Choosing Your Doula
25 Jul 2012 1 Comment
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A doula is a woman trained in the physiology and psychology of birth, and in the art of providing labor support to birthing mothers during pregnancy, the birth process, and immediate postpartum period. Choosing to birth with a doula is a wonderful way to support yourself in having a positive birth experience. It has been well-researched and documented that women who birth with doulas have shorter labors, are far less likely to have a cesarean birth, are less likely to use pain medication during labor, and report being much happier with their births. Women who have birthed with doulas are typically more likely to describe their birth in positive terms, and feel more attached to their babies.
A good doula is an asset to your care team. She will accompany you in labor and birth as a support person, helping to gather information and facilitating communication with your birthplace care providers. She will provide reassurance and perspective, suggestions for comfort and labor progress, massage, and help with relaxation and positioning. She will be continually present throughout your labor until after your baby is born.
There are as many styles of doula care as there are women who are doulas. Each doula brings her own talents and experiences to your birth. Finding a doula who is a good fit for you can go a long way in helping you create a birth that you feel really good about, so choose wisely. Ask your doctor or midwife if she has worked with a doula that she might recommend, and then schedule a few interviews to choose the doula who is just right for you.
The following questions may be helpful for you to ask in the interview process:
Why did you become a doula? What is your philosophy about birth and supporting women and their partners through labor?
Hearing a doula’s reasons for choosing her career will help you get a feel for who she is and the style of care that she provides. You may not agree with every word she says, and that’s ok. Hearing her philosophy of childbirth will help you get a feel for whether she is someone with whom you can work comfortably.
What training have you had? Are you certified? If so, by what organization, and what was required in order to receive this certification?
If a doula is certified, you might consider checking out her certifying organization. Looking them up online might give you a stronger understanding of the kind of training that they offer, or the standards of practice that their certifying doulas are encouraged to uphold. Some training organizations are very hands-on, and others may be more textbook-based. Each also has different standards that must be met for certification.
How long have you been in practice? How many births have you attended?
An experienced doula is a wonderful find. Her wisdom and years of experience can deeply enrich the support she provides for your birth. In the birth world, having a wide range of experiences can help a doula maintain a calm and steady presence throughout your birth. Do not, however, automatically rule out a doula who is a newbie, especially if she has had good training. A new doula’s energy and enthusiasm might make her an excellent fit for you. Ask if she is working with a mentor – you might benefit from having her mentor’s experience in the advice a newer doula offers.
Do you have education and experience providing any other type of care for childbearing women, such as childbirth education, midwifery care, nursing care, breastfeeding support, or postpartum doula support?
Many doulas also have experience teaching classes in your local community, helping new mamas with breastfeeding issues, or providing in-home care for new mothers and babies. Your doula might have a wide variety of experiences and services to offer that will enrich your work with her.
Do you have anyone else due near the time I’m due? Do you know of anything now that may cause you to be unavailable around the time of my birth?
Most doulas limit the number of clients they accept to two to four per month, and consider carefully the commitments they are making when agreeing to attend your birth. Doulas who work full-time in doula service have lives that are structured around being on-call for your birth. Doulas who work part-time might have other commitments, such as other jobs or small children at home, that they take into consideration.
How do you view your role at the birth? How would you work with and involve my partner?
Most doulas are comfortable including partners, family members, and other non-medical support people on your team to the fullest extent that others are willing and able.
How do we get in touch with you when labor begins? When do you prefer to join women in labor? Do you come to our home or meet us at the place of birth?
Some doulas regularly meet you at home in labor, when it’s too early yet to go to your birthplace. Others typically meet their clients in the hospital or birth center after labor is well established. It’s important to learn what your doula’s standard practice is, and to know if this is a good fit for you. Some women prefer to have support at home at the first twinge of labor, while others who may have given birth before are more comfortable going through their typical daily routines until labor is too strong to continue to do so.
What services do you provide during labor and birth? What do you bring with you? How do you help women cope with labor?
Doulas may be trained in many different modalities of labor support. Some offer massage or reflexology, some may know hypnotherapy techniques, while others are well-versed in using different labor positions for comfort and labor progress. Your doula is a valuable resource – learn what she has to offer!
What is your view on the use of pain medication in labor?
The point, here, is to know that your doula is realistic. It is important that she offers your support unconditionally, regardless of your plans, and irrespective of anything unexpected that may happen in your labor. Medication is a tool – as with any other tool in labor, there are appropriate times and places for its use. A competent doula will likely assure you that her interest is in your satisfaction with your birth experience.
Which labor coping techniques do you think tend to be the most helpful?
Here is where a doula’s training or special interests may again come into play. Most doulas are knowledgeable about many different childbirth methods and comfort techniques, and can offer valuable input on their effectiveness, in her experience. If you have a particular method in mind, ask her about her experience with it, so that you know her ability to support you in this choice.
How long would you stay after the birth?
Some doulas have a set time frame, such as one or two hours, that they continue to provide support after your birth. Others use guidelines such as “when you’re cleaned up and ready to rest”, or “when you’d like to be alone with your partner and baby, I’ll ask you to send me home.” Others have their own guidelines that fit within your birthplace’s policies.
Do you offer any special services?
Some doulas may provide massage, photography, aromatherapy or other add-on services — such as writing out your birth story — for no extra charge.
Do you provide any services in the postpartum period? What about reviewing my labor and birth experiences or helping me with breastfeeding? Are you available by phone? In person?
Some labor doulas also work as postpartum doulas and offer care after the birth. This may include breastfeeding support, light housekeeping, errands, and help caring for older children as well as the new baby.
Do you have a backup arrangement with another doula or group of doulas in case you’re not free when I go into labor? May I contact them?
Doulas are real people with lives of their own. As responsible and committed as even the best doula may be, there may be times when she is unavailable. Knowing that she has a solid backup arrangement will help put your mind at ease.
May I please contact other women who have recently worked with you as their doula, to ask about their experience with you?
It’s a good idea to check a few references. Ask what they liked most about the doula and whether there’s anything they wished she had done differently.
Are you familiar with my doctor/midwife/hospital/birth center? What have your experiences with my practice/facility been like?
It can be especially nice when your doula and other practitioners know one another and have a harmonious relationship. Your doula may have valuable insight on what it may be like to birth with the practitioner you have chosen. If the doula you choose does not know your practice, ask if she is willing to have her contact information shared so that your doctor or midwife may contact her if they would like.
When will we meet again to address any concerns or questions I have and to review our birth wishes? How often are we in contact with one another between now and the day of my birth? May we call you with questions or concerns before and after the birth?
Good communication with your doula will help her provide the best possible care for you. Find out now how and when she prefers to be contacted, and how to best remain in contact with one another between now and the time of your birth. This will help avoid any confusion or missed communication down the line, and will help your confidence in your doula to remain strong.
What is your fee, and what does it cover? What is your refund policy?
Doulas’ fees range from about $400 to $1,600. Some charge a flat fee that covers all prenatal visits, phone support, and labor and postpartum. Others charge an hourly fee, and still others charge an hourly rate that is capped at a maximum point. Refund policies may vary widely – know in advance what your doula’s policies are, so that you are clear with one another.
Do you have any experience with reimbursement from health insurance plans?
As more and more insurance companies are providing coverage for doula service, this may be another area where your doula has experience that can be a big help. Some doulas have standard receipts and letters that will be provided for you, and others may have their own Insurance Provider Numbers (the same sort of code used by doctors and nurses). She may even be able to help you learn about how to be reimbursed, even if you are not sure what your insurance company will cover.
Do you accept alternate payment arrangements, such as sliding scale, time payments, or barter?
If finances are a concern, many doulas are able to accept alternate payment arrangements, or may be able to help you find another doula, such as a doula in training who is working for reduced fees. It can’t hurt to ask!
After the interview, try to imagine the doula at your birth with you and see if you feel good about that.
Ask yourself:
Do I feel comfortable around this person?
Is she warm, enthusiastic, and knowledgeable?
Does she communicate and listen well?
Will she support my choices or does she have her own agenda?
Your doula will support you in feeling safe, secure, heard and included in the process of your birth. Your own empowerment is her priority. Finding the right doula for you is an excellent step in having a happy birth.
Good luck, and blessings on the journey.
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