If you read my last two blogs, you know that OBGYNs and Midwives are both medical professionals that provide care for birthing women. They practice differently, not just because of money; rather, a cultural perspective of birth that's practically opposite. We do have some Doctors that we love and are within reach from our little Valley in the Temecula area. We also have different kinds of midwives that provide different options and potential for charging your insurance company. So now, it's time to talk Doulas. First, here's some pictures of myself - in action - as a birth doula. As you can see, I don't really have that many pictures of myself doing something at the birth. Most of these are after the birth or at the postpartum visit. Usually, I'm very focused on what's happening with the mom. If there's a chance for a picture, it's because I'm grabbing a camera to capture the beautiful connection between Mom and Dad. Out of 73 births, I've only had two where there was a photographer. So that's where those pictures came from. You can see that my face is often pretty close to the mom's especially in times where she needs to hear encouraging words. I use words a lot because of my HypnoBirthing training. Our words are so powerful. One time I led an unmedicated laboring woman to sleep with relaxing words in-between surges (contractions) at 9 cm. Sometimes, however, it's the exact opposite. Sometimes I'm massaging her feet and saying nothing. Sometimes, what she needs is to be all alone and I'm just setting up the room for when she gets out of the bathroom. My role can vary so much! One time I was blow drying my client's hair, many times I've taken parents on walks outside, Often I'm helping the Dad communicate with the hospital staff or finding creative ways to communicate the parent's desires without actually speaking them to the nurse or doctor. Because of my lactation certification, I usually help the nurses out by getting things started with breastfeeding. First, let's talk about what a doula is NOT. One thing a doula is NOT, is a medical professional. They do not take fetal heart tones (although many times I find myself trying to help the nurse get the baby's heart rate if she is struggling to get her work done and the mom is moving around a lot). They do not do vaginal exams generally speaking (although some doulas are also student midwives or former labor and deliver nurses and do include that). They do not deliver the baby or perform clinical tasks, although they might be the most qualified person to help someone in a situation where there is an accidental car birth or something of the sort. If you read the previous blogs you know that OBGYNs and midwives are medical professionals, so to set the record completely straight: A doula is not the same thing as a midwife. So how does a doula get their education?Some doulas are not officially trained or certified at all. Sometimes they just fall into the role because they have 6 friends who all asked them to be at their side while they birthed. But for most very active birth doulas, they do seek formal education and usually some kind of certification. There are different programs that certify and educate doulas. The most popular is DONA. But there's also CAPPA, ToLabour, and probably a few others out there. The trainings consist of a weekend course. Sometimes 3 or 4 days. The certification process is much greater. I am certified with DONA. This required reading a variation of books about birth and being a support person at a birth as well as breastfeeding, attending births and being evaluated by the medical professionals, continuing education (like my acupressure certification), and writing essays and taking tests. All that work couldn't possibly compare to the hands-on education I've received simply from attending all kinds of births.
So what does a doula actually do?
But wait, there's more! Just because a doula is not a medical professional doesn't mean the don't know how to help you have a safe experience. Having a doula takes away the pressure from the Dad to have to remember every little thing he learned in your childbirth education class. What are the signs of infection? What are signs of progress? What are all the different positions we can try? What do I need to say to her to help her release fear and ease into a more efficient birth? What was that drug their suggesting all about again? A doula will make sure that you get informed consent, that you know all the benefits and risks of every single turn of events. If a nurse is making a suggestion, the parents can ask for a moment to discuss it, and your doula will remind you not only all of the benefits and risks, but also the alternatives to that intervention. Doulas definitely maintain the midwife philosophy which is that you don't fix what's not broken and physiological birth works left alone in the body of a confident woman who feels safe and comfortable. Some doulas are real google experts. Just kidding, it's not the doctor-google sort of thing. But doulas will have a real medical journal or scientific study for you to check out on a dime, just to make sure you can feel confident about whatever decision you're making. For example, I've read EVERY SINGLE SCIENTIFIC STUDY ON GBS THAT EXSISTS. Yeah, that took a while! Different shapes and sizes... Some doulas do this and some doulas do that. Some doulas are also childbirth educators, like myself, and some doulas maintain different philosophies within those different methods of natural birth education. I've taken nearly every method of childbirth education there is, and picked up different tricks from all of them. But I definitely maintain a priority in the mental and emotional components, especially a lack of fear. Some doulas are placenta encapsulators, I am not. Some have worked with a lot of military families. Some, like myself, know what it's like to birth without a husband for reasons beyond a deployment. Some doulas work in groups, some work in partnerships. Unless you say otherwise, all doulas will have a back up doula for your birth in case of emergency. Some doulas specialize in multiples (twins and triplets), some specialize in VBACs, some are more experienced with home birth, and some are very particular in which hospital they will or won't work within. Unfortunately, I've witnessed more coercion that I can stomach, so I'm very limited now in what clients I'll take. I expect my clients to go out of their way to truly make sure they're in the best hands they can possibly be in. Some are also postpartum doulas, some have lactation certifications (I'm a CLEC). Some are also massage therapists, and some are even Labor and Delivery Nurses too, Some are professional photographers! We usually say that you should interview about 3 doulas and really go with your gut on who is going to make you and your support team feel the most comfortable. Generally speaking, they all normally do at least one or two prenatal visits, attend the birth for it's entirety, and one postpartum visit. What does a doula charge?
In this area there's a wonderful range of doulas and options. We have student doulas who might charge as little as $300 and even take payments. The more experienced, but still a little fresh doulas might charge more around $500-$600. More experienced, skilled, and proficient doulas charge more around $800-$1200. Some do packages where you can choose what kind of services they offer (for example, including photography or not) and that would create a range within their fees. Rarely, some insurance companies do cover birth doulas. You can use your HSA (health savings account) to pay for your doula if you have one. Although, I'm doing much less births than I used to, I will still interview with you, especially if you're my HypnoBirthing student! I charge $800. Otherwise, please allow me to help you find a doula who will fit your budget! I think EVERYONE deserves to have a doula! So what happened when a doula, a midwife, and an OB walked into a bar?They all talked about how amazing it is to witness the unpredictable, completely transformative, miracle of life. And they all had only one drink because who knows when the next 2am phone call would be.
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Karen Brann
Birth Doula, Childbirth Educator, Lactation Educator/Counselor Archives
July 2019
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