There are several types of Doulas, each with their own scope of work.

BIRTH DOULA– Educational and Emotional support for the Laboring Person and their family

POSTPARTUM DOULA– Cook, clean, help with lactation, care for baby, care for family, errands, shopping, an experienced support for the new family

FULL SPECTRUM DOULA – Activist, anti-racist, will work with pregnancy loss, incarcerated individuals, abortion, as well as birth and postpartum.

SCOPE OF PRACTICE:

Doula cannot perform medical procedures (Blood pressure, vaginal exams, etc)

Doula cannot prescribe (medication, herbs, homeopathics)

Doulas Do not speak for a client. They can advise, educate the parents, but are not there to argue with medical personnel.
Always choose a Doula who is CERTIFIED by a reputable organization.

QUESTIONS TO ASK A PROSPECTIVE DOULA:
Are you certified? By What Organization?

How many births have you attended?

Have you previously worked in my birthing place?

Have you previously worked with my medical provider?

Do you carry insurance?

Any other services you provide?

What is your fee? What does that include?

Do you provide a contract?

Do you have backup in case you are unable to attend my birth?

How many births do you take a month?

Are you familiar with pelvic biomechanics?

HOW TO FIND A DOULA

1. Certifying body website usually has a list of doulas listed by state/ city(ICEA.org, DONA.org, CAPPA, ToLabor, SISTER SONG)

1. Doulamatch.net
2. Facebook Doula groups
3. Recommendations from friends

DOES INSURANCE COVER A DOULA?
You will need to check with your insurance company to see if they cover these services. Tri-Care (Military Insurance) has begun covering these services if your Doula is certified with certain organizations. Many HSA’s will cover these services.
Medicaid in certain states have started covering Doula Services.

Most first time parents will want to take a childbirth education class. The best time to plan a class is between week 32-34.  Ideally both partners should attend all sessions. This will allow you plenty of time to practice new skills for birth, but not so much time to forget. A well rounded class will include the following topics: Anatomy & Physiology, When to Go To The Hospital, How To Time A Contraction, Breathing and Relaxation Techniques, The Stages of Labor, A Birth movie, What Happens in the Second Stage of Labor and How to Push, Informed Consent, Medical Aspects of Birth (Medications, Inductions, Interventions, C-Sections), Comfort Measures and Postpartum. The information should always be evidence-based and current. You can expect up to 6 hours of education, often broken up in several weeks.

There are also specialty classes offered in Newborn Care, Breastfeeding, Car seat safety, Infant CPR, Advanced Comfort Measures, Partner classes, Infant Massage, Grandparents Class.

There are many excellent methods and types of classes… but any of them should include the information above. They each have their own spin on birth.. its good to investigate what resonates with you and your partner before choosing a class.

One of the most critical decisions you will make in the course of your pregnancy is your birthing place and medical provider. These decisions are made early in the course of pregnancy, perhaps made on the basis of location, references, or insurance. As you understand more about your birth preferences you will want to be sure you are in alignment with your provider and the services your birthing place provides.

For example, if you’d like to have a water birth, but the hospital you choose doesn’t have tubs or doesn’t allow birthing in the tubs, you’ll need to rethink either your plan or your place of birth. If you want a Doula to be present, but your Dr’s office does not see the value in this type of support.. you can see there may be a conflict. It’s important to trust your instincts, because no one knows YOU as well as you do. Be prepared to ask your provider direct questions about their c-section and induction rates, feelings about Doula’s, unmedicated birth, use of alternate birthing positions, use of episiotomy, their knowledge of pelvic biomechanics and closed knee pushing.

Types of Birthing Places:
Hospitals
Birthing Centers (free standing or connected with a hospital)
Home

Types of Providers:

Doctors (M.D, D.O, Family Practitioner)
Midwives (Nurse-Midwives, Direct Entry Midwives, Lay midwives)
Nurse- Practitioners (may deliver in office care, but not delivery)
Physicians Assistant (can prescribe, do surgery, most functions of a Dr.)

It’s been fascinating to research the obstetrical history of the US.  To understand the origins of modern medical practice is an eye opening and somewhat disturbing experience.  The most difficult part to traverse is that the medical “establishment” for the many strides they’ve made toward our health and well-being, have also been responsible for some really awful things. Here are few from the last 50 years:  Thalidimde, mid and high forceps deliveries, episiotomy, the undermining and near eradication of midwives and their role in our society, and the newest addition to this list.. elective cesarean section.

To say there has been a “systematic” process on a societal level to undermine women’s confidence that she can birth or breastfeed- smacks of conspiracy theory.  But when i look at the evidence, the women who come to my hospital classes, when I listen to their fears and hear what someone out there has said they can or can’t DO… it’s hard not to think there is something systematic about it.

Women don’t believe they can birth or breastfeed… when the evidence, if we look at our anatomy and physiology is quite the opposite. There is an epidemic of fear about birth and handling the pain, there is a notion that we can understand everything we need to know about childbirth from a book, app, or some other intellectual process. As a society we are so disconnected from ourselves, from our bodies from an intuition that will guide us rightly.  We are told plain and simple that birthing is ‘dangerous’ and we need medicine and interventions and safely navigate these waters.

In nature about 6% of the population would require a cesarean section for the safety of either mother or baby. The World Health Organization says we should aim for 10-15%, which gives some wide latitude.  How do we then explain the US rate of 32-35% then?  Some of the hospitals in my area are as high as 40%.

My goal is not to create conflict or mistrust- however, I do believe women and their partners need to understand ALL their options.  “If you don’t know your options, You don’t have any”.  Ignorance is not bliss. So I encourage everyone to do their research about pregnancy, labor options. Research the hospital and the Dr. to make sure you are in alignment with their practices. Don’t be afraid to ask questions or make changes if you discover you might be in a place not in accord with your desires.

Approximately 3-4% of babies are in a breech position (bottom-down) at the end of pregnancy. Most women who have a baby in breech positioning have limited options for how they can give birth, with the majority (90% in the U.S.) giving birth by Cesarean. I have already written about the evidence for using external cephalic version, or the hands-to-belly procedure, for to turn breech babies. But what is the evidence for using other methods, like moxibustion or accupuncture, to turn a breech baby? Is moxibustion junk science or does it actually work?

Click Here

New research on the discussion of to cut the cord right away or wait.

Click Here

Ok, we’ve not talking about throwing it on the BBQ… but Placental Encapsulation is a process where the Placenta is saved, prepared and freeze dried after birth and consumed by Mom.  The hormone drop after birth is significant and can trigger Baby Blues and Postpartum depression.  This is a wonderful way to get the hormone support needed for the postpartum period, PMS and even menopause.

The finished product after the encapsulation is a large jar of cranberry colored capsules- nothing gross or unsightly.

Here is a wonderful article about one woman’s journey and why she chose to encapsulate her placenta.

One important word:  Most placentas go to pathology for some examination after birth.. this is a NON – STERILE process, because usually the placentas are thrown away.  Make sure to inform your staff you are encapsulating, so they can use STERILE procedures in their examination process.

CLICK HERE FOR ARTICLE

Read this latest study brought to you from ACOG (American College of Obstetrics & Gynecology)

CLICK HERE

Birth Plans came into fashion many years ago, and every couple has their “take” on what should be included in that document.  I often tell my students that Birth cannot be “planned” and often the harder we try and “make it” go a certain way, the further things sometime slip away. It’s always best to keep a flexible attitude when it comes to birth, holding a vision for what you might like, but being present for what’s happening and what’s needed in the moment.  I’ve come to really like the concept of a Birth Preference sheet. This simple 1 or 2 pages can be a great springboard for discussion with your provider about things important to you, and be a great way to let your staff ( in a hospital birth) know how they may assist you.  Take a look at one of my favorites (reprinted with permission).  It’s concise, the table format is easy to read, and shows that these parents have done their research.

_____________________________________________________________________________

We are excited about the arrival of our baby and to be sharing this experience with the doctors and nurses of XX Hospital.  Our ultimate goal is to ensure a healthy mother and healthy baby and we know we can achieve this with your help and guidance.

XXX, the birthing mother, will be joined during all stages by her partner XXX.  We also will be utilizing the doula services of XXXXX.

This is the portion of our birth plan which outlines our wishes for Labor and Delivery. At your earliest convenience, please read through our plan and bring any items of question or concern to our attention.  Mom can be reached at XXX-XXX-XXXX.

Best Regards, Mom & Partner

 

Labor

Labor
Preferences	Notes
Natural/Unmedicated	Unless mom or baby is at risk, we are looking forward to an unmedicated, natural childbirth.
Heprin Lock	It is important for Mom to be able to move freely during labor. We would prefer a heprin lock rather than IV.
Fetal Monitoring	Unless baby is in distress, please monitor intermittently to allow mom to move around.
Quiet Environment	We would like a quiet environment to facilitate relaxation during labor.
Light Snacks/Liquids	Mom would like to snack lightly and drink fluids to maintain energy and hydration during labor.

Delivery

Delivery
Preferences	Notes
Varied Pushing Positions	Please allow Mom to try different pushing positions if desired.
Ease the Baby Out	Please help Mom avoid tearing as much as possible by guiding her in easing the baby out.
Avoid Cesarean	We would like to avoid a cesarean unless Mom or Baby is at risk.

Immediately After Birth

After Birth
Preferences	Notes
Delayed Cord Cutting	We would like to cord to stop pulsating before being clamped and cut.
Breastfeeding Immediately	We would like to try breastfeeding immediately after delivery to encourage placental delivery.
Spontaneous Placental Delivery	We feel strongly about trying to deliver the placenta spontaneously.  Please delay administering Pitocin until at least after breastfeeding and cord cutting.
Newborn Care After Bonding	Please delay routine newborn care until Mom has breast fed Baby and the happy family has had an opportunity to bond.

 

FOR NURSERY:

Thank you so much for taking care of our little boy for us while we are at the hospital.

 

This is the portion of our birth plan which outlines our wishes for Newborn and Postpartum Care. Please review at your earliest convenience and bring any items of question or concern to our attention.  Mom can be reached at XXX-XXX-XXXX.

 

Best Regards, Mom & Partner

 

Newborn Care

Newborn Care
Item	Notes
Bottle/Pacifier	Please do not offer without our consent.
Postpartum Rooming-In	We plan to room-in as much as possible.
Nursery Care	If baby is moved to the nursery, please return him to mom for feeding at any time of day or night.

 

Newborn Procedures

Newborn Procedures
We have reviewed the list of newborn procedures and would like to proceed as outlined below.  If something is not on this list, please obtain our consent before proceeding.
Please Proceed	Notes
Bath	We ask that baby only be rinsed with water – not scrubbed or cleaned with soap.  It is okay with us if some vernix is left on his skin to come off in its own time.
Temperature Regulation
Eye Ointment
PKU
Glactecosemia
Hearing test
Vitamin K shot
Pediatrician visit
	OPT OUT- Hepatitis B Shot  no Consent given

 

Our Pediatrician

Practice Name

Address

Suite

City, State, Zip

Child’s Name – XXXXX

Sharing a very in depth article on this topic.   Click Here to Read