By: Emily Accrocco

It’s tough being a doula. Not only do you work long, unpredictable hours, you may be required to stay up all night, face serious  birth complications and challenging hospital situations. While juggling all  these tasks during a birth, advocacy is important for the mother and family.

 A few things doulas advocate for:

Taking childbirth education classes: A doula who wishes to become certified through an organization is usually required to take a childbirth class or to take a childbirth educator class (CBE). Some doulas include CBE in their agreement to accept services and may tag on an extra fee. Taking a series provides clients with a minimum understanding of what they are going to go through in the months to come. Topics include stages and phases of labor, behavioral and emotional characteristics of each phase, specific positions and comfort measures, relaxation techniques, what to expect immediately postpartum, newborn procedures and more! (Doula International Magazine, DONA, Vol 21, Issue 2, 2013). Taking a course helps ensure that there is informed consent or choice in the way your labor and delivery pans out. You will know the risks and
benefits of many hospital procedures and will be encouraged by your doula to ask probing questions if you are unsure about a specific one. Ask your doula to provide you with referrals to CBE classes and teachers in your area. Your doula may also offer access to her extensive lending library and educational DVDs. 
 
Writing a Birth Wish/Preference, not PLAN: We doulas don’t like to call a birth “plan” a “birth plan”. Birth rarely goes as planned so it’s easier to call it a wish or a preference. There are plenty of tools online, such as:

http://www.columbiacenter.org/tools/birth-preference.htm or
http://www.hellobee.com/2012/06/19/the-birth-preference-list/

which have templates and guides to help you write one. I always assist my clients with their preferences
at the second prenatal meeting. I remind them of items they may have left out, like whether or not to circumcise their little boy, or newborn medicines, such as a vitamin K shot, or eye drops put in soon after birth which can make a newborn’s vision blurry. And mamas, you want that baby to be able to see you
immediately after delivery to enhance the bonding! I advise my clients to bring at least six copies of their birth wish to the hospital or birth center because of nurse/doctor shift changes. When I’m at a birth, to every new face, I introduce myself and then ask if they have reviewed the family’s birth preference. 

Avoiding unnecessary inductions: I know from experience that the last couple weeks of pregnancy are bru-tal. I was in North Carolina, during hot, hot summer for my third trimester. With no A/C in my car, I was a big,
 sweaty, (but beautiful!) beast. Mamas, it is very important to wait it out and let your baby come when he or she is ready. Your body and baby will work  together at the right time. Check with your provider to make sure no bar  mitzvahs or vacations are scheduled around your due date. If that is the case, meet a second provider or back up for your provider. A fetus’s lungs aren’t developed til week 34 in your pregnancy and babies born before this week may  have various breathing difficulties and will most likely require a stay in the
  NICU.  However, if there are certain complications, induction may be medically necessary. According to the
March of Dimes, “Babies born after 37 weeks of pregnancy are full-term. However, new research has shown that a baby’s brain nearly doubles in weight in the last few weeks of pregnancy.” So, keep bakin’ that baby! A doula can help remind you of natural ways to induce your labor, such as herbs, tinctures and the various
hospital procedures that are nonmedical like a foley catheter or breaking your water, as long as she’s within the scope of practice of her agency.

Mamas, be well prepared for your birth! Wait out your pregnancy. Don’t make hasty decisions during labor. Review your preferences with your doula, provider and partner so they can remind you of what you wanted before all that pain began! Birth can profoundly transform a woman, strengthening her faith and deepening her identity, so make sure you’ve educated yourself on these topics. And hire a doula!

Did y’all hear about:
 
The mother in Minnesota who lost her newborn for five days because she tested positive for drugs after eating a poppy seed bagel?! Don’t worry, she received a settlement AND got her baby girl back! 

What about the woman who went into labor at a Rolling Stones concert in the U.K.? 

OR the mother whose twin son was pronounced dead and she was able to revive him after TWO hours using skin-to-skin contact?!?!

By: Emily Accrocco

“So, we’re going to have a complete stranger in the delivery room with us? I mean, you seem cool…” said one father-to-be during my second prenatal interview with potential doula clients. His remark didn’t shake me at all, as I’ve learned how precious doula support is for the father as well as the mother. Some fathers are thrown off at the idea of a doula, but are very grateful to have had an experienced support person in the room with them for the beautiful transition into parenthood. “The training of a doula emphasizes quiet
reassurance and enhancement of the natural abilities of the laboring woman. A doula is constantly aware that the couple will carry the memory of this experience throughout their lives” (The Doula Book, Klaus, Kennell, and Klaus). The doula must be sensitive to this time and compatible with mom and dad. Things to consider when interviewing a potential birth doula: 

1.      Are you available during my due date? Most doulas will offer to be on call for you two weeks before and two weeks after your due date.

 2.      What is your training? Are you certified? If so, by what organization? What were the requirements for certification? DONA, for example, requires birth doulas to attend three births with positive evaluations from the OB or midwife, the nurse, the mother and father or birth partner.

 3.      How many births have you attended? How long have you been a doula?

 4.      Why did you become a doula?

 5.      What is your stance on pain medication during labor?

 6.      Are you familiar with my OBGYN/midwife and hospital/birth center? Have you been to a birth with my provider before?

 7.      How would you be able to support me during labor and delivery? What is in your birth supplies bag? 

 8.      How would you involve and assist my partner during the birth? 

9.      When would you join me once I am in labor?

10.  What is your back up plan if you are unable to attend my birth? Can I meet the back up doula?

 11.  What is your fee? Fees for doulas can range from $300-$1000 depending on your location and the doula’s experience. Some doula students offer birth services pro bono, on a sliding scale, or for trade of goods or services. 
 
12.  What does your fee cover? The majority of doulas offer up to 2-3 prenatal visits, attendance at your birth and up to 2-3 postpartum visits. Unlimited phone, email or text support for your pregnancy from date of hire.

13.  What is our refund policy?

 If you like her, schedule another meeting to go over your birth preferences. After the interview, ask yourself these questions:

 1.      Am I compatible with this person’s personality?

 2.      Can I imagine this person with me for the big show?

 3.      Does this doula seem to have her own idea of how your birth should go or is she supportive of your decisions?

 4.      Does she listen and communicate well?

Keep in mind that this kind of support requires a high level of trust- in yourself, and in the doula’s knowledge and skills. Make sure she is someone that will reassure you and ground you. This is your body, your birth, your baby. 

A great site to find birth and postpartum doulas is Doulamatch.net!

By: Emily Accrocco

Doula-what? Doula-who? What the heck is a doula anyways? Doula comes from the ancient Greek word for a “woman who serves.” Women have been helping women have babies for centuries and this has carried on into the modern world. Doulas are everywhere, and are trained and experienced professional birth support workers. Most women who become doulas see becoming a doula as a calling, a vocation. They have a passion for pregnancy, new mothers and families and new life. A doula provides physical, emotional, mental, and informational and partner support. A doula does not take  the place of the father or birth partner. If anything, a doula increases partner involvement during the laboring process.  The family is born in the delivery room and the presence of a doula reduces pain, anxiety, discomfort and fear during birth for both the mother and the father. Doulas are mostly hired because a family or mother desires a natural, unmedicated birth, but are still extremely helpful with a medicated birth. As doulas, we hope to empower mothers to give a new start at life while helping create a healthier generation.

 I’m drawn to pregnant bellies. I can’t stop chasing the mothers down and asking, “Do you have a doula?” Many, if not all respond, “What is a doula??” This was the same reaction I had when I was pregnant. When I did some research, I was floored. There IS a support person used purely for labor and delivery. It can be affordable, or pricey, depending on the doula’s experience and practice area. Most doulas that haven’t been certified through various agencies, including DONA or CAPPA, provide free birth support, but fees for experienced doulas can be up to $1000. We will also provide you with a list of community resources. A doula does not do anything medical—we provide hot and cold therapy, massage, advocacy, aromatherapy, reflexology and various physical and emotional comfort measures for relief, continuous phone or email support and are on call for you two weeks before and after your due date. A doula is with a mother 100% of the time during labor and delivery and is there to ensure that a mother has the birth that she wants and to remind her that she has options during her birth experience.

 If you hire a doula, you will meet at least twice prenatally and discuss your birth preferences and prepare and investigate ways to avoid unnecessary medical interventions. Doulas spend a lot of time educating families on healthy pregnancies, changes during labor and delivery, newborn and postpartum care as well as breastfeeding. There are also postpartum doulas that charge by the hour and visit you at home assist with light housekeeping as well. Doulas work in hospitals, birth centers and during homebirths! Birth is seen as a transitional and natural process, where a doula is witness to a woman becoming a mother. It is one of the most powerful experiences on earth and most humbling to the doula. 

Facts About Doulas:

The presence of a doula at your birth:

~ increases birth experience satisfaction and postpartum bonding
~ lowers c section rates
~ lowers medical intervention rates
~ shortens labor
~ reduces fear and anxiety about labor and delivery
~ lowers level of stress hormones
~ lowers chances of postpartum depression
 And much more!