The Doula As Witness-Cross Post from The Childbirth Collective

by Jess Helle-Morrissey, MA, MSW, LGSW, LCCE, CLEC

Doulas serve a multi-faceted role in a birthing family’s life: supporter, encourager, normalizer, educator, guide. We rub backs, we squeeze hands, we stroke hair, we breathe, we hold space.  We press cool cloths to a birthing woman’s head as she brings her baby (or babies) forth from the warm, wet womb to the bright spinning world.

One role that is often overlooked, but is perhaps most sacred to my own doula heart, is that of witness. As doulas, we witness over and over again that unique and unparalleled moment in a woman’s life when she becomes a mother. Whether it’s a first birth, or a seventh, a mother is born each time she births a baby.

When a woman has a transformative birth experience (and really, what birth isn’t transformative?), she deserves to be fully seen. And that role is often uniquely the doula’s. Partners are witnessing, but they are most often deservedly caught up in their own personal experience of the moment. Midwives, doctors, and nurses are present, but they have medical tasks to attend to. Doulas are able to attend wholeheartedly to that moment.

We witness the joy of birth. We witness mamas finding their true selves for the first time in their lives as they birth their babies. We see the look on a mama’s face when her baby is five minutes old as she tells us, “Everyone said I couldn’t do it, but I knew I could.” We witness the hilarity of birth – I’ll never forget one mama who turned to me after birthing her twins and exclaimed, “That was f*cking AWESOME!” We get to see the way a partner looks at the birthing woman in complete awe as she makes her way through contraction after contraction. We get to see him or her wipe a tear away as this new little person makes that first yawling cry.

We witness the disappointments, too. And when things don’t go as planned, we can remind her that she is strong because we have seen it with our own two eyes, and we have felt it in our own doula souls. And we remember in a way that she might not.

So as witnesses to those moments, we begin to help her reframe:  Last summer, one of my doula mamas had a surgical birth after a long and difficult labor. In a case like this, it is easy to go to a place of dwelling in what went wrong. I go to my postpartum visit. We talk about all that happened, and I validate the disappointment. I sit with the pain.  But I also tell her, because I need her to hear, “I have never seen anyone work so hard for so long. I have never seen anyone fight so hard for what she wanted. You. Are. Amazing.” And she begins to feel it is true because I have seen it and I know it to be true. She knows I was there. She knows I saw her fully. And as I write this, I remember her fierce birthing spirit as if her baby was born yesterday, and I feel the hair on the back of my neck stand up a bit. Because I will never forget her strength, and the gift she gave me by allowing me in.

Above all, it is that sheer strength of birthing women – no matter how they give birth – that we doulas are witness to. The strength to carry on when it feels like all the reserves have been depleted. The strength to make a choice to go a different direction than we’d dreamed. The strength to joyfully claim a place in the history and lineage of birthing women.

And the repercussions of that witnessing can last a lifetime. I spent a good part of my own life feeling like I was not a very strong person. When I gave birth to my twin boys, I found strength I never even dared to imagine I had in me. Today, more than two years later, each time I see one of my two wonderful doulas, I still stand a little taller and feel that swell in my heart – “SHE has seen my strength! She knows the amazing things I am capable of!” A bit dramatic? Perhaps. But life-changingly, soul-stirringly profound for this mama? Most definitely.

So when you invite a doula into your life for some portion of the nine months of your pregnancy (and a couple months after), know that the benefits don’t end there. We not only witness, but we also remember. I tell my mamas, “If you ever need to be reminded of how incredible you are, call me and I will tell you as many times as you need to hear it to believe it.” So on behalf of all doulas,  thank you to birthing families everywhere who invite us to witness your incredible journey. Thank you for giving us the best job in the world.

What's in a Doula Fee?-Cross Post from Jodi the Doula

Happy Saturday, Everyone!

Guess what?!

I scheduled my first mama!!!

She's due in December, which feels like a long ways away, but it gives me time to do some re-reading of important doula books, I'll have taken one prenatal Yoga course and my essential oils book will have arrived from Amazon.com which means I'll be able to create more room sprays and massage oils for my mamas. And, and this is the most important, it means that I'll have that much-needed, hands on experience to help my doula practice grow.

When I first started to train to be a doula I worried about fees-would I be charging to much, would I be charging too little, should I charge while I'm still certifying.
My December birth's compensation? A metro card. And I'm okay with that.

The organization that I did my doula training and who I will certify with is called Ancient Song Doula Services (ASDS) and their focus is not only to train women to be birth and postpartum doulas, but to make doulas available to women who wouldn't be able to afford them. I'm a volunteer doula with ASDS, which means that some of the births that come through their practice will be done for free of for a minimal fee. I'm happy to do the work, especially as I continue the certification process, but also when I am certified because I truly believe that every woman, no matter her financial means, should have the support of a doula. It is because of that conviction that I want to do low-cost or free births even after I'm certified.

And, I want to be a full-time, full-spectrum doula. I want to become a certified prenatal Yoga instructor, a lactation consultant and a birth educator. In order to do all of these things, to pay for these certifications I, and a lot of doulas, have to pay for it ourselves. Doulas make their living supporting women through labor and birth. Many doulas, myself included, work full-time to cover the bills, but hope and dream of doing birth work exclusively. Which is why we have fees.

I thought hard about how I would charge my doula fees and came up with fees based on financial means. I created a chart that is broken down by income to determine how I charge my doula fees. It's interesting because it's based on trust. I trust that the mamas who come to me are honest about their financial status and they trust that I will fully and holistically support them before, during and after their births.

I was pleased to see Jodi the Doula's recent blog post about doula fees not because it "proved" anything, but because it helps me better explain and understand what a typical week looks like for a full time doula. The opening paragraph and a link to the post is below.

Every doula has heard it at least once…
“So, if my birth is really fast, you’ll refund part of what I paid you, right? Because then you didn’t really have to work that much.”
“How can you be ok with charging so much?”
Or, my personal favorite, “You know, what you’re doing is an act of service. It’s really special. It’s like doing The Lord’s Work. So, don’t you think it’s wrong to not do it for free?”
The money questions… it’s enough to make any doula want to crawl under a rock, or wish we could go live in a yurt, in a nudist colony, on a self-sustaining  farm, so that our living expenses could be lower.
How a doula sets her fee is an unclear concept to many people who are seeking or offering birth services.  On the surface, it may seem like a doula’s fee is a lot of money for what amounts to one big day of work. I offer this so that new parents and new doulas have greater clarity of what a doula’s fee really includes.
A Typical Work Week:  Booking one “due date” per week is more than just one day a week at work – it’s a full-time workload.  Consider this – for every client I take on, I offer up to three face-to-face prenatal meetings, unlimited phone support throughout pregnancy and the first week postpartum, and an in-home postpartum visit.  This means that an average work week for me will have four to six home visits (about two hours each), six to ten hours of phone time, and eight to twelve hours of travel time. Throw in a couple of hours for recordkeeping, appointment scheduling, text and email support, and the extra hours it takes to call everyone and reschedule when I have a mama in labor. That’s typically a 37 hour work week, before I’ve spent even one minute at a birth. When all is said and done, each client, on average, has had the benefit of 30 to 42 hours of her doula’s time, and most of those hours have been when she hasn’t been in labor.

Keep Reading here.

As always, if you or anyone that you know is expecting a baby, please reach out to me to discuss the services that I offer.

All the best,

Erika

Cross-Post: Doula-ing for Cesareans

One of the things that a new doula must do in order to be certified is to attend births, sometimes three and as much as five. This doula has attended a whooping 0 births. Are you willing to be my first mama?

I have, however, been a back up doula to a few of my doula friends, yet none of them have needed a back up, so I'm waiting. I was pretty sure that July would be my month, especially since my doula friend has two mamas with very close due dates. I was a bit disappointed to learn that one mama had elected for a scheduled c-section. Not because I oppose the c-section, but because I knew that a c-section would mean that there was no chance that the two mamas would overlap.

It got me thinking about how important a doula is, even to a mama who's having a c-section so I was delighted to find the following post. Read it here.

Getting Insurance to Pay for Midwives

Cheryl Senter for The New York Times

Earlier this week the NYT posted an article siting America as the costliest place to give birth. Several people, myself included, cross-posted the piece and the comments section has hundreds of replies. Many people blame the insurance companies for the price of birth, while others blame doctors and hospital's often unnecessary and costly interventions. What was missing was other birthing options; at home or in a birthing center with a Midwife.

NYC has only one free standing birthing center, Brooklyn Birthing Center. This is where I hope, Gd-willing/Inshallah/Bezrat Hashem, to give birth when my partner and I get pregnant. The fact of the matter is, birthing with a midwife is substantially cheaper not because you receive inferior service, but because most midwife births are women-centered. A midwife and doula team supports a mother and her partner fully and holistically, relying not on the use of pitocin and monitoring to get the baby out, but on the body's own ability to birth a child.

Here's a quote from the article:

In the United States, the use of midwives varies hugely by state and region; they can deliver babies at a birthing center, in hospitals or in homes. They generally need physician back-up in case a pregnancy has complications they cannot handle. There are few midwife births in the South and Texas, while the rate is above 15 percent in Oregon and New Mexico. In Britain and Denmark, more than two-thirds of all births are attended by a midwife.

Read the entire article on the NYT here.

The American College of Obstetricians and Gynecologists Warns Against Inductions

I think it's important that birth professionals; whether OBs, midwives, doulas or childbirth educators keep an open mind. This, I realize, is hard because it's very human to form ideas, thoughts, or convictions, but when it comes to birth it's really up to the mother to decide what she feels is best for her.

Keeping that in mind, I'm aware that sometimes a mother will have ideas about birth that may not necessarily align with my own thoughts about birth, but those thoughts, my opinions, must be pushed aside so that I'm able to fully-support a mother. I do, however, think that women should look into all of their birthing options and educate themselves on the many options available to them. If I can think of one criticism of the medical and healthcare system it would be that it doesn't empower patients, especially women who are pregnant. Instead a woman, under the care of an insensitive or authoritative physician, can sometimes feel small and inadequate. She is made to fear her body and the birthing process and doubt whether her body is "big enough" "strong enough" or "young enough" to do what it's supposed to do.

I love this quote by Ina May Gaskin:

Remember this, for it is as true and true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.

 Read the ACOG's complete article: Five Things Mothers and Physicians Should Question

Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age.

Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.

Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.

Ideally, labor should start on its own initiative whenever possible. Higher Cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.

Advantages of Breastfeeding for Moms-Cross Post

From Breastfeeding Magazine.

Everyone hears about the advantages of breastfeeding for babies, but breastfeeding actually has some significant benefits for moms as well.

Who knew that doing the very best thing for your baby’s health and well-being was actually the best thing for mom as well?

The Benefits of Breastfeeding for Moms

Here’s a brief list of some of the benefits of breastfeeding for nursing moms:

*Breast milk is always sterile, fresh, perfectly clean, just the right temperature…no need for cleaning or heating it up at a 2 am feeding!!!

*This is one case where the healthy choice is also the least cost option! How often is that the case? Formula can be a very expensive addition to your monthly expenses that you can just avoid!

* Breastfeeding releases more oxytocin into your system in order to stimulate postpartum contractions. This reduces blood loss and helps return your body to its pre-pregnancy condition faster.

* Nursing increases the rate of weight loss in most breastfeeding moms without needing to diet.

* Breastfeeding has been shown to reduce the risks to mom of certain cancers including those of the breast and ovaries. Studies have shown that the longer you breastfeed, the better protected that you are.

* Breastfeeding women report psychological benefits such as increased self-confidence and a stronger sense of bonding with their little sweet babies!

 Mothers who do not breastfeed are at a higher risk of:

—Pre-menopausal breast cancer
—Post-menopausal breast cancer
—Ovarian cancer
—Urinary tract infections
—Osteoporosis

NYT Cross-Post: Birthing in America is Costly!

Josh Haner/The New York Times

As a doula, my job is to sort of come outside of myself, my wishes, my thoughts and my needs to focus solely on a mother as she labors. This means that I support a mother who wants to give birth in a hospital with an epidural as equally and fully as a mother who wants to give birth squatting in her living room. As a woman who's TTC I find this article by the New York Times shocking!

I've been considering a home birth when we, Gd willing, get pregnant. Birthing at home or at a Birthing Center with a midwife and doula insures woman-focused, mother-lead birthing with a caregiver you've had a continuous relationship with, but it's also, quite shockingly, cheaper!

In nearly every other developed country in the world, midwives, not OBs attend births. Why? Because birth isn't a medical "problem" and OBs are trained surgeons. Of course, and I know this because I have fibroids which may put me in the "high risk" area of moms, some births have medical complications where having an OB is necessary. But for women who are healthy, birthing is and should be a natural process. Our bodies were made and are perfectly capable of birthing babies.

It wasn't until the 1950s that birth came to hospitals, before then the majority of American births were done at home. It's also interesting to note that while our births have moved into the hospital and away from the home, we've lost more mothers and babies. In fact, the U.S has one of the worst mother and baby mortality rates.

What are your thoughts on this article? 

From the New York Times: American Way of Birth; Costliest in the World

 LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.At a prenatal class in March, she was told about epidural anesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Keep Reading at the NY Times