you are available to provide emotional, physical and informational support. You are not to provide medical advice or perform any clinical procedures.

These guidelines mean different things during each stage – pregnancy, labour, birth and postpartum. During the pregnancy stage, a doula is responsible for helping to develop a birth plan, providing emotional support and sharing resources and information that could be beneficial to each individual client. During labour and birth, you are responsible for providing emotional and physical support as well as helping to open the lines of communication between your client and their caregiver. Throughout the birthing process, you should also continue to provide informational support to your clients and help them to be aware of any issues that they may wish to discuss with their caregiver in greater detail. During the postpartum stage, one of the best ways to support your clients is by encouraging them to discuss the labour and birth process and by acting as a sounding board – become someone they are comfortable sharing their experiences with. One caveat is that as your clients develop a relationship and build trust, they are increasingly likely to begin relying on you, their doula, for advice and guidance that is beyond your scope of practice. It is important to always remain aware of what you say when dealing with clients. Failure to do so, opens up you and your practice to increased liability risk.

The instant you step beyond your scope of practice as defined by your certifying organization, you are exposing yourself to unforeseen liabilities and potential litigation should something ever go wrong. The slip of tongue can be slight and no harm may be intended. The one time you tell a client not to worry about a potential problem, there is risk that the issue may be more serious than you anticipated. If your client takes your comment as professional advice instead of just personal opinion, you could be in trouble.

Risk Management For Your Doula Practice

So what are some options to reduce your level of personal and professional risk when practicing as a doula? Some potential options could include:

• Maintain certification through a professional organization such as DONA International or CAPPA. There are also many local doula organizations that provide a secondary layer of professionalism. You should strongly consider maintaining membership and certification through one of the national organizations and ensure that you are following their guidelines for scope of practice.
• Maintain liability and/or malpractice insurance. There are pros and cons to this alternative. Typically, annual insurance premiums are not expensive for doulas and this is likely related to the well defined scope of our work. However there are some doulas who feel that the risk of being named in a lawsuit is minimal and in fact carrying an insurance policy increases the risk of being sued. The decision is a personal one.
• Beyond carrying an insurance policy, you should also be careful to avoid situations that could open you up to potential liability. Not providing advice is a great place to start! Simply direct your client to the appropriate sources of information, help them to understand and encourage them to ask their health care provide for a professional opinion or advice.
• Consider how you could be putting yourself at risk in other situations that are not specifically related to providing advice. Perhaps you give some of your clients a foot massage using oil. What if one day a client slips and falls? Is there a possibility that they could blame you? Do you ever drive clients to the hospital? What if you have a car accident? Are you potentially liable? Have you ever told a client that there is no need to go to the hospital yet because they are still in early labour? What if this time there is something more serious happening and your clients decides to hold you accountable? As a doula, do you recommend any holistic or herbal remedies to clients? Are you required to have a license to do so and if something goes wrong, who will your client blame? Just because something is “natural” does not make it OK for you to recommend or prescribe.
• One of the most important things you can do is maintain open lines of communication between youself and your clients. Have a printed copy of your “Scope of Practice” available for clients to read and sign. Make sure they acknowledge that they understand your role as a doula. Better yet, make sure they acknowledge it in writing! Have your forms available at your first prenatal meeting and leave a copy with your clients. As the client-doula relationship develops over time, don’t be shy about reinforcing your role as a doula.
• Have your clients sign a waiver that releases you from any potential liability. It may even be worth considering having a lawyer draft the appropriate document. As an alternative, your local or national certifying organization may already have a generic waiver/release of liability form available for your use.

Liability & Malpractice Insurance For Your Doula Practice

Perhaps the biggest argument for maintaining liability and/or malpractice insurance as a doula is the fact that the premiums are very reasonable. Typically, annual premiums run between $50-$150 depending on who is underwriting the policy. In Canada, members of CAPPA Canada have the option of purchasing group insurance coverage through LMS Prolink Ltd. In order to qualify you must be a certified member of CAPPA in good standing. Given the few options available in Canada for doula liability/malpractice insurance, this represents an excellent alternative to seeking out your own personal policy.

For doulas working in the United States, a popular source of insurance coverage is Malpractice Insurance For Postpartum Care Providers/Doulas available through CM&F Group Inc. Premiums are also very reasonable. Currently (June 2011), annual premiums are between $94 and $136 depending upon your State.

With such inexpensive annual premiums, it becomes increasingly difficult to justify not carrying an insurance policy. In fact, you would have a difficult time finding any other professional business where the owner or individuals practicing were not insured. Your doula business is just that – a business. Protecting yourself by working within your defined scope of practice, communicating clearly with clients and by insuring yourself, makes good business sense!

I always knew I wanted a natural childbirth. I’d heard too many stories about how hospitals push interventions that can lead to C-sections, and I didn’t want to have my daughter lying in bed with my feet up. I wanted freedom to let my body birth my daughter in the way most natural and comfortable to it. When I got pregnant with my daughter, I found a hospital that offered water births and a midwife who favored natural births. But this midwife doesn’t stay with laboring moms until the pushing stage, so I knew I needed someone I could trust to help me through the actual labor. I did not have time for birthing classes, and I figured I’d be much better off hiring a doula who would be there giving the advice I’d need during my labor.

Enter Talitha Seibel, a labor doula with four kids, a calm demeanor, and a great attitude. More important, she’s committed to helping mothers have the type of natural labor they desire and avoid unnecessary interventions. (A word to the wise: don’t think your husband will be able to provide the support you need during labor. While my husband was about the most supportive imaginable, he would have been useless without Talitha there to coach him.) Though I hired her to be there through my entire labor and delivery, what I didn’t realize was how much help she’d be before a single contraction commenced.

Talitha met with my husband and I twice before my due date and showed us some labor moves as well as exercises I could do to prepare my body for birthing. She was always available by phone to answer all my pregnancy and birthing questions. As my due date approached, my midwife’s office set me some appointments with a different midwife. One day this midwife gave me some confusing advise about taking certain herbs that could help induce labor. I called my doula, and she said that it’s not normal for midwives to prescribe those herbs unless they plan to stay with you while you take them. She advised me to do some exercises she sent me instead. Because of her advice, I called my regular midwife, who agreed with my doula.

When I finally went into labor, I didn’t think the period-type cramps I felt could actually be contractions, but just from talking to me over the phone, Talitha knew they were, and she knew when was the right time to meet me at the hospital.

My labor was difficult and long. I went into my own zone where I was barely aware of what was going on around me. Talitha took care of every detail in the room so that I didn’t need to think about a single thing except the actual labor. She monitored my labor, helped me move when I needed to, and took turns with my husband providing counter-pressure. No nurse ever talked to me. I never thought of taking drugs and barely noticed the passing of time.

There’s a sign I see on the freeway. It shows a picture of a really cute baby and says, “Delivered to you by [hospital name].” I’m so thankful that my daughter was not delivered to me. I delivered my daughter through the power of my own body, and through this process I transitioned into motherhood. My doula provided me with all the advice, support, and wisdom I needed to bring my daughter into the world in the way that I chose.

There are two main kinds of doulas— labor or birth doulas, and postpartum or postnatal doulas. A worker of the former type provides care other than medical (i. e., emotional, physical and informational) up to and including the point of labor, while the latter type cares for the mother and baby immediately afterwards, sometimes for six weeks or more. The doula helps the pregnant and laboring mother to relax, works with her to find comfortable birthing positions, informs her as to what options she has regarding birth, and provides her with an environment in which she can feel comfortable and secure. She also provides emotional support for the father of the soon to be born baby.

Unlike the higher level careers like those of a midwife or obgyn, the practice of the doula is not regulated by law in the great majority of the world’s countries and doula certification or training are not required.

Certification can come from a number of organizations, each of which has its own set of requirements.  One such organization is DONA International, from which the candidate may purchase a certification package which remains useful for two years. Requirements include an accumulation of sixteen hours in a workshop approved of by DONA International; classes include Training in Childbirth Education. Alternatively, the candidate may gain experience working in the field as a registered nurse before she can become a doula.  DONA International also has a list of required readings, which can be downloaded at their website. The organization provides a list authorized course providers in Australia and other countries.

Childbirth International is another such certifier. Unlike DONA International, it does not require its students to attend workshops. Again, they have a list of books to read. Candidates must also complete a childbirth survey; submit evaluations of each of the modules in the manuals provided; support two women in labor and complete a childbirth survey with two assignments – one in communication describing your own births or alternatively, a significant life event. This assignment is to be done at the student’s own pace The second assignment is an “open book” test covering the study materials. You should expect to take 3-7 month to complete the certification process in it’s entirety.

The International Childbirth Education Association (ICEA) is an organization of trained professional doulas. It has two sets of doula certification requirements, depending on whether the candidate has received an educator certificate from the association. In both cases, the candidate must read one or more books from their reading list; attend an ICEA- approved training workshop; complete six “contact hour program tests;” and submit certification materials. In addition, those who are certified educators must audit at least one childhood education class, and confirm three experiences with labor or postpartum support. The total cost of the certification program can be a few hundred dollars, and covers such items as ICEA membership, enrollment, textbooks, and training.

CAPPA (the Childbirth and Postpartum Professional Association) is the last certifying body to be discussed in this article. Ninety- two percent of all those who apply for certification from this organization succeed in obtaining it. Only those who have purchased membership in the organization may apply for certification as a doula. In addition to some of the requirements discussed above, the candidate must also complete the company’s pre-workshop study guide and have it ready when she shows up for training as well as pass a knowledge and skills test. It is also possible to take distance courses from CAPPA.

CAPPA also has a Canadian branch, whose policies and certification requirements are basically the same as they are in the American. Branches of CAPPA in other nations include those of Ecuador, India, Israel, and the Caribbean.

Other countries also have doula organizations, but many of them have only begun to be organized. In Great Britain, for instance, there is only one nonprofit organization for doulas— Doula UK, which celebrated its tenth anniversary just this year. Whether or not an individual desiring to work as a doula— in whatever country— decides to obtain formal training and certification is essentially her personal choice.

Parents who are seeking out a doula should take the time to find out about the reputation of the various certifying organizations. Do the doulas certified by such- and- such an entity have a reputation for good work and successful delivery? Contact other couples who have had doulas perform their deliveries for them, and ask what their experience was like; then find out which organization had certified that person. Whether or not a doula is certified is only one factor to consider, there are many doulas who choose not to maintain long term certification beyond a certain level of experience.