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Where Did Your Doula Train?

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Today I read on www.doulamatch.net that there are 67 different doula organizations listed on their site. Wow. While there has been an increase in recent years of different certifying paths I had no idea there were that many.

As with just about everything in life and business there are pros and cons to this explosion of new ways to train doulas. Respectfully I submit a few of my thoughts on this matter:

Pros:

  • More professionals and parents are seeing and reaping the benefits of doulas
  • Easier access to training, along with likely various payment methods
  • Doula has become a household name
  • Being a doula does not have to be synonymous with charity work; more doulas are rightfully charging a living wage, which in turn allows for more pro bono or volunteer work when their own financial needs are met
  • Teams of doulas can partner up or create agencies which can lessen the hard work of being on call
  • Fresh organizations can bring fresh ideas and instill new energy
  • More families are being served

Cons:

  • The trusted and well known organizations who have been around for years have a well crafted method of making sure they are creating professional doulas, do the newer organizations also have the same ethic or are they jumping on an opportunity to sell an online program to as many people as possible?
  • Clients and professionals may find that there is no standard of ethics, codes, or grievance policy — essentially there is no national standard for doulas.
  • A person seeking to become a doula may not be able to tell the difference and spend their educational budget on a program that is not suited to them or does not equip them to be a doula. They may choose one solely based on ease of training, location, or budget price.
  • Doulas who are fresh out of training, in my opinion, require mentoring from their organization as well as continuing education and hands on experience. Will they receive this from a course that only includes a booklet of skills they check off and submit?
  • The doula profession has a high burnout and turnover rate. The initial interview process and reference check can save an applicant much time and money — sometimes being a doula isn’t a good fit for everyone or it isn’t a good fit for a particular time in someone’s life. If it isn’t a good time or fit for the doula it is not going to be a good fit for their clients or the professionals they are in contact with.

I mentor newer doulas in our area who reach out to me and go through an application process and are a good fit. My view is the world needs more doulas. Experienced doulas should be available to help the newer ones where possible but one of my requirements is for my mentees to have completed a training through an approved certifying organization and either to have been certified or actively working towards that certification. Certification is for everyone’s benefit. It demonstrates the doula understands and is committed to a scope of practice and follows it. It gives any families and medical personnel a place to file a grievance should that ever be necessary. It gives the doula ongoing support through the certifying organization and continuing education. I myself trained and certified through CAPPA (Childbirth and Postpartum Professional Association) and kept my certification active for many years. Eventually I moved my certification over to Hypnobabies once I became a Hypno-Doula but I still attend CAPPA conferences when I can and I was an ICAN (International Cesarean Awareness Network) leader for 7 years and received extensive training, support, and continuing education through that organization as well.

So if you are considering becoming a doula, carefully consider who to train through. How long has the organization been around? What do they offer in the way of not only training and certification but also in ongoing support and continuing education? Their low training fee may not be a bargain if their philosophy does not mesh with yours or if you are getting an incomplete education. My advice is to always try to round out any training with local volunteer opportunities such as a Birth Network or La Leche League, etc, in your area.

If you are considering hiring a doula, how can you know if they have had a good training? Ask who they trained (and hopefully certified or are working on certification) through. Google the organization and see if there is a public scope of practice listed, if there is a grievance policy, if the organization has been around for some time. There could be a new organization that is wonderful and has just begun so also listen to your instinct! Was there any in person or hands on training or was it completely on line? Do they connect their trainees with any mentors? Do their trainees attend yearly conferences or continued educational opportunities? Are there clearly defined guidelines of how to achieve training goals (ex: a set amount of births in a set time frame with satisfied clients as well as satisfied medical personnel giving reviews). Do they do background checks or at minimum, call references? (you probably wouldn’t want a doula with an arrest record, for example).

Growth is good and at times it can be messy. For the first half of my career I usually had to explain what a doula was. Rarely do I have to do that now and I love that! Few people are going to go into birth work unless they have a desire to help families. I feel most of the newer organizations are trying to make it easier to have training easily accessible and are trying to bring in fresh ideas to improve on trusted outlines.  We just have to make sure there are some professional standards and that everyone is getting the training and the trained doula they expect and deserve. Happy doula-ing and birthing!

 

All Rights Reserved, 2017, Kimberly Sebeck, Knoxville Doula.

 

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A Cautionary Tale for Doulas About Giving Medical Advice

Doulas who attend trainings with a doula organization are taught to not speak against medical provider advice. We are told that we aren’t to get between the clients and the medical providers. Yet, it happens. Usually it’s a very subtle thing, like our client calling us first to ask what to do if her water is broken. The proper response would be to ask their provider, of course, but perhaps we first offer some helpful tips like putting a pad on and seeing if it’s urine or letting them know the smell and color of amniotic fluid. Perhaps their provider suggests a procedure and they call us to get more information about the procedure such as what it is for or if there is an alternative. I like to think that these conversations are about helping the client educate themselves and get evidence based information so as to go back and have an empowering discussion and decision with their provider. What I would choose to do is not relevant and not only do I say that but I encourage the woman to listen to her gut feelings and ask for as much information and clarification as she needs.

Have I seen things that have given me pause? Of course. Have I felt like I would make a different choice at times? Yes. But none of that matters — it is not my birth. I am there to support decisions and facilitate the birth process no matter the circumstances. Now I will tell you about a recent scenario, with some details changed and names left out. Even after 15 years of being a doula, I am always learning.

One morning I receive a text from the client’s husband saying the amniotic fluid is very low and baby needs to be born and an induction is going to happen immediately. I text back and say ok, let me grab my stuff, call me when you can and give me details and how low is the fluid. I am told the level of fluid is an 11.  I won’t go into great detail over what is considered low and the fact that many providers perhaps are a bit overzealous with inductions for low fluid. In my head I thought the level is an 11? That’s not that low — but I correctly assumed that I was missing vital pieces of information. After a little while another text comes that the OB is recommending a cesarean. This really made me pause — why not an induction and trial of labor first? Again, I remind myself that I must be missing information as I know this provider and truly do trust his opinion and judgment and the fact he is called the male midwife in our area. I receive a phone call from the clients and get a little more information as I am driving to the hospital. The fluid was so alarmingly low that the ultrasound technician said there was none and as the OB explained to them that with there being no dilation or effacement of the cervix even past the edd that he was leaning towards a cesarean to safely deliver baby, but it was their choice.

I am confused, I admit it, but I keep it to myself.  My client is being sent straight to the hospital for monitoring and to make her decision about induction or a cesarean that afternoon. I assure them I am on my way and we will sit and discuss all the details so she can make a decision. When I arrive we sit and talk extensively. I ask the client what her gut feeling is. She says to do a cesarean, for a variety of reasons. She cries, we hug, we grieve a bit. Then we sit and discuss what she can expect for a cesarean. She is concerned that she has to wait a few hours but I assure her she is being monitored and if anything adverse happens that she and baby will be well taken care of. We spend the next few hours making sure the father gets all their stuff from home and gets something to eat and just going over things.

When it is time for the cesarean we are all prepped. This OB happily allows doulas or birth photographers in the OR. I have never been in the OR at this hospital with this OB — this is how rarely one of my client’s under his care gets a cesarean. I talk to the father while we are not allowed in for those few moments and keep him company and give him some advice for post cesarean care. We go in and the cesarean begins and I snap photos. Mama looks gorgeous despite the circumstances and I take some photos of her and speak reassuringly to them.

Beautiful baby girl is born in minutes, quickly taken to the warmer, and then given to Daddy for skin to skin. In moments we discover why the cesarean was an excellent decision. The placenta has already previously torn away in a partial abruption. There is virtually no amniotic fluid. An infection is suspected. The OB graciously shows this to me and we nod at each other over our masks. The surgery goes well and baby is given to mama on the way back to the room and we almost immediately initiate breastfeeding.

I stay for a few hours and we discuss what a good decision was made. I know that it’s a whirlwind of activity at this time and I offer to come back the next day to help process and give cesarean care tips. Unfortunately we had a huge snowstorm that night so I speak to them on the phone and come the following day. All is going well. We discuss the partial abruption and later we find out that the amniotic fluid level was not an 11 but instead was declared a 0.

Would it have been possible to have a successful induction? Maybe. Maybe not. No one is concerned about that any more because the decision has been made and it was an empowering and successful birth even if it wasn’t an unmedicated vaginal birth.

I am reminded yet again why we don’t give advice counter to medical advice. Doulas are not OB’s or midwives. We are not even labor and delivery nurses. There had been no symptoms of a partial abruption — no bleeding, no pain, no contractions. There was no fever to indicate an infection. Baby’s heart rate was good on the monitors. The week before the amniotic fluid had been at over a 20 level, then went to virtually none. Sometimes you take the signs, symptoms, and trends and have to make a tough decision.

I am reminded yet again why it’s important to have a birth team that you trust and also for my clients to trust their intuition. As we discussed while she was making the decision — no one could give her a guarantee either way of the best call. You make the best decision you can with the information you have at the time. Hopefully you have an OB like hers who doesn’t unnecessarily frighten or make you feel you don’t have a choice. She had a choice and the risks and benefits of both were clearly outlined. Yes, mother and baby were both fine and healthy but the bonus was that my clients felt empowered in their decision and were supported all the way and their emotional health was considered and supported.

Being a doula is a precious role and one that should stay within the proper scope of practice of non medical advice while offering emotional and physical support.

All Rights Reserved, 2015, Kimberly Sebeck, Knoxville Doula

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What if I Miss A Birth?

One of the most frequently asked questions I receive is: what if you miss a birth?

Well, to date, I haven’t missed a birth yet even when they’ve been fast and furious. I have been at 100% of my doula clients births except:

. Two years ago one of my clients very graciously understood the death of a close relative meant I wouldn’t be able to support her the same due to my raw grief and met with my backup at least days before labor began and was supported by my backup for her successful VBAC. I am grateful she understood that the sudden death of the man who raised me would impact my capacity to support her unhindered.

I think those are outstanding statistics. One day it will happen that I have two women who go into labor at the same time or on the same day and I will call in one of my two backup doulas. I will feel deeply disappointed that I couldn’t be there. When I sign on a doula client it is with the firmest understanding that I will make every effort to be the doula at her birth. Life happens, however. At my interview with clients I tell them the same thing I have said since I began taking doula clients: I will make every effort to be at your birth but if my daughter is in the hospital for a serious illness or from a car accident then I will be with her. Not once have I had anyone express anything but complete understanding and acceptance of that.

Another frequently asked question I get is: How many births do you take in a month?

The answer varies. I try to stay around 3 per month but upon certain circumstances I might take up to 5 depending on how many are first time moms, high risk, third time moms, etc. There is no exact science to it. All I can say is that my gut feelings and theories have worked out thus far. The months that I do take a higher number of clients I also make sure I have at minimum 2 backup doulas I know and trust. My backups are not chosen at random. The months I have a higher number of clients I am constantly assessing the situation in my head, ready to orchestrate the best case scenario for all involved. Some of my clients would not be unduly upset if I sent another qualified doula to care for them. Other clients would be more disappointed than others due to a variety of reasons: perhaps they are high risk or seeking a VBAC or perhaps I have already attended a previous birth with their family. All of this is taken into serious consideration for the what if and possible scenarios.

Hand in hand with that question comes: Do you have anyone else around my estimated due date?

I can virtually guarantee there will be someone around your estimated due date who is also a client of mine. Because a due date would be better termed a due month I do not put extreme focus on a day your baby is supposed to come. Again, various circumstances come into play such as if there could be indications for medical induction, multiples, etc. Again, it is not an exact science. The issue with not taking someone due the same day or even due the same week as another client is that babies come when they want to. For example: if one mother was due on May 7 and another mother is due on May 29, I have found there is a much closer overlapping than you might think. There might even be a June 5 mother who has preterm or early full term labor and births her baby before the May 7th mama does. I think in terms of a 5 week spread, from 37 weeks to 42 weeks. This is why I also do not just go on call at 38 weeks. I have met with some clients who were due in February who then called me the last week in December in early labor who asked me to meet them at the hospital. I did. If I didn’t take anyone close to another due date I would be helping a lot less women and families.

Rest assured that your birth is truly important to me. I am not in this for a numbers game or simply to make money, although I do support my family this way. Through the years I have adjusted what is a good amount of clients — for my clients and my sake so that I can always offer the best of care to each family but also have enough business to pay my electric bill.  Life circumstances change as they do for everyone. When my daughter was 3 yrs old I would not have wanted to have 5 clients in one month. I have been fortunate to rarely get ill and not around the time of a heavily scheduled month. Things have worked out so I believe they will continue to.

Do you have a question about doulas? 

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All Rights Reserved, Knoxville Doula Kimberly Sebeck, 2014