When living in Chico, California, and starting as a doula, I did not enter this work with a professionally-created business plan clutched in-hand – I walked in with my heart open and extended, ready to help families. The focus on business in the doula world has been huge in the last few years, and I absolutely see the value in that. When I started as a doula, there simply were not resources past the doula trainings we took. I did as many others did – made things up as I went along. With freedom and (eventually) experience, I made changes as needed to better fit how I wanted to do business. I have known all along that I do things differently than many other doulas, and I am perfectly content in that. In order for me to stay sane, happy, and sustainable as a doula, my business beliefs and practices have to match me. Take, for example, payment.
It is the norm for doulas to be paid-in-full before a baby is born – often by 36 weeks. The agreement generally is, if you have not paid your doula before your birth, she does not consider herself on call for you. I deviated from this years ago after seeing an uncomfortable situation with a doula friend and her client.
Anne was called to labor with a client at home. The client had not yet paid the second half of Anne’s fee, but Anne made the choice to attend her client. After a night spent working through contractions, labor stopped. Anne left to wait for her client to share when labor began again. But Anne’s client never called, and soon Anne learned the baby had been born. Expecting to be paid, Anne contacted her client to make arrangements. The client, though, expected that since she didn’t have direct doula support for the birth, nothing was owed. For weeks and months I saw this play out, and I felt bad for Anne. The amount of time and energy she put into trying to collect payment was painful to watch. I understood Anne’s side of things, and yet I could imagine a situation where her client felt good about birthing without a doula.
Anne never was paid.
I have since moved from Chico to serve the areas of Visalia and Bakersfield, yet my belief hasn’t changed: my true heart of this birth business lies in wanting families to have what is right for them – even if that means they change their minds about me. I cannot stress this enough! Thoughts come to me: what if a family finds that fee-remainder would be more important to them than doula support? What if I miss a birth? What if they are laboring confidently and a doula’s presence doesn’t fit the flow of their birth? What if a planned cesarean birth is needed and they feel well-enough supported? I wanted my clients to have an “out,” to be free not to call me, without worry of penalty.
My contract expectations are as follows:
There it is – all in place should a family find it useful.
This structure is worrisome to many doulas I have shared it with. What about being on-call and then suddenly having your time wasted by not attending the birth? Unless I block my calendar out for specific dates (and as my husband is a teacher, I block out some time in the summer), I am on-call a lot. When weighing this as an option for families (against my inconvenience), I want families to win.
Ultimately this has been more of a non-issue: I am getting close to 200 births as a solo doula, and I changed my contract to reflect this option around birth 30; in all of that time, I have never had a family NOT call me, and I have never had a family NOT pay me. So why keep it in my contract at all, if it isn’t going to be used? Because I believe birth is a time when your choices shape your outcome – and who is on your birth team should always be one of your choices.
I had a client once whose doctor openly laughed when she said she wanted to delay her baby’s umbilical cord clamping. Her doctor claimed there was no benefit – which (he assured her) is why they cut cords so quickly. He went on to share the “risks” as well: the baby would get jaundice, the baby could get a dangerous “backflow” of blood, and my client’s chances of bleeding too much after birth were increased. My client still chose to delay cord clamping (except the delay wasn’t as long as she had wished), and mother and baby were healthy and happy, with no complications.
The American College of Obstetricians and Gynecologists released a committee bulletin entitled “Delayed Umbilical Cord Clamping After Birth,” and it replaces their past 2012 opinion (which I cannot even find to link to, as I keep getting 404 error messages), which was not terribly positive or supportive. What a benefit to have current recommendations to share with our ACOG-connected providers! The Institute of Medicine says it takes an average of 17 years for professionals to change the way they practice medicine based on new evidence – so it is up to parents to advocate for best-care practices, and understanding current ACOG recommendations is a great place to start.
For some really great information check out this Lamaze "Science and Sensibility" post where Dr. Mark Sloane shares the evidence in favor of delayed cord clamping.
Another favorite I have shared in my classes for years is this piece which claims delayed cord clamping is a baby's frst stem cell transplant.
And of course, ACOG's recommendations are the base of this post an infographic -- families don't forget to print out the pdf to share with your provider.
I recently had an inquiry into my doula services. Knowing there was a slight chance I might be out of town for a couple days around this couple’s EDD, I offered a partnering situation, where a second doula and I share all the pre-birth responsibilities, and then whoever is most available attends the birth and the follow-up visit (for more information about ways to work with other doulas, contact me). In a case like this, we split the deposit, both attend all prenatals, and then have a way of determining who will most likely arrive at the birth (sometimes this is as simple as who is more rested in the case of another recent doula birth, sometimes we wait and see who the family contacts first, and sometimes it is just a pre-arranged agreement between doulas). The family agreed with this type of arrangement, so I contacted a doula friend, asked if she were game, and all of us met for an interview.
The partner I selected for this birth is much my junior in the birth world. We had recently partnered for a birth where I was asked to help a young mother-to-be in foster care – there were no funds for doula support, yet this situation was too important to let that stop me. Knowing I had a pretty busy birth schedule, I asked this doula if she would partner with me for this volunteer birth, and she heartily agreed. I loved her style, her knowledge, her heart. She has a real passion for serving, and I can’t wait to work with her more.
Our interview went well. The family originally found me through my website. They were impressed that I kept an active blog, and they appreciated my experience, certifications, and the seriousness with which I take this work. The expectant father is someone who deals a lot with numbers – he is a numbers guy. He did seem concerned that I might be out of town during their due-week. I also live about 40 minutes away from the hospital where the couple would be birthing, and my partner lived about 10 – this was another number for the expectant dad to absorb and think about. The expectant mother, because it was her second baby and she had a fast-paced job where she gets little rest and is always on her feet, had practically been assured by her doctor her baby would be early. With the dual coverage provided, and knowing babies don’t generally come lightning-fast, she seemed very comfortable with how the situation would work out.
Upon ending the interview, the expectant mother basically said, “Thanks for taking the time to meet with us. I will call you tomorrow to let you know how we want to proceed. But I am feeling pretty good about all of this.”
My partner and I walked away feeling really positive about the meeting, and we said our good-byes.
The next day came and went, and I didn’t receive a call. Because this family was due within a month or so, this day passing without hearing from them was a tiny, pink flag to me. The following day, I did get a call from the expectant mother. I could tell by her tone she was having a hard time putting her words together. That’s when I knew for certain: they were not choosing me. Okay, that sounds weird, as we were already aligned to work as partners. But I could sense they wanted to alter the design, and being as mine was the only contact information they had, that meant they had to, essentially, go through me to get to my partner.
Talk about awkward! I held the reins here. The expectant mother explained, it really came down to me possibly being gone, and that 40 minutes of driving for me to reach the hospital – her partner was not comfortable with these numbers (maybe they felt a better connection to the other doula? And if so, they did not mention this, but she is amazing, so of course it could add to their reasons, but they did not say that to me). I stopped the woman, as she was uncomfortably offering a finder’s fee, and apologizing all over the place – I knew she felt bad and this was hard for her to do. I told her one of my core values as a doula is that families find the doula who is right for them, and that won’t always be me. I hold true to that, and I really believe I get the clients I am meant to get.
I assuaged this mother’s guilt as best as I could. I told her not to worry about it one more minute. I gave her the other doula’s information, then asked if I could talk to my partner doula first? She agreed. I wished her well, again told her I was happy they found a match that felt comforting, and said good-bye.
Then I dialed my partner doula.
She was in disbelief, knowing I had more experience, and that the family found her through me. She was also extremely apologetic and humble. I assured her this family was firm in their decision, and I told her she should take the time to feel good! She was chosen! Relish in that and feel proud! I said I appreciated her being gentle with me, sounding and feeling disappointed and surprised, questioning their choice, and I wanted her to let it go to her head a bit – celebrate! I knew she would be a great doula for them, and I could honestly say I was happy with how things turned out.
I do, absolutely, feel everyone deserves a doula, and that doula won’t always be me. Families come in all shapes, sizes, and situations, and they have ever-branching needs. I feel confident in the work I do and the care I have to offer. And I know so many other incredible doulas I can say the same about. It is more important to me that we support families than I be the one supporting all the families. Because of this, I can still be happy and gracious when the right one is not me.
♥ four young boys and a boy dog (offspring)