What Your Doula Wants You to Know

This Spring marks the 14th year that I have been serving families as a doula.  In attending many births and in networking with other doulas during these years, it seems there are a few things that every doula would like for her clients to know. So parents, if you are using a doula for your birth or are considering hiring a doula, here are some thoughts to keep in mind.

Keep me in the loop. You have hired me to attend your birth, and I’m really looking forward to that. It’s important that you know that a big part of the support that I am able to offer you begins long before labor does. Please don’t hesitate to reach out to me. I’m here to be your “walking birth wiki”. I’m way less scary than Dr. Google, and I love to talk about birthy stuff. Pick my brain. Ask me questions. I will offer you information, share my resources, give you encouragement, and lend an empathetic ear to your concerns.   I especially want to know if you go to the hospital for any reason, or have something happening that you are worried about. It’s good for me to know what’s on your mind as you prepare for your baby, because this might come into play with your birth experience. Keep me posted about what’s going on with your prenatal care. Even if it’s just a note that says “Hi, we’re all great!”, I want to hear from you. It’s never “bothering me” to call. No apologies or guilt necessary. I’m going to let you set the pace for our communication; call me once a day, or call me once in pregnancy – that’s up to you. Everybody’s needs are different. I’m going to trust that you know that I’m here, and that you are reaching out as much as you need to.

Understand my role. You are the boss of this birth, and you have hired me as your doula.  This means that I don’t get to tell you what to do. You tell me what’s right for you. As an experienced doula, I might have relationships with your doctor, midwife, nurses, or hospital. With any luck, they are good relationships, and our being on a birth team together is something that will enhance your experience.  Providing non-medical labor support is my role on the team. I will do all I can to help you give birth the way you want to, while respecting the medical professionals and the rules of the birthplace you have chosen.  I am not there as a bodyguard or a bouncer. I don’t arrive prepared for combat.  I cannot throw myself between a woman and the doctor who is about to break her water. If I tried that, they would throw me out and never let me or any other doula come back. I want to support your birth, and I also want to be able to show up for the next mama who plans to birth there. So, I won’t speak to your doctor on your behalf. I don’t get to tell them what you will do. You certainly may, though. What I will do is remind you of your goals. I encourage you to ask questions that help you gather information, so that you have clarity to make your own decisions. I stand behind you in exercising your right to use your own voice to speak up about what you will accept or refuse.

Set yourself up for success. If you really want to have a low-intervention unmedicated waterbirth that’s “as close to a homebirth as possible”, then the big teaching hospital with a 95% epidural rate and no tub is probably not the best place for you. Chances are pretty good that if you choose to give birth there, the birth you want isn’t going to happen. Make sure that your birthplace and your birth attendant are a good fit for what you have in mind. You, as the consumer, have a choice. Look into the facilities that are available to you. Ask what options they provide, and find out what they offer to support you in creating the kind of birth you want to have. The same is true for choosing your doctor or midwife. The practitioner who says, “Ugh, I don’t like doulas” isn’t very likely to be into the idea of other requests you make, either. Take personal responsibility for learning the rules of your attendant and your birthplace. Though I, as doula, may wish the highest and best for you, my being present will not protect you from factors that come with the territory of the location or practitioner you have chosen.

Prepare yourself for your birth.  It is up to you to take charge of readying yourself as fully as you can for birth in body, mind, and spirit. Participate in good classes, educate yourself about birth options and coping skills, and take excellent care of your body and your mental and emotional health. Seek out the support that you need to do this. Your power is already your own, whether you choose to claim it or not.  It  is not mine or anyone else’s to give to you or to take away from you. I do not empower your birth. I do not advocate for you.  I support you in learning to empower and advocate for yourself. Likewise, I know a lot about having a baby, but I am not having your baby. I can make suggestions for positioning or comfort measures, and help you remember all of the ways that you have learned to cope with the intensity of labor. I can encourage you to ask for what you want. I cannot guarantee you that your birth will be easy or uncomplicated. Labor is hard work, whether you have a doula or not.  Birth is unpredictable, even when you’re well-prepared. When all is said and done, you are the one responsible for your choices. You are the one who will go through this process to become your child’s mother. Prepare yourself to surrender and release, and let your mind, your heart, and your body be open.

You have my unconditional support. This is your birth, not mine. My priority is to see that you know what your options are, and that you are informed in making your own best choice. I want to understand your hopes, fears, and goals for this birth, so that you feel seen and heard. When I ask about these things, I want your deeply honest answer. Please don’t concern yourself about the “right” answer, or what you think I want to hear.  I will offer comfort in whatever way I can to help your experience happen in the way that you hope for. I will remind you of the wishes you have shared with me, and give you encouraging words and hands-on support if you want to have a drug-free birth. I believe in you, and I know you can do this. I will not leave you if you change your mind and decide that pain medication is the right option for you. I will not judge you for the choices that you make. This is your body, your baby, and your birth. I trust you to make the best decisions for yourself. If something happens differently than what you had hoped or planned for, please don’t apologize to me. You have my support when you are scared. You have my support when you think you can’t do it anymore. You have my support when you are crying. You have my support when you are angry, or irreverent, or unglued, or unlovely. You have my support in your joy.  This is your birth. I’m here for you.

Our relationship will change. I love being your doula. I love the whirlwind courtship of getting to know you well in a short time. I love hearing your stories about your life,  the births of your children before this one, the story of how you met your beloved, the story of your own birth as your mother told it to you. I ask intimate questions that perhaps you hadn’t even thought about before, about your hopes and fears, and how you cope with overwhelm, and what makes you feel safe. More than anything, I listen. Toward the end of your pregnancy, we may be talking once a week. In the last few days, we might be checking in every day.  I might not ever know the names of your siblings, or where you grew up, or any of the other things your friends would usually know, but by the time your baby is born, we have forged a bond that is close, and real, and beautiful. Then, after your baby is here and you are settled in as a new mother, I don’t see you much anymore, and we hardly ever talk.  Please don’t take it personally. Know that I still care very much, even if I probably won’t make it to your child’s birthday party. Our relationship as doula and mama happens for a finite period of time. I miss you. I still love you. I cherish the memory of the time I have shared with you, and now I’m offering that same support to my next mama. I’m just as busy with her as I was with you. This is what doulas do.

I will always be grateful. Thank you for allowing me to serve as your doula. I would say thank you every day, if I could. Thank you for inviting me into your life, your home, your birth space.  Thank you for trusting me to witness the birth of your child. Thank you for the honor and the privilege of caring for you through this part of your life. Every birth touches my heart. Every birth brings a lesson, and I am grateful for the learning that comes from your birth. I am grateful for this place where our paths crossed, and our life stories are woven together for this short while.  Thank you always, and blessings on the journey.

 

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My Least Favorite Doctor

For years, I’ve had a very strong personal policy about not speaking out against other professionals. Harmonious professional relationships are one of the biggest assets of my practice, and I work hard to keep it that way. Even in the rare occasion when personalities may not make for the best fit, I will respectfully defer to a professional judgement call. Most of the time, I genuinely love the doctors I work with. I’ve seen them offer boundless patience and encouragement in the longest of labors, and I’ve seen them offer wise advice in times of need. A few, I’ve witnessed handling true emergencies with admirable grace. With every encounter, my respect grows deeper and my gratitude for them is stronger.

However, sometimes a woman gets fed up. Sometimes, things just need to be said. Sometimes, a relationship just isn’t working, and needs to be let go. This is one of those times. I confess now, there is a doctor I can no longer stand.

He is reactive in the face of the smallest concerns – every mysterious bump or blemish needs to be tested for cancer. Every strange hiccup might be an emergency, and an immediate trip to the hospital is warranted. More than anyone I’ve ever known, he loves to trot out the words “this could be fatal.” And yet, his inconsistency is equally maddening. In times of true concern, he’s just as likely to say, “Ignore it, don’t do anything. This is probably nothing.” For second opinions, he’s abysmal. More than answering with anything evidence-based, he loves to contradict whatever advice someone has already been given.

People love him for his availability. I’ve heard stories of his answering questions at the oddest of hours – 10 am, 10 pm, 4am, whenever. He exists to hear himself give answers, without it mattering in the least whether they’re actually right. It seems he never sleeps.

His bedside manner is horrid. Not only does he completely ignore an individual’s unique circumstances or test results, he has no compassion whatsoever for anyone’s feelings, or what a family may be going through. It’s either “You’re going to die” or “Stop being a baby.” He’s calloused and completely unresponsive to feedback.

The worst part is that there’s not a chance of his being fired. As far as any state boards or governing organizations are concerned, he’s untouchable. His license is bunk. He’s a quack. And just as frustratingly, though this reputation is well-known, people ask for his input anyway.

So, the most I can do is refuse to work with him anymore. From here on out, I will tell people to ask someone else that they (and I!) can trust. I will not encourage listening to his advice. Don’t contact him, don’t listen to him, don’t give him your attention. And, I will say it here for everyone else to see:

DOCTOR GOOGLE, I HATE YOU. WE ARE THROUGH.

Doulas and Nurses – A Mighty Team

nurse

In the birth world, whether on message boards, at a nurses station or in a doula meeting, it’s not uncommon to hear tension on either side of the story. “UGH! This nurse! She kept saying ‘You can get an epidural anytime, you know. It’s not like you get a better baby without one.'” “Oh, this doula, OMG. She kept taking the monitors off, and every time I came in the room, she was on a mission to keep me from doing my job!”

Both have tough jobs, to be sure. A nurse, in her twelve-hour shift, might be attending to three people at a time, assisting with who-knows-how-many deliveries in the course of a day. She’s watching Room 5, who has an epidural and is sleeping, on the monitor screen when the fetal heart rate goes wonky. Then she’s helping Room 3 push, then assisting Room 7 in getting an epidural. Room 4 is admitted with ruptured membranes, having no contractions, and has seventeen people camping out for her in the waiting room for whom the nurses will be playing diplomat for the next thirty hours. Room 10 is having a panic attack, and Room 8 is using self-hypnosis and doesn’t want anyone to talk to her in any way, shape, or form. That’s just in the last two hours. Who even knows what the rest of the day will bring? If she’s lucky, she’ll get five minutes to pee. Forget about lunch.

She’s fluent in the communication style and preferences of each of the eight doctors on shift that day, and can turn on a dime as needed. Dr. David loves it when everything is ready for delivery, gloves and all, when he comes in the room. Dr. Wendy doesn’t like questions, and will ask for everything she needs, so just do as she asks when she asks for it. Dr. Zen is going to be calm if her patient takes all day, and Dr. Zip is going to order pitocin in the next hour if her patient doesn’t get moving. Dr. Fortissimo is a yeller. Dr. Brown likes to be called in after pushing is well underway, and Dr. Green always does her own internal exams and wants an update at least once an hour, please. Dr. Shiny, the brand-new Resident, is eager to overmanage and hasn’t yet learned the art of patience and diplomacy. No problem – this nurse can handle it all with style and grace.

She makes the transition from one scenario to another countless times in one day. She goes from the blissful welcoming of a long-awaited firstborn to the fear-filled room of a teen mom laboring alone. Then she enters into the room of the grieving parents whose preemie baby isn’t handling labor so well, and from there to the exhausted mom who has been laboring with her third for two days. In each room, she smiles. Each one, she asks about comfort and how needs can be met. Each interaction must be accurately documented (with the software that is different this week than it was a week ago,) meaning that she must find the balance between interacting compassionately with her patient and facing a screen. Meanwhile, in her head is the ongoing chess game of which patient’s need is greatest in this moment, and hoping that the charge nurse, who is the air traffic controller of all nurses who sees that all of the tasks get done, will let her be where she thinks she is most needed when she needs to be there.

The doula works just as hard, in a somewhat different way. Her focus is on one birthing person at a time, for as long as this birth takes. She, too, provides long hours of support. She tends to comfort measures, position changes, counterpressure, and talking through fears. She keeps the birthing person informed about her options, and encourages her in her decision making. She has the time and availability to answer questions, and explain each step of the process of labor, in a way that others on the team may not.

When doulas and nurses work together in harmony, the outcome can be spectacular. The nurse is free from worry that her patient is being well cared for. Her stress level is lower, and her time in the room can be more focused on providing high-quality care, and less on housekeeping and getting more juice. When doulas and nurses work in conflict, the consequences can be stressful for all involved. So, what can doulas do to ensure a happy birthing team?

First, remember that we’re all human. Communication skills and styles vary widely from person to person. For some, it’s a strong suit, and for others, not so much. However, what one nurse lacks in “warm fuzzy” she may make up for in knowledge, or patience, or strong clinical skills. Remember, too, that everybody has an “off” day now and again. Take nothing personally.

For every one nurse who makes a snarky comment, there are surely ten more who are going the extra mile, staying fifteen minutes after the end of her shift because the patient she had bonded with was delivering and she didn’t want to leave. And, you know what? Nurse Snark probably did that yesterday for somebody else, but today, she witnessed something really intense at the beginning of her shift, and now she’s exhausted. Maybe another patient just bit her head off. Perhaps she just got called out of a room with someone who really needs her, and she is worried that the person taking her place now won’t be a good fit for the patient she just left. Maybe her kids were whining this morning because she’s working today, on her day off, because someone else called in sick. We’re all going through more than we reveal out loud. Be gentle in your judgments.

Second, if you want to be on a harmonious birth team, act like it. Introduce yourself. Look the nurse in the eye and smile. Let her know that you’re happy to help in whatever way you can. Remember to say “please” and “thank you,” and call her by name when you do. She changed soggy bed pads? Say thank you. Said something really encouraging to your client at just the right time? Thanks again. Brought extra towels into the room for the third time? Thank you. Brought you the birth ball and the rocking chair, and has the tub room all ready for your client? Thank you, thank you, thank you!

Let her show off her skills, too. Doulas and nurses both come into this line of work as compassionate people with a desire to serve others. Chances are, just like you have, she’s learned a few things along the way. When she’s in the room, let her do her thing. If she wants to share a few of her precious and limited minutes doing some of the good stuff – taking a few moments to breathe with your client through the contraction, rubbing her back, making a comfort suggestion – welcome it. Take this opportunity to learn from her, and expand your own repertoire.

Stay within your own scope of practice as a doula. Remember that you are a guest in the hospital staff’s workplace. If you have questions about the hospital’s rules and protocols, ask in a way that communicates respect and a desire to work within their guidelines. Refrain from offering medical advice, and support your client in making her own choices. Let your client speak for herself. It’s seldom a good idea to start with,”But her birth plan says…” Ask all of the questions you need to in order to help gather information, let the nurse share what she knows as well, and leave the decision-making part up to the client and her partner. Don’t speak to the doctors or nurses on your clients behalf. Remember that you are responsible for fulfilling your support role, and the client is responsible for making her own choices and letting her own wishes be known.

When all is said and done and the birth you’re attending is complete, share your good thoughts. In a job full of intensity, when laboring women are often seen at their most raw, it means the world when someone else notices something that was done well, and says so. Did you notice her gentleness? Was she great with an anxious mama? Did she sit on the floor and contort her own body to hold a monitor in place for ten whole minutes so that your client could stay in the comfortable position she’d found? Let her know that you noticed, and that you appreciate it. If she was really fantastic, perhaps even consider writing a letter to say so, and sending it to her boss.

We’re all in this together. A great team makes for a great birth experience. When doulas and nurses work together well, everybody wins.

“You Don’t Really Need a Doula”

Most of the time, when I get a call from a potential client looking for services, the first words out of her mouth are, “My practice gave me your number.” Her midwife or doctor, discussing her birth wishes during a routine appointment, said, “Here, call our doula. She’ll help you.”

Every now and then, though, I’ll hear something more like, “I hope you’ll work with my midwife. She said I don’t really need a doula – that if I want one and can afford it, that’s alright, but she’ll do everything a doula would do. I still really want one, though. Do you think that’s ok?”

This boggles my mind.

Almost always, a doula is a welcome addition to a birthing woman’s care team. In a hospital setting, the doula, the midwife, the doctor, and the nurses all have different roles. The doctor or midwife’s primary job is to attend to the medical safety and wellbeing of the mother and baby. The nurse’s role is to track a mother’s vitals and labor progress, and report to the doctor or midwife any information that may mean that this birth needs help. She may be offering this care to three people at a time, and might see a dozen or more birthing people in the twelve hour shift that she’s there. The partner’s primary role is to love the mother in whatever way comes most naturally. It’s the doula’s role to provide one-on-one non-clinical support throughout labor. This might mean offering simple comfort measures, suggesting position changes, words of encouragement, information for decision making, or just keeping the space calm and quiet – whatever the birthing person needs.

Usually, the doctor or midwife is most actively involved in the “home stretch” of labor, when the baby is about to be born. At the time they are most needed, a midwife is paying attention to many things at once. Their internal dialogue sounds something like, “How’s the baby’s heartrate? Does it seem like the baby is ok? Yup, looks good. How much blood loss is this? Some, not too bad. What position is this little one in? A little crooked, but head’s moving out just fine. Good. How’s this perineum? Give it good support so she doesn’t tear… Where’s that olive oil? How’s mama’s heartrate? How’s her blood pressure? Ok, all is well there. Oh, this fluid isn’t looking so clear… how’s baby’s heartrate now? Went down a little, coming back up fine. Good.” There are a hundred thoughts at once moving through the practitioner’s head.

At the same time, out loud she’s saying, “Ok, Jane, you’re doing fine, just little pushes now. That’s good. You’re doing great.” When something doesn’t look great, which can happen suddenly, she’ll know exactly what to do for the safety of mother and baby. The biggest work of the doctor or midwife happens in short, intense, highly-focused bursts. Like Olympic athletes, they stay calm and make it look easy only because they’re very good at what they do. If they’re a hospital practitioner or in a busy birthing center, then after this birth, they may be called upon to do the same thing six more times while they’re on call in the next twenty-something hours. In a homebirth setting, she’ll need to rest up and practice good self-care in case this is one of the weeks that all four of her current clients go into labor right in a row.

The doula’s work happens in longer stretches of energy and effort. We aren’t responsible for checking blood pressure or doing cervical exams. Though this information is beneficial for those responsible for a mother’s medical wellbeing, those tasks fall outside of our doula role. Our job is to tend to labor support. Prenatally, we spend our hours getting to know you and your wishes for your birth. We talk at length about your hopes and fears. We talk about what calms you when you’re feeling scared, or perks you up when you’re tired. We’re available every day to answer your questions. We learn what is most important to you for this birth, and support you in learning how to help that happen. We spend long hours in helping you get through early labor, when it’s too soon to go to your birthplace or call in your homebirth attendant. We help you figure out when it’s time to call your doctor or midwife, and when it’s time to go to the hospital. We make sure your partner is rested and nourished. We help you communicate with the people who provide medical care for you and your baby. We provide physical and emotional comfort when labor gets intense. By the time your baby is emerging and your trusted caregiver is most needed, the bulk of our work is done. Supporting your labor up to this point might wear me out, and that’s ok. That’s what I’m there for.

For a primary birth attendant, whether doctor or midwife, to practice both as doula and perform in their own role would be irresponsible medicine. Prenatally, it would be foolhardy for your doctor to spend the fifteen minutes he has with you to talk about what calms you on a stressful day instead of talking to you about your latest bloodwork and your baby’s growth. In labor, there is no way one person alone could maintain hip squeezes, breathing through every contraction, and giving pep talks for twelve hours at a stretch, and still remain sharp-witted when their knowledge is most needed to ensure that all is well. From a simple logistical perspective, it’s impossible to support someone’s perineum and also whisper in her ear and wipe her brow with a cool cloth at the same time!

A good doula knows that when a medical judgement call is in order, that’s outside of a doula’s scope of practice. In that moment, it’s the doula’s role to stay out of the way, and to help the birthing couple to understand what is happening and why. Likewise, a supportive practitioner knows that when doula support is desired, having a qualified doula on the team is only going to serve to make the person in his or her care happier with her birth experience.

So, if you’re one of the lucky ones who has found a practitioner who says, “Here, call our doula,” cherish them. Know that your care is in excellent hands. You’ve found a practitioner who cares about your wishes and wants you to be happy with your birth experience. And if yours is the practice that says, “Ugh, I don’t like doulas,” or “Don’t call a doula, because I’ll do everything a doula would do,” I encourage you to question why wanting this support for yourself would ever be considered a bad thing.

You deserve a birth you feel good about. You, your doctor, your doula, your midwife and your partner are all playing different positions on the same team. We’re all in it together. Everybody wins.

The Woman and the Elder

Once upon a time, there was a woman who hungered for learning. She had endless questions about life and the mysteries of the universe. So, she approached a wise old medicine woman, and said, “Please, teach me everything. I’ll do whatever you ask of me.” So, the elder told the woman exactly what to do. She instructed the woman to part from everything and everyone she knew, go into the woods and dig a pit in the ground in which to dwell, and lower herself into it. Each morning, the elder would approach the pit with her walking stick in hand, look down upon the woman, and ask, “Well, have you learned everything?” “No,” the woman would answer. “You disappoint me,” the elder would reply, and raising her stick, she would hit the woman in the head and walk away.

In this way, days passed, and weeks, and months. The woman, yearning more than ever for her enlightenment, would pass the time walking through the woods, gathering the wild plants that fed her. She spent hours and days on end in singing, and meditation, and prayer. She watched the animals, and the sunset, and the moonrise. Every night, she would lower herself into the pit to sleep. Though she learned quite a lot, she knew that she had yet to learn all that she longed for. Every morning, the elder would approach. “Have you learned everything?” “No.” “You disappoint me,” followed by a harsh blow.

Years went by, until one morning, same as ever had been, the woman was approached by her elder. “Have you learned everything yet?” “No,” she answered. This time, seeing the walking stick begin to rise as usual to deliver the painful thump, the woman raised out her hand and grabbed the end of the stick. Looking the elder square in the eye, she said simply, “Stop it!”

Taking a step back, the wise woman nodded. “Good,” she said. “Your work here is done.” She walked away, never to be seen again.

The woman climbed out of the pit in the ground for what would be the last time. She knew, now, that she would never know the answer to everything, but she knew how to stop the pain, and that was enough.

**Special gratitude to Melodie Beattie for the concept of the story, shared in her work The Grief Club. The retelling of it is the author’s own.

The Cow, the Highway, and the Doula

Once upon a time, there was a village, and in this village was a field, and in this field there lived some cows. It was a nice field, full of lovely green grass for the cows to eat. There were a few sunny flat spots just right for resting on, and a big tree with branches that were just the right height for a good back-scratching. There was a small hill where breezes would drift by and blow the flies off the cows’ backs on a hot day. There were shady spots filled with delicious sweet clover, and a small pond nearby was always full of fresh water for drinking.

After a while – nobody remembers exactly how long – with the cows meandering from the pond, to the trees, to the hill, and to the nice resting places, a path began to form where the grass no longer grew from being trod upon. As all of the cows plodded along from one favorite place to another, day after day, the path on the ground grew a little flatter and a little wider. It formed into such a nice clear path that after a while, people noticed it, and began using it, too. The path had some odd curves to it, where the cows had stepped around a bush or avoided holes in the ground as they wandered to and from the parts of the field they liked best, but nobody seemed to mind that, much. The path was better than walking through the trees or the tall grass, where you might come across a snake or a hornet’s nest. The children used it as a shortcut on their way to and from school. The grownups in the village began using it to walk to and from town. The farmer used it to ride his ox-cart to take his goods to market every Saturday. The path began to grow bigger.

Over years, the little village grew, and people from nearby villages began using the cow path, too, trotting on the backs of their horses as they traveled from one village to another. After some time, the path had become wide enough and busy enough with bustling people, that the cows (who were known to interrupt traffic and be a bit of a nuisance) were moved away from the path and into another field, where they were fat and happy. What was once a field was now home to a long and winding dirt road. Some of the trees with their low-hanging branches were cut back to make more room for the road and the people. A straight line cut through the field might have been a little faster for getting from one place to the other, but the cows had done the work of trampling away all the grass, and it was such a nice little road, that nobody really complained. After a while, nobody even remembered that it was once a cow path.

The milkman used it, to ride his buggy in and out of the villages every morning. The farmers set up fruit stands beside it. The baker began peddling his wares along it.

Then, a problem began to form. You see, one Spring, it rained a lot, and the path turned to mud. Everybody’s boots got wet and mucky, and the wagon wheels had an unpleasant way of getting stuck. So, some very clever people with some very modern ideas decided to pave the road, to make it easier for travel all year round. The paved road was great for business for the little village, and the people were happy.

Over years, the paved road, with its impractical meandering curves, got quite crowded with traffic, and was made wider. Most people began to drive cars. Some stop signs and traffic lights were put in, and speed limit signs, and grocery stores and gas stations and shopping malls. That little road is now a four-lane highway. The state owns the highway, and the governor allocates money every year to keep the highway free from potholes. The policemen work to keep it safe (though not always) from speeding cars and texting drivers. Thousands of folks every day use the highway to get to work, and school, and church, and piano lessons. Nobody who lives nearby has seen even one cow for years, except for the one at the petting zoo.

Some folks call this progress, some folks call it backward, and others call it “the way we’ve always done it.” No matter what folks call it, most people are going to keep on using the highway, winding and complicated though it may still be. They’ve always known it to be there. They’ve always used it. Their parents used it, and maybe even their grandparents did, too. Most of the time, people who take the highway are going to be just fine. They’re going to get to where they want to go without much fuss, and without thinking much about the road they’ve taken after they got to where they were headed.

For some folks, there might be safer, or less crowded, or more picturesque or direct routes to take to get to where they want to go. A paved cow path isn’t always the best way for everybody – even though it may be the best known. Some people might like to walk or take a bicycle, and there are easier roads for doing that. Others might want to avoid the traffic, or enjoy a scenic view. That’s ok, too.

And then, there are some so opposed to the highway that they think nobody ought to go that way. They might yell, or hold up signs and scream or rent billboards about how stupid it is to take a paved cow path to get to where you’re going. And then, there are others who holler just as loudly that only hillbillies and hippies would ever want to take a route that isn’t the highway. The problem is, not many people want to listen to someone who is screaming. Screaming doesn’t make someone right – it just makes them louder. They might be dismissed for seeming rather silly before anyone actually hears what’s being said. The highway is already there. It may have started as a paved cow path, but it’s not going anywhere anytime soon. It’s what people know.

But what if someone is willing to sit down, and talk it over? What if we start by saying, “Oh, you’re going somewhere? How wonderful! I’ve been there a few times, there are some nice stops along the way. Would you like to talk about how you’d like to get there?” Maybe it’s possible to start by listening to how excited they are to be traveling, and what they’ve thought about taking with them, and what they’re going to do when they get there, before we start with “I would never go that way!” Maybe there are some beautiful side roads we can share stories about. Maybe this is the first time they’ve ever heard about some of them. Maybe they do really want to take the highway (and if they do, do they want to go by car, truck, bus, taxicab, Winnebago?) Maybe they’ve heard rumors about some other roads, and want to know more. Or, maybe a friend took the back roads and had a beautiful time, but they don’t know just how to do that themselves yet. Maybe they’ll choose that way, and maybe they won’t – the journey is up to the traveler.

A doula is like the compassionate guide who shows up with a map. We say, “You’re having a baby, how wonderful! Have you thought about what you’d like your birth to be like? You have some great options available. Let’s figure out which ones are best for you. You can go whatever way you want to. I’ll help with the directions. I’ll help when you or your companions get road-weary. This journey is yours. I’ll do all I can to see that you’re happy with the memory of the road you’ve chosen to travel.” If we’ve done that much, it’s enough.

The Doula Path Experience

Are you ready for something exciting and new? Are you ready to breathe new life into your work, embrace your gifts, invite abundance and joy into your life, and become the doula you know are called to be? This is an opportunity you won’t want to miss.

In March of 2014, I am calling together a group of brave doula souls. Working together, we will co-create a safe space – a “container’ – in which we will delve into deep personal work together. We will challenge ourselves to create a more prosperous and successful path that serves us in living more vibrantly, with joy in every day, so that we may thrive and more richly serve others during the major life transition of birth. We uncover and transform self-limiting beliefs, learn new ways to nurture ourselves, and create a network of accountability and support for meeting our own self-care needs as we define and strengthen our professional goals.

Are you ready? Is this circle for you? Are you feeling called to say “I’m IN!” Are you ready to connect deeply with other women who are also doing this powerful work of service? Are you ready for a time of loving yourself more fully than you ever have, and embracing your own vibrant self as never before, so that you can more deeply provide loving support to those whose lives you touch?

The focus of the Doula Path Experience IS:

– Receiving ongoing guidance from an experienced colleague
– Building confidence in your personal skill set as a doula
– Connecting with others who share your passion for this work
– Receiving compassion and encouragement
– Examining the Core Values that limit us, hold us back, or push us forward
– Inviting abundance and prosperity on multiple levels
– Taking your next brave step into achieving your vision
– Believing in the value of showing up for yourself

Within this program, you will learn:

– Nuts and Bolts tips for day-to-day business management
– Exercises to discover and define your unique strengths as a doula
– Establishing, Communicating, and Maintaining Strong and Healthy Boundaries
– Identifying and Attracting your ideal clients
– Acing the Interview
– Conducting prenatal appointments with confidence
– Recognizing Red Flags, and what to do with them
– Tools for respectful and effective communication with clients and care providers
– Defining Your Doula Practice
– Teaching Clients the Process of Informed Decision Making
– Developing Daily Personal Practices to Prevent Burnout
– Finding Balance to Achieve Professional Success while Nurturing Personal Priorities
– Developing your personal five-year plan

This six week program will include six weekly 1 to 1.5 hour group teleconference sessions, beginning Tuesday, March 4th at 1pm US Eastern Time. These calls will be recorded and available for listening at other times. You will also receive three one-hour private mentoring calls with me. An online forum with daily support from me will also be included, providing connection with your colleagues within this container, offering one another encouragement, support and compassion throughout this growth and learning process.

Who am I?

I am an active doula with 15 years and 500 births under my belt. I have served for several years as public speaker and workshop facilitator for many women’s health and spirituality conferences. For eight years, I have run the ongoing program of Radical Self Care for Women, supporting hundreds of individuals through a six-month process of learning to live with greater joy, empowerment, and abundance. I am now ready to share this work online, to support doulas from near and far.

Program Requirements:

You must be an active doula, either full- or part-time, with a goal of building a thriving doula practice. Whether you identify as a beginner or as a more experienced birthworker, it is important that you have already attended a doula training, whether or not you have become certified, as this is a big step beyond the basics of doula work. You will be challenged within this program to move beyond your fears,resistance, and uncertainty, and into the thriving doula work that you dream of!

A Word About Resistance: On the brink of any big growth experience, it is normal for feelings of resistance to surface. Anyone working with birth knows that, and has seen it happen firsthand. Notice the place where resistance shows up as “I would love to, but I don’t have enough…” Enough what? Time? Energy? Resources? Money? Support? Smarts? Confidence? Then ask where you have used that limited belief to hold yourself back before. Consider how this “not-enough-ness” isn’t serving you, has held you back from living life to its fullest, and perhaps has even prevented you from accomplishing the desires of your heart. Then, give your “YES”, and do it anyway. Show up, resistance and all, and be ready to grow. You are enough. You do enough. You have enough. Come as you are.

Registration and Fees:

Priced at my current fee-per-hour rate, this six week session would cost over $600. As an introductory kickoff, the first six-week round of this Doula Path Experience program is offered at $250. That’s less than a night class at a community college, and the life-long lessons you receive will be immeasurable. Building your passion into your business is worth the investment. A $125 deposit received by March 5 will hold your space. This program is being capped at 7 people, in order to ensure my focused attention to each individual, and to build a strong and intimate container together. Payment plans may be available upon request. Check, money order, and PayPal are all options. Instructions are on the registration form, which can be found here:

What’s in the Bag?

backpack3

A most-frequently-asked-question circulating in the doula community always seems to be, “So, what do you carry in your birth bag?”

I get it. I’ve been there. I’ve talked about it, I’ve shown my bag to clients, I’ve even led workshops about it. I’ll tell you – when I first started out as a doula, I carried a hiker’s backpack with everything but the kitchen sink. It weighed about fifty pounds – over a third of my own bodyweight.

What was in it? Massage tools – wooden and battery operated. Massage oils, scented and unscented. Essential oils. An acupuncture activator. Moxibustion sticks. A rebozo. A pump for my birth ball. Duct tape, in case my birth ball sprung a leak (though I joked that it was in case of a mouthy mother-in-law.) Rice socks, to use as hot packs. Tennis balls. Snacks. Lip balm, and an extra in case mama forgot hers. Hair ties. CDs of good birthy music (this was pre-smart-phone.) A yoga mat. A homeopathy kit. A reference manual. Toiletries, in case birth was long. The list went on and on and on. If I thought I might use it, ever, it went in the bag. Like any good girl scout, I was prepared.

Know what happened? Stuff broke. Bottles leaked. Things got ruined. My shoulders got sore from schlepping this massive bag from house, to car, to hospital, and back to the car again. Most of the time, I didn’t use much of what I’d brought with me, and sometimes, even though I had every material thing I thought I could possibly ever need, birth still didn’t go the way I thought or hoped it would. I felt tired, disappointed, fatigued. My recovery from the “reality vertigo” of attending a long or difficult labor, even when everything went (what I judged as) “perfectly”, sometimes took days. The real work of doula support, I learned, wasn’t what I could do with “stuff” – it began with what I could do within.

It’s not about the bag – it’s about the baggage – MY baggage. The biggest hindrance, I’ve seen, isn’t in not having the right tools in the bag, it’s about having the right tools in my toolkit. Not the tools I carry in a pack, but the ones I carry in my own head, and my own heart. The most effective tools I now carry come out in my words, in my energy, and in my hands.

My hands are among the most powerful comforting tools when my heart is committed to service. Whether I’m offering a loving touch, or removing a distracting clock out of a mother’s field of vision, serving her birth means keeping my thoughts attuned to what a laboring woman wants or needs, free from my own ideas of what “should” be. Believing in my heart that she is capable and strong, that her body knows how to birth and her baby knows how to get born makes my words of affirmation in moments of challenge a greater source of strength than any massager or homeopathic remedy could ever be.

I learned to unpack my “stuff”. It started with the unpacking of the heavy stuff I carried in the pack. What I bring now is basic and simple – a dry shirt, a phone charger, my wallet, gum. What was harder was unpacking the even heavier stuff that I carried within me. The judgments, the “shoulds”, the “have-to’s”, the “can’t”, the “try to”. It included releasing my own definition of what a “good birth” is, letting go of any ideas of my own agenda, and just showing up ready to serve in compassion and support.

I began to re-stock my kit with learning the importance of good self care – keeping myself nourished, energized, and fulfilled, so that I can give wholeheartedly without giving out. I learned how to recognize the difference between what I want, and what someone else has the power to choose. I learned how to set and keep effective boundaries. I learned the language of honoring both myself and another. I learned clear communication skills.

The simplest, most effective tool a doula can carry is love. Show up, and love her. That’s all. Love her in her moments of strength and in her moments of vulnerability. Love her in her power to make her own choices, whether or not it’s the choice I would make for myself or another. Trust her to do her best for herself and her baby, knowing that she is the only one who can say what “the best” may be.

Most of the material tools can be brought by the mother herself, or can be made up on the spot at home or in the hospital with what is already on hand.

What are you carrying that no longer serves you? What do you believe to be true about birth, about yourself, about your own strengths and weaknesses? What expectations are you bringing? What are you judging as “right”? What are you wanting, more than a mother may want for herself? Forget the bag, and check your baggage. You’ll be glad you did.

How to Set a Doula Fee

I’m seeing a lot of buzz recently from newer doulas who are wondering what to charge for services. While they’re beginning to recognize that their work in the world has value (yay!), there seems to still be a lot of mystery around where to even begin when deciding a fair price to charge. So, with that in mind, I suggest the following guideline.

1) Determine your expenses. Doulas have a fair amount of expenses incurred as with any other small business.

How much do you pay for your on-call cell phone? Divide that number by the number of clients you have (or wish to have) per month.

What do you pay for internet? (If it’s a home account shared by your business, determine the portion of your internet expense that is used for your business). Divide that by your clients per month.

How about printer ink? Books for your lending library? Figure that into your per month/per client number, too.

What do you spend per month on scrubs, “work clothes”, good work shoes, etc?

What percentage of your automobile use is for work? Figure in that much per month of your automobile insurance.

How much do you drive, or are you willing to drive, for client appointments and births? The current IRS allowance is 55 cents per mile. If, for instance, you drive 20 miles one way to a client’s home, and you offer two home visits, support in labor, and a postpartum visit, that’s 160 miles you’ve driven for one client, for an expense of $66.00

Remember to also calculate any miles you may travel to doula meetings, or birth support groups, and divide that up per client/per month.

What do you spend per year on trainings, continuing education, or resources to continue your own learning and growing? Divide that into a “per month” amount, and divide that number by your number of births per month. Don’t forget to include your costs for certification, professional organization membership dues, or liability insurance you may carry.

Remember that you may need to pay for tolls or parking at the hospital, as well.

Do you have children of your own? How much do you spend per month on child care for appointments and birthing times?

If you’re at a birth for any amount of time, you’re likely to need to pay for at least one meal, so figure that in, too.

Consider also any fees you pay to have legal documents created, such as your contract.

Include any fees you pay for business cards, advertising, or web design.

Are you paying for your own health insurance? That’s an expense for you, as well – one that is incurred by those who are self-employed. Divide that by your number of clients per month.

When you start looking at the numbers, you may be surprised to learn how much each birth is really costing you out-of-pocket!

2) Consider the value of your time.

How many hours, on average, do you spend with each client on the phone, or offering support by text or email?

How many hours do you offer in prenatal visits, including your time driving to and from these appointments?

How many hours on average do you anticipate spending with each client at her birth? (Some doulas include a specific “up to 12 hours face-to-face support” clause in their contracts, while others average out the number of hours they’ve spent at births already attended. For me, average is 16 hours, including drive time.)

Now, how much do you think is a fair hourly wage? Multiply that number by the total number of hours you’re working for your client.

Now double it. That’s right – double it, because self-employed small business owners actually pay about half of what they earn (after deducting expenses) in taxes.

Now that you’ve considered your expenses and your time, take your “expenses” number, and add it to your “fair hourly wage” number, and that’s what you should be charging, minimum, for every birth you take on.

This is not including numbers that would need to be considered for paying for backup support. It also is based on a doula taking on her full client anticipated load every month, without taking weeks off. These are expenses that would also need to be considered, if this is work you wish to do full time.

Are you charging what you’re worth?

See What’s In a Fee? and No Free Births! for more!

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What’s Your Nervous Nelly?

After attending births for a while, some stories begin repeating themselves. Every caregiver’s eccentricities begin to become apparent. A doula begins to learn that one doctor seems to caution every mother about big babies. One midwife insists that every mother wears a belly band after 32 weeks to keep baby from flipping into breech position. One practitioner wants to know that everyone’s membranes have ruptured, whether naturally or artificially, by the time she’s six centimeters, while another is adamantly opposed to breaking anyone’s membranes at all. Another midwife gives each patient “the shoulder distocia talk.” One lactation consultant hates nipple shields, while another sends every client home with one. Why, when practice is supposed to be evidence-based, does this happen?

I explain it to my clients this way – Everybody has a Nervous Nelly. A Nervous Nelly is a set of circumstances that makes our red flags go up. It’s a moment that holds the potential to have our inner self sweating and wringing her hands with worry. As birthworkers, our experiences and our memories make up a huge part of who we are in our work. There’s more to birth work than “just the facts.” The wisdom that comes from our experiences plays a huge role in the decisions we make and the advice we give.

Anyone who works with birth for a significant amount of time has probably been part of a story that she doesn’t want to see repeated. So, she learns more about it, looks into the details of why it may have happened, and learns what may prevent it from happening again. This becomes the advice that is given to everyone. It becomes part of the client education that is given in the future.

It’s important to know your own Nervous Nelly, and talk about it with others. I have this conversation with every client, and I own openly and honestly that my personal Nervous Nelly is the mama who knows that her water broke, and isn’t willing to tell her practitioner about it. Why? Because once many years ago, after a beautiful and uncomplicated birth, I was pulled aside (into the newborn nursery, in front of tiny babies, no less) and screamed at (at top volume) by a doctor who was furious that this had happened – that I knew the mama’s water broke that morning, and she didn’t. Now, I didn’t know that the doctor hadn’t been told – I had asked my client, as I ask everyone, if she had called the practice to let the doctor know she was in labor, and was told “yes.” That doesn’t matter. The fact is, I knew relevant information that the doctor didn’t. Now, I’m much more clear in my guidelines – if it’s important enough to tell me, it’s important enough to tell your doctor or midwife. If the fear is that a practitioner won’t be supportive, it’s important to me now that a client learns this early on, so that she can choose a practice that she trusts enough to tell the truth. So, we talk a lot at first appointments about how to choose a practitioner that a client can trust. One rough experience, one time, with one doctor, changed the way I will deal with every client now and in the future.

Doctors and midwives are the same way. One powerful experience, one time, changes the way he or she thinks. This isn’t “bad” or “wrong”, it’s just part of what makes each of us unique. We’re all human. Our experiences become part of who we are. Sometimes statistics matter less than what we’ve seen with our own eyes. It doesn’t matter if the risk is one in a thousand – if you’ve seen the one, whatever that one may be, you likely don’t want to see it repeated, and are more inclined to actively prevent it from happening to someone else, ever again. The resulting advice may not always be factually accurate, but it almost always stems from compassion and caring.

Know and befriend your own Nervous Nelly. Let that inner wisdom guide you into becoming better at what you do. Know that everyone else has a Nervous Nelly, too, and allow the compassion that comes from this understanding to transform you into a being a better communicator with everyone on the birth team.

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Five Books My Kids Never Got for Christmas

Let me be clear, here. I love to read. Reading for pleasure is something that happens in my life every single day. I’m usually working on four or five books at a time. I wanted to pass this love along to my children. My kids were regular attendees of storytime at the library long before they could walk or talk. They’re always certain to include a “what I want to read” item on their gift wish lists. Reading is a great way to nourish the imagination, teach life skills, impart moral lessons, bestow warm fuzzies, and pass time snuggled up and cozy.

Ok, so we’re clear that this is not an “anti-reading-to-kids” thing, here, right? Good. That said, there were some books, which though they are well-beloved by many, that never made it on to my children’s bookshelves. At least, not with my buying power, though I’ll admit that a few were given my a well-meaning mother-in-law who considered my children deprived for having never read them. Then again, she thought I was a monster for not buying green ketchup when that was a thing, so take that for what it’s worth.

Call me cynical, or too literal. Maybe I just don’t get it. Maybe I’m doing enough to put my children in therapy all by myself, with no help needed from dysfunctional children’s literature about giving away body parts or unreported breaking-and-entering. In any case, these are the books my children never got.

1) The Giving Tree.

the giving tree

a.k.a.: Codependency 101 “Dear boy, I love you so very much that I consider myself completely responsible for your feelings. Let me give you everything I have so that you will be happy, even though you weren’t happy the last time I did that, or the time before. Don’t worry, I don’t need a thing. I’m happy just knowing that you’re happy. But not really. Sigh.”

2) The Runaway Bunny

runaway bunny

Or, as my oldest son and I have come to call it, “Run Away, Bunny!” “Dear little bunny,” says Mama Bunny, “No matter where you go or what you do to get away by yourself for a while, I will always, always, be… right… there.” A classic, sure to annoy or terrify introverts of all ages!

3) Love You Forever

Love You Forever

A new mama is rocking her baby and singing him to sleep. D’awwww, how sweet! A few pages later, a sixty year old woman is driving across town in the middle of the night, a ladder strapped to her vehicle, to silently break into the window of her still-single middle-aged son’s house, so that she can rock him and sing to him in his sleep. Because that’s not creepy at all. D’awwww!

4) The Rainbow Fish

rainbow fish

Hey, kids, if nobody will play with you because you’re too pretty, you can always try cutting off your own body parts and gifting them to everyone. Maybe then they’ll like you.

5) Guess How Much I Love You?

guess how much I love you

What starts out as a simple expression of affection between a son and his father quickly becomes a ruthless display of machismo. Face it, kid, you dad is bigger, stronger, can reach higher, can hop farther, and can sure as heck love more than you. Better just give up now. You’ll never measure up.

And there we have it. Books I’ve never read to my children, giving them an incomplete childhood for the sake of honoring my own squirm factors.

I’m sure they’ll tell their therapists this one day. For now, I’ll just be over here, reading.