Archive | May 2017

How to become a doula.

Nearly anyone who may be interested in becoming a doula can do so, no special pre-requisites are required. If you have a passion for birth and want to help improve the birth scene in your area you should consider becoming a certified doula. You will need to take a specific training, read a certain number of birth related books from an approved reading list, consider the tools you will need to fill your doula bag, figure out childcare; someone who can come tend to your children with little to no notice if necessary, and prepare to be on your feet for many hours at a time – sometimes even days. The costs vary from some to a lot, average is close to one thousand dollars by time everything is said and done. Travel fees, cost of books and other training materials, attire, a doula bag and comfort measure items you will need can quickly add up. It can take anywhere from six months to two years to complete all the requirements for certification depending on the program and your dedication.

**All of the doulas at TDS are trained through either Childbirth International , DONA or Stillbirthday or a combination of these. **

There are dozens of agencies and organizations out there for an inspiring doula to sift through and find the one for them to train and certify with. Find the organization that has a mission statement that you align your birth philosophy with. Some trainings require in-person workshops be attended, usually held over the course of a weekend. Others allow for all the training to be completed through their online program. Prices all vary depending on the organization or agency. Some are more affordable at four to six hundred dollars; while others can surpass one thousand dollars. Once you have signed up for a training you should begin reading the required books that are necessary for your certification. If you take an online certification you can begin your studies right away. These usually include lots of reading and taking some quizzes followed by two small book reports, a childbirth education class evaluation and then attending a required number of births – usually two or three births.  The online reading will consist of learning about the physiology of pregnancy, labor and birth. This is also where you will learn about how to physically and emotionally to best support a laboring mom. You will learn the variations of normal in regards to labor, birth, placentas and newborns. During an in-person workshop these things are gone over in a much shorter time frame but you get the chance to practice comfort measures on other trainees.

            After you have completed your training you will need to find clients for your required certifying births. It is advised to charge when seeking these certifying births, even if not as much as you would if you were certified but something to cover the costs you will have. The easiest way to do this is to talk to expecting friends or family members. You can advertise online or locally as well. It’s up to you. Your training agency should supply you with sample contracts that you can edit and use. It’s important to have contracts so that everyone knows their role and what is or isn’t expected of them. You will need to meet with your clients at least one time prenatally so that you can learn their desires for their birth. You should practice comfort measures and learn what each mom might, or might not, like to utilize during labor and remember to be flexible. Just because a mom liked a certain thing during a practice run, doesn’t mean she won’t hate it during labor. So be prepared to change along with the needs of each client.

You will likely be ‘on call’ starting at the two-week mark before your client’s estimated due date and stay ‘on call’ until baby is born. Building your doula bag should be done before your client’s birth. What you put into it is up to you, but there are some basic things that you should consider having. On the list of things I recommend for your bag would be: lotion or oil for massage, a rice sock, massage tools, essential oils that are safe and recommended for labor, LED battery operated candles, personal care items for yourself, protein and shelf stable snacks for you or to share with your client during labor. Having a change of clothes in the car is a good idea as well. Scrub pants are wonderful for doulas because they are stain resistant, comfortable and durable(I pair mine with a TDS shirt so as to not be confused with medical personnel in scrubs).

After your clients have birthed you will be required to fill out a questionnaire to turn in to your certifying organization to make sure that the stipulations were met to make it a qualifying birth.  Usually these questionnaires just ask for the hours spent with the client prenatally, during labor and postpartum. Along with details of the birth: medications used, interventions done, vaginal or cesarean birth. The average amount of time the certifying agency is looking for spent with each client is about 24 hours total; not just the hours spent with the client in labor. There will be a few reflective questions asking things like ‘what was an area you think you had a strength/weakness in’ or ‘what might you do differently next time?’ After completing the questionnaire, you will turn it in to the appropriate person in your training organization which will likely be your appointed trainer.

Your trainer will go over your book reports, training exam scores, birth questionnaires and anything else that you have turned in. They will submit everything to their higher up to request your certification of completion. Depending on the organization it can take a few weeks to get your certification in the mail. Once you have completed every step of your training you are ready to go out into the birth world and look for clients who want labor support.

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Why every woman should have a doula.

Sarah is preparing to go to nursing school and some of her pre-requisites required that she write certain types of essays. As you can imagine, most of the essays were birth related if it fit the criteria for the essay. This last essay due is a persuasive essay. So of course Sarah had to write about why every woman should have a doula! A grade hasn’t been received for the essay yet, but we would love you, the reader, to give her a grade and leave some feedback!

“If a doula were a drug, it would be unethical not to use it.” – John H. Kennell, MD. This phrase is powerful and probably one of my favorites that is related to birth work. A doula is a professional childbirth support person, who has specialized training and often is certified, but is not a medical professional – unless the doula happens to hold separate medical licensing too. As a doula I provide you with all the information you could ever need, if I don’t know the answer to a question you have; I can find it.

Doulas support you emotionally throughout pregnancy, during labor and postpartum as well. We comfort you physically with massage, position suggestions, breathing techniques. Most of us have a doula bag full of tools to aid a mom during labor as well. As a doula our job is to help you know about all of your options and to be empowered in your decision making, to open the lines of communication between family and medical personnel and even translate medical jargon into easy to understand terms.

Dad and other family members are not excluded in the support when a doula is in the picture either, we provide emotional support for everyone in the room. A lot of women ask “Why should I hire a doula? I have my husband/mom/sister to support me. I didn’t have a doula for previous births so I don’t need one this time.” I like to say that having a doula for the first time is like having a Starbucks drink for the first time; you don’t know what you are missing until you have one!

Doulas improve overall birth outcomes. This happens in several ways. Studies show that having continuous labor support from a doula – not a family member, friend, or hospital employee – is when the best outcomes occur (Gruber, Kenneth J.). Up to a 31% decrease in use of Pitocin, a 28% decreased risk of a cesarean section, 12% more likely to have a spontaneous vaginal birth, 9% decrease in use of pain medication (which may not seem like a lot, but our biggest delivering hospital has a 93% epidural rate so it would make a small dent in that), a 14% decrease in the risk of baby being admitted to the NICU and a 34% decrease in the chance of mom being dissatisfied with her overall birth experience (“The Evidence On: Doulas.”). Considering that our nations cesarean rate is hovering around 32%, which is double to triple the recommended cesarean rate, any opportunity to help bring that number down is a great tool to utilize (Almendrala, Anna).

A study from Minnesota found that women who had a doula were 22% less likely to have a preterm birth. By reducing the cesarean rates, doulas can save private health insurances about $1.74 billion each year and state Medicaid about $659 million (Bess, Gabby). Even the American Congress of Obstetricians and Gynecologists (ACOG) recommend the use of doulas during birth for their benefits and helping to shorten labor times (“Women’s Health Care Physicians”).

Even in the event of a cesarean, planned or unplanned, a doula is beneficial to have in the delivery room (Dekker, Rebecca). A doula is the constant, and the familiar even when the birth plan goes out the window. While physically there is not a lot that a doula can do in the operating room, the emotional support is most important. Taking pictures, making sure mom and dad are both understanding what is happening every step of the way, reassuring them both that everything is ok and their baby will be with them soon. Often baby goes to a warmer with a nurse immediately after birth and dad goes along too. This leaves mom alone, but with a doula by her side she’s never alone. In the OR I give constant reassurance and describe baby to mom if she cannot see baby, how beautiful baby is and how wonderful everyone is doing.

Being on the operating table can be such a lonely experience, and a doula changes that dramatically. We help facilitate skin to skin and breastfeeding in the OR as soon as possible to help mom have that golden hour of bonding and get breastfeeding off to the right start. I always have lots of tips for moms during the recovery of a cesarean so they have the easiest and quickest healing period possible. Having extra training through the International Cesarean Awareness Network (ICAN) has helped me to become a better doula for cesarean moms and to be better able to help moms avoid an unnecessary cesarean.

As a doula, I am always furthering my education to learn more about the physiological happens during pregnancy and birth. I’ve been studying pregnancy and birth since 2005 and I still learn something new at every birth I attend. Keeping up to date on new studies, ACOG recommendations, local hospital policies and even going backwards and reading old books to gain helpful information is crucial to me as a doula. Women deserve the very best care while they go through this life changing time, and I strive to give each woman just that. My very best.

Doulas also provide postpartum care to new moms. Having a doula postpartum is said to decrease the likelihood of a mom developing postpartum depression (Chee, Allie). We continue to take care of the mother after she has become a mother herself. While friends and family come over to see the new baby in the days and weeks after birth, a postpartum doula comes to make sure mom is taken care of so she can focus on taking care of her new baby. We do things like run errands, go get groceries for mom, clean up around the house, dishes, laundry, making sure mom has eaten and stays hydrated. By lifting this burden from new moms, we are helping her heal; physically and emotionally.

The birth of her child(ren) is a time that is going to be forever remembered by a mother. Our goal is to make sure that she has the best memory possible. That her birth(s) are stories that she wants to tell repeatedly, being filled with joy and empowerment when she thinks back on that time.  25-34% of women say their births were traumatic (B, Danielle). That number is too high. Our hopes are that through our work as doulas we can lower or eliminate the percent of women who experience birth trauma and replace it with a higher number of women who felt empowered, respected and in charge of their births.

 

References

Almendrala, Anna. “U.S. C-Section Rate Is Double What WHO Recommends.” The Huffington

Post. TheHuffingtonPost.com, 14 Apr. 2015. Web. 02 May 2017.

B, Danielle. “14 Women Share The Heartwrenching Details Of Their Birth Trauma.”BabyGaga. N.p., 25 Apr. 2017. Web. 02 May 2017.

Bess, Gabby, Andalusia Knoll Soloff, Kimberly Lawson, Leila Ettachfini, Sophie Wilkinson,

Kristen Yoonsoo Kim, Amos Mac, and Annabel Gat. “Every Pregnant Woman Should Get A Doula, Study Says.” Broadly. N.p., 14 Jan. 2016. Web. 02 May 2017.

Chee, Allie. “A Postpartum Doula for Every Motherby Allie Chee.” A Postpartum Doula for

Every Mother – by Allie Chee. N.p., n.d. Web. 02 May 2017.

Dekker, Rebecca. “A Doula Facilitates Skin-to-Skin in the Operating Room.” Evidence Based

Birth®. EBB, 01 Oct. 2015. Web. 02 May 2017.

Gruber, Kenneth J., Susan H. Cupito, and Christina F. Dobson. “Impact of Doulas on Healthy

Birth Outcomes.” The Journal of Perinatal Education. Springer Publishing Company, 2013. Web. 02 May 2017.

“The Evidence On: Doulas.” Evidence Based Birth®. EBB, n.d. Web. 02 May 2017.

“Women’s Health Care Physicians.” Approaches for Ob-gyns and Maternity Care Providers to Limit Intervention During Labor and Birth in Low-Risk Pregnancies – ACOG. ACOG, n.d. Web. 02 May 2017.