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Doula Cost & Payment Questions

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Many more families are using doulas because they hear how valuable they are. The use of doulas are not relegated to “crunchy” or “natural” clients any more. However, if you’re new to the world of doulas, you may have some questions about the fee and payments. Rather than wonder about it — let’s talk frankly about it.

While I can’t speak for all doulas, I can tell you how my pricing and payment is set up.

  • A complimentary, no obligation consultation is available for anyone curious about hiring me as their doula.
  • A $200.00 non refundable deposit holds your spot. Why is it non refundable? Because I may refer out/turn away other clients near your estimated due date to ensure I do not have too many clients. It also helps me schedule any mentees or backups, prepare my birth bag, and helps you to have less than a full balance to pay in the coming months.
  • The remainder of the package you purchased is due by 37 weeks. Why is it due before the birth? Because, simply put, I don’t want to ask you for a check on the way to the hospital or bring that energy transfer (money) into the birth. By 37 weeks our money transactions should not even enter into our energy exchanges, appointments, and interactions. We will have already had our prenatal appointments, classes, and gotten to know one another. My life will revolve fully on being on call for you at that point.
  • Pay how you need up until the deadline of 37 weeks. It doesn’t matter to me if you pay something each month, the full fee at the beginning or the end, etc. What types of payments do I take? Cash, check, credit cards, and PayPal.
  • Discounts are available for postpartum care if you have hired me as your birth doula or if you have purchased in advance a certain amount of hours. Why is this? Again, it helps me with planning and I can focus much more time on your family based on a suggested schedule.
  • Postpartum services in smaller amounts or randomly are available but not at the discount. I usually ask for a weekly check for postpartum services rendered without a contract.
  • Insurance is not yet happily reimbursing for doula clients. Can you file to your insurance and see? YES. I encourage it. I do have a NPI (national provider identification number) and can create an invoice for you to submit after the birth of your baby. Medical Savings Accounts are the easiest way to receive reimbursement, however, your insurance may attribute the charges to your deductible or out of pocket and submitting a form is worth your time.
  • This is my career as a birth professional, not a hobby. My overhead includes rent for an office, class materials, doula materials- many of which are replaced at every birth, continuing education, a life on call not knowing when I could be supporting a client for days at a time, payment processing fees, lending library, self employment taxes, professional organization fees, and a cap on how many clients I can take per month.

I hope this answers some of your questions and if you have specific questions about package pricing, please contact me at kimberly.sebeck@gmail.com

Kimberly Sebeck, CLD, CCCE, HCHD “Knoxville Doula” 2016

 

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{K: Birth Story}

Wild Blossom Photography

Kimberly has been my doula (natural birthing coach) for my past two deliveries.  Kimberly’s career is supporting mother’s as they labor through bringing their child into the world. Kimberly watches mother’s unite with their own children, all while there was a hole in her own heart as she hasn’t known her own birth mom. A precious DNA ancestry gift from a client, began to open the door for Kimberly and her birth mom to be reconnected. The test connected her to a cousin and eventually to her mom. 40 years later, they are united! When she asked me to take photos of their reunion birth, I was honored. Kimberly’s story of adoption, how she found her birth mom is simply beautiful. I love how God is true to His word: “Take delight in the LORD, and he will give you the desires of your heart.” Just like birth stories, the long…

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A Birth/Adoption/Reunion Story

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I have a magical tale to tell you. It’s a birth story. We all know how much I love birth stories, but this is my most favorite of all. It’s mine.. but so much more.

I am adopted. I grew up knowing this. My brother is adopted and he came first — 7 months before me. My adoptive family received a phone call one night and they were told there was a little girl a the hospital from a surprise, private adoption situation. They said yes, on the phone, and I always joke that I was taken “sight unseen”. There are photos in my baby book of our party we had in celebration of the adoption being final. My adoptive parents never hid it or made it seem weird. We had several cousins who were also adopted. I had been told my birth parents were young and a few other details that didn’t give me any identifying information. I could write a lengthy novel about how being adopted affected me but there isn’t room for that here. For the most part it was simply a fact of my life. I never had the negative connotation that some adopted children do, but it still affects you. Every medical form I filled out in my life had a big line drawn through the family medical history section with the letters N/A (not applicable) scrawled on it. Every year on my birthday I wondered about my birth parents, specifically, my mother. Where was she? Was she thinking about me? Was she even still alive? Was she happy? Did she have other children? Did I look like her?

Every day access to the internet and my being pregnant with my own daughter coincided roughly at the same time. I found myself wondering more and more about my birth mother. When did she find out she was pregnant with me? Was she happy about it? Did she feel me moving inside her and had she had prenatal care? What were the circumstances surrounding the pregnancy — what if it had been a case of something darker than young love? Would my own daughter be born and share some characteristic or physical trait of my birth parents? Would I even know? As a child I had told myself fantastical tales that I was really a princess and had been given up for adoption to protect my identity. I told myself completely opposite tales of my mother searching endlessly for me and then switching to a story that she had moved on and never thought of me. I found myself in the early forms of forums and message boards (AOL, anyone?) and I decided to register on some national sites for adoption. On these sites you would put a few identifying details such as the hospital you were born at, a birth day, etc. The thing is, in 1972 it was not uncommon for birth certificates to have changed some of these details. I looked at the postings from birth moms looking for their children. Nothing matched. I did, however, connect online with a woman who worked in the hospital where I was born. HIPPA had not yet been signed into law. She said she would search through any records and give me what she could. She gave me a list of last names from all the births that had happened at the hospital I was born at — with a week spread of my birthday. She also gave me more information that something might be off about the details because I had been told I was born in an ER of a hospital that did not have a maternity ward and she told me there had always been a maternity ward where she worked. On a side note, I am happy to report she found the birth family she was looking for and I appreciate her doing that investigation for me even if it would now be prohibited due to HIPPA.

So I had this list of last names. What would I do with it? I would stare at it and wonder about my heritage. But I didn’t know what to do with it.  Around this time I did consult with an attorney in Florida, my birth state, about having the adoption records unsealed. It’s a big investment. Financially, time and travel, and emotionally. I decided to pay instead for some “non-identifying information” in the hopes it would give me a direction to head in and some medical information. It was fairly unproductive and didn’t tell me much about either my medical history or heritage. It did confirm some of the details my adoptive family had told me. Not that they were hiding or lying anything but they only had the information given them by the attorneys or a few other involved parties and who knew if it was accurate?

My daughter was born. She looked exactly like I knew she would. She looked (and looks) just like me. I became caught up in being a new mother, beginning my doula journey, and eventually going through a divorce. My birth family did not occupy center stage in my brain any more. I changed names, I changed addresses, emails, phone numbers.  I cannot remember if I went and updated any of the adoption registries. I do remember once checking out how many were now available online and finding it dismaying how many charged a fee simply to register. Maybe no one was looking for me, anyway. Maybe they didn’t even want to be found. I could respect that my existence may be a painful chapter someone wouldn’t want to open or revisit.

Years pass… I lose my adoptive grandfather to a heart attack. I see my adoptive grandmother aging. There are estrangements in other parts of our family. I begin to fear I won’t have any family. I begin to feel alone. I am not alone, of course. I still have my amazing second husband and my daughter. I am surrounded by good friends. I just feel like something is missing.

I am hired by a client to be her birth doula. She also wants a postpartum doula but due to the high number of births I attend she is concerned I won’t be able to help as much as she wants so we search for another postpartum doula for her but nothing pans out. It works out that all of my birth clients have their babies by the time she needs postpartum help. She has a Ph.D. in American Studies and Ethnicity. She writes books and lectures on African Americans seeking out their heritage and stories. In our discussions I tell her I am adopted and we speculate and joke about what my heritage may be. She asks me if I have ever done a DNA test. I say no. She asks me why not? I struggle to explain that I am not sure anyone would be happy if I was connected with them. What if they have their own family, perhaps not even telling their spouse or children? She encourages me to do one if only to find out my country of origin. Near Christmas when I am ending my work with their family she hands me a DNA test and says, “Merry Christmas.” I cry at her thoughtfulness and generosity.

I immediately do the test as soon as I get home and mail it off wondering how I can wait weeks for the results even though I have waited 40+ years for any answers. My results come back at the end of January. You receive them in an email and I am shaking so hard I can barely type to open the results. It tells me that I am mostly French Mediterranean, with a smattering of some other countries, like Germany. I am delighted by this news since France is my favorite country. I also have a ridiculous amount of DNA matches to relatives. One is extremely close of a match and says this person is a first cousin or closer. Wow! I am in shock about this. Does he know about me? How are we related? I spend many hours searching through the matches but the format is difficult for me. There are few photos of people and then it is usually very old photos. One sticks out — if I was going strictly on looks, this must be a relative of mine. I save her photo to my computer. betty Her name is Betty. She is deceased but is the relative of my closest DNA match. I am confused and slightly frustrated at how difficult it is for me to navigate the matches. I put it away for a bit and go on vacation with my husband and then get busy with work and life. After six weeks I open it all back up again, take a deep breath, and message my closest match. It is May 5th, 2016. My email says:

Hi there. I was gifted a DNA kit by a client of mine because she knew I was adopted. You are my closest match and while I hope I am not bothering you, I did wonder if you knew anything about my being relinquished for adoption back in October of 197- in Florida.

I would greatly appreciate any information you may have on my biological relatives and/or background.

Thank you.

 

I wake up on Sunday, May 8th. It is Mother’s Day. I feel sad for some reason. I write this post on my personal FB page:

I’m quite conflicted on Mother’s Day. I’m adopted and don’t know my bio mom. I have no relationship with my adopted mother due to many reasons…. I have felt quite motherless all my life but especially since I was 17 and moved away from my mom. I tried recently to care for her in her old age..for a few years, in fact, but tigers don’t change their stripes. All I can say though is that I see amazing mothers every day. Ones who struggle. Ones who seem to breeze by. Ones who have heartache. Ones who find the true meaning of mothering in their journey with their children… Which is how I feel about my own child.I had to wing it but I know that my child is worth more than anything. Anything. Being a mother myself…indescribable.

My husband, daughter, and I go on a wonderfully long walk with our dogs. I receive lots of loving messages, texts, etc from friends and clients. I am sweaty and happy from the physical exertion and the sentiments I have. I plop down on the couch and write a quick post thanking everyone for their love. I see a notification in the window of the DNA site and think to myself, oh, it’s probably just the staff wishing everyone a happy Mother’s Day. No. It is this email:

Kimberly,

It turns out you are my niece. One of my sisters is your Mother.

There is more to it, his contact information, etc, to contact him off site. I make some noise although I am still unsure what it was. Derek, my husband, is in the kitchen and runs over to see what is wrong. I can only point to the screen. Derek says well email him! I email him and he gives me my birth mother’s name and a few ways to check her out online as well as a bit of family history. He is excited! I spend a few hours looking at my mother’s FB page, and her pinterest, and her Instagram.. and I am thrilled and slightly amused she has such a strong social media game. I can see she is making things public on her FB profile and assume it is so I can see it. I see that it is, indeed, Betty, who was my relative and is in fact my biological grandmother.

The following day I am at a birth. I get a notification that I have an email from my mom. I am very focused on my clients so I wait until I have just a moment to myself and scan it quickly. It will have to wait.  I have waited over 40 years. I need to read it and savor it. When I am able to give it my full attention I find she has filled in so many details. All of the details I had been given were accurate, except for the hospital part. I was born at a different hospital and transferred to the hospital my birth certificate is from. She had been looking for me. Was this one detail the reason we missed each other on adoption forums? Sometimes I feel sad about it but I am so overwhelmingly happy and in awe of how we found each other that it really doesn’t matter. We have found one another. We were looking for each other, yet both in a way as to not intrude into someone’s life who may not want to be intruded upon. My friends have many questions and many are unanswered, especially in this early stage. They ask, well, didn’t you ASK HER? And I say… imagine me talking to me. It’s true. We are very alike.

Since then we have talked many times, frequently, and for hours. She will be visiting me in person soon. I have been emailed by the rest of the family and found out I have a brother and step-brother and aunts and uncles and cousins and a stepdad. We are both amazed how some saliva in a test tube brought us together. We are eternally grateful to my client who gave me the test.. In a way I can’t really describe in words. I remember my client saying if I found my birth family that she would know we were supposed to have met each other as doula and client. So you see.. this is a birth story. It’s a lot of birth stories. And as is the case with birth stories, I haven’t shared every snippet of information. Some of it is private and precious and some of it is not mine to tell, but we have the rest of our lives to cherish our magical story.


Kimberly Sebeck, Knoxville Doula, 2016

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Tips For Dealing With Conflict at Birth

You took your childbirth classes. You read books and websites. You created a beautifully printed birth plan. You envisioned a birth full of candles and flowers and looking like a birth goddess, or perhaps you envisioned getting pain medication and watching movies and visiting with your friends and family. And then..

Circumstances changed. Maybe you had a transfer from a freestanding birth center and went to an unfamiliar-to-you hospital. Maybe your baby stopped growing optimally and a medical induction became a reality. Maybe your no intervention birth plan is toppling so far from your preferred choices that it becomes bewildering and frightening to you.

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As an ICAN leader and experienced doula, I sometimes receive phone calls from women in these situations even though they are not my client. I had one this week. Without giving too many personal details, her situation was such that it seemed a medical induction was best for the safety of the baby. She was transferred to a high risk group. Upon arriving at the hospital she was told that the induction would be slow and could take days and there was no time clock. And then..

Multiple residents came in with different suggestions for getting the baby out now. She had researched a good deal and asked wonderful informed consent questions. Is this an emergency? Am I or the baby in danger to proceed slowly? The answer was no. Still, she called me crying at the pressure of having one doctor after another file into her room with dire warnings of distress to the baby (and worse) and predictions of a cesarean if she didn’t allow them to perform all of the interventions they were recommending, even if she was not comfortable proceeding that quickly versus giving her body a chance to swing into active labor on its own.

I listened to her cry. I listened to her fears and her disappointment that things were not proceeding as she had imagined. Then I reminded her that informed consent is actually informed consent and refusal. We went over the informed consent questions again. What are the benefits and risks of doing a certain procedure? Why is it being suggested? Were there any alternatives to what they were recommending? What happens if we employ expectant management and give things more time to progress? Would you give me a few minutes to discuss with my partner and make a decision I feel good about?

Disclaimer: I wasn’t there. I’m also not a medical provider and do not give medical advice. I am not the one responsible for the safety of that mother and baby. I am unaware if there was information that made her medical providers feel one course was the best. I am a doula. I am used to listening to women who are frightened, disappointed, and unsure of the right choice to make. I am interested not only in physical safety of mother and baby but an empowering birth experience — no matter how it plays out. I am interested in her looking back and feeling that she made the best decisions with the information available at the time. I am interested in the birth team cohesively working together to ensure a safe AND empowering experience.

She focused on finding some inner peace and asking these questions. Unfortunately, it did not go well and the pressure became strong and some not nice words, phrases, and tactics were used, per her. Her providers agreed there was no emergent reason (as in safety of mom or baby) to pile on the interventions but told her they were certain she would end up with a cesarean if she didn’t comply.

That is an awful, if not impossible, way to try to labor and open your cervix. So as I have mulled this scenario over in my mind I decided to come up with a few tips in case something similar happens to you.

  1. Ask your informed consent questions. If there is an emergency, not only will they tell you but your medical providers will already be swiftly acting. When you sign in as a patient you are giving them an agreement to save you and your baby’s life. We are not talking about clear indications for life saving measures but more those gray areas of trying to decide which path to take.
  2. Engage your nurses, if possible. In this case the charge nurse came in to speak with her and reminded her that these were the suggestions but that the mother is the one driving the decisions and that it is informed consent and refusal, should that be her choice.
  3. Follow evidence based medicine. While it should not be the case that each laboring mother has to know facts, studies, and regular or alternative standards of care and treatment, it might be in your best interest to quote recommendations given by pregnancy organizations such as ACOG.
  4. Should there be a complete personality clash between you and the provider caring for you, consider asking for a different doctor or waiting for the on call schedule to change. Again, this is obviously not always possible when there is a serious or emergent situation happening. In this case, the on call doctor changed in 3 hours and she decided to wait until she could speak to that doctor.
  5. The vast majority of providers are not there to make your experience terrible — or to get to their golf game. They really are interested in your physical safety and that of your baby. However, they may not realize how important certain decisions are to you. Talk to them. Convey not only how important certain things are but why they are. Suggest or ask if there are alternative methods to what they are suggesting. (examples would be: instead of starting Pitocin using a breast pump, instead of rupturing your membranes, sitting on a birth ball, etc.). Maybe their answer will be one of excited acceptance or perhaps they know something about your personal situation that is causing them to recommend something else.
  6. Find a place of calm. When a situation becomes tense there can be certain phrases and tactics that are used that are triggering. Stick to the facts and if there is a doomsayer in your room or someone who constantly promises you will end up with a cesarean, let those words and phrases bounce off of you in the emotional sense. Conversely you can request your provider to stop using those phrases unless it an absolute certainty that is the correct path to take. Having a baby is an emotionally charged experience! Hear the words but do not attach emotions to them. If you find yourself overwhelmed, go in the bathroom and take a nice soothing and dark shower, or walk in the halls for a change of scenery. If you are confined to the bed for actual medical reasons, play soothing music or listen to music through ear phones. Ask your partner for hugs and massage. Clear the room and ask for a set amount of time to get yourself emotionally back on track.

 

These are just a few suggestions I can think of. I would be remiss if I did not mention that having a doula is an evidence based way to ensure emotional support for you and your partner and to help you try alternative methods to keep you and baby safe but also stick as closely as possible to your desires and wishes for birth. No, doulas will not speak for you or argue with your medical providers. We will remind you to breathe, to take a shower, to relax, to ask appropriate questions, and do all we can to use our tricks and tools to help your labor progress even if it has veered off course.

What happened with the mother who called me? She texted me a photo of her beautiful baby and said the atmosphere completely changed for the better when the on call doctor changed to one more emotionally understanding of her. Just by making the decision to wait those couple of hours enabled her to relax and to make more progress and to feel good about her decisions.

Do you have any tips for dealing with tense medical situations?

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All Rights Reserved, Kimberly Sebeck AKA Knoxville Doula 2016

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Cesarean Rates – With a Grain of Salt

Note: This post is not about your medically necessary cesarean, or even one you chose. The author of this post respects all births and philosophies.

As more education and advocacy spreads about high rates of cesareans many natural birth advocates will encourage women to ask for their doctor and/or hospitals cesarean rates. Sometimes it is hard or impossible to find these rates as they are not always maintained by each physician, hospital, or even in public records. It is usually easier to find your state or region’s cesarean rates.

What is a woman to do when she searches and cannot find anything but internet reviews and anecdotal accounts?  What if she asks her obstetrician and they say they do not know what their cesarean rate is? What happens when a woman finds out that the hospital she has chosen to birth at or the obstetrician she is using has a 30%, a 60%, a 25% rate of cesareans? What does it all mean?

Information is always useful. But consider a few things.  If your state or regions cesarean rate is 30% but a certain hospital has a cesarean rate twice that — it could give you pause. Or you may consider if they only accept high risk women and are staffed by all or mostly high risk women’s specialists. Perhaps your provider is a large supporter of women who are attempting VBAC (vaginal birth after cesarean) and this skews their overall cesarean rate because there is always the chance a previous cesarean will result in another cesarean for the same woman. Large hospitals may not have accumulated statistics any more recent than a few years ago or even longer.

A rate will not guarantee you will have the information about choosing a hospital or provider.

Some suggestions for finding out deeper information are to ask these questions:

  • Ask your ob/gyn if they can provide a recent cesarean experience concerning their philosophy on birth. Was it due to a time limit? Was baby or mother not faring well?
  • If the birth facility itself has a seemingly high cesarean rate ask if this is due to specialists, high risk situations, hospital policies, or something else?
  • Has the doctor or facility implemented any measures since the most recent statistics that could help lower the chance of an unnecessary cesarean? Such as welcoming doulas, adhering to ACOG recommendations about reducing non medical inductions and considering active labor as beginning at 6 cm instead of the outdated 4 cm, utilizing midwifery care, and updating the tools provided to laboring women?
  • Does your hospital or doctor keep current on certain methods that can reduce unnecessary surgery by providing peanut balls for women with epidurals, having wireless monitoring for mobility, water labor options, etc.?
  • Does your hospital or doctor support VBAC?
  • Does your provider speak with compassion and understanding when you ask these questions or are they defensive or minimizing your concerns?

I hope some of these questions have helped to show that a rate is not always just a rate. Again, information is useful. It is a good starting point to ask more questions to make sure your provider or place of birth is in line with what you want for your birth options. Ultimately labor and birth is an unknown and you can only do the best with the information you have at the time.

Happy birthing!

All Rights Reserved, Knoxville Doula, Kimberly Sebeck 2016