What’s in the Bag?


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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