I know as a doula and birth professional who works with hundreds of families a year, there will always be families who want a doula who has the most experience at a higher price tag, and there will always be families who are happy to work with a less-experienced doula at a lower price tag. There is no right or wrong, there is just what is right for you.
Doulas aren’t like other professions we may sometimes link them to – take nurses, for example. You understand when you have need of a nurse that they all met a standard competency, and they all work to keep that license up. Even if your nurse went to school in Washington, or Florida, or the Netherlands, there are core competencies all nurses are expected to learn. There can be some slight variations, but for the most part, the educational requirements are similar.
Your heart pounds, your mouth dries, your ears begin ringing, and your face suddenly feels so hot! You just got a call that a potential client wants to meet for an interview. This often leads to a mad-scrambling of resources, or the paralyzing shock of sudden responsibility.
No need to fear! First off, keep in mind these people have contacted you because they are aware of the services you provide, and they are wondering how you as a doula can help them as expectant parents.
Place: Where to meet? There are many different ideas about this. Many doulas feel there is nothing better than to meet in the expectant parents' space -- their home. The advantage here is, you are able to show them you can fit into their home and life. Pregnant women are traipsing to a lot of different places -- the doctor's office, the ultrasound office, the hospital to pre-register, their childbirth classes. Nothing is really accomodating, so to be able to visit a mom in her home can help with the whole why-one-might-want-a-doula-in-the-first-place: Having an advocate to help with physical, informational, and emotional support who is more just a random stranger on shift.
Sometimes a doula might feel meeting in one's home, without any prior meeting or credible information about a potential client can be a safety issue. For some doulas, if they personally know someone who personally knows the potential client, they are comfortable meeting at their home. If it is an absolute stranger, you can try to supersleuth on Facebook to see if the profile is real, see if there are pictures of the pregnant person, see if you have any friends in common. Going with your gut can be helpful here -- we encourage women to use their intuition to aid in their process of birth, we need to remember that and apply it to ourselves, as well.
There is another school of thought that says, this is an initial meeting where no commitment has been agreed upon yet, so the doula and the expectant family should try to meet in a public location about as in-the-middle as can be, which can be helpful if a doula lives a distance from the potential clients. This saves her gas money and travel time. Often if a doula is hired, she makes the full trip to the clients' home for her prenatal meetings.
A good alternative to meeting in a private home is a comfortable, public location. Places like Starbuck's, Barnes and Noble, local tea or coffee shops work. Other places people meet are parks (good if the weather is nice or the interviewee has other children), restaurants, medical office waiting rooms (this helps streamline a woman's appointments), her work place at lunch, WIC Office, baby store, or an apartment's recreation center.
It would be naive not to take some cautionary measures for your safety when going to an interview.
-Leave a note detailing where you are going, who you are meeting with, and how long you will be gone. Information that should be included: The names of the folks you are meeting, the address of the location, the email address or access to any online exchanges you have had with the person.
-Bring your cell phone with you, especially if you are meeting at a private home.
-If you feel something's fishy about the situation, choose a public place, and perhaps have someone come with you, incognito at another table, or as a doula-in-training learning the ropes -- saftey in numbers. I know this sounds odd, and if you really felt strange about something why go at all? There are times, however, where you aren't sure about the situation. If you have a "I'm not sure," kind of situation at or after an interview, or from initial phone or email contact, proceeding with a back-up plan is just an added measure of protection in an uncertain situation.
The point of all of this is not to strike fear into your heart, the point is to remember to listen to your gut and be mindful of your safety as you proceed down this road.
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.
Melissa is another fabulous doula in the Modesto Doula Group. She brings up some great points about doula work, including potential awkwardness when the mom you are supporting is older than you are, and the many reasons why doulas burn out.
I am currently 24. I started "Doula-ing" when I was 21, right after the birth of my first child. I had always been fascinated with the biological mysteries that surrounded birth. It was always my most anticipated subject in science. I was a birth junky from the start and I didn’t even know it. I first started out like most young doulas, volunteering free services just for a chance at some experience. I attended the birth of a friend; other than that though, business was fairly dry for me in the beginning. It was slightly discouraging as I was so eager, but at the same time I had a 6 week premature infant to care for so I wasn't exactly striving to be extremely busy with births.
I got the opportunity about 6 months after my first DONA training and birth to come and sit in the Bradley class I had taken while pregnant, by my old teacher. It was potential for a birth and I felt fairly confident. I was hired by two couples in the class, both women about 6-7 years older than myself. I felt the twinge of hesitation from the both of them when I told them my age. I wasn't surprised. Standing at 5'2 and only about 114 lbs soaking wet, I looked more like 16. The teacher assured them of my skill set, and I was officially on call.
When I was called into the first birth I was slightly nervous, not knowing if I was going to have to work harder to gain trust from someone older than me. I was taught to "Mother the Mother." How do you "mother" someone older than you without sounding slightly patronizing? All in all it worked out fantastically and we found our footing together. When I really think back through the births I have been hired for, I have noticed that almost all the women I have served were older by quite a few years, and it makes me wonder if the younger doula's out there question age gap between themselves and their clients.
I did a very informal, and simple, one-question survey (thank you, Facebook): "How old were you when you started Doula-ing"? Out of 100 answers that I got, I averaged it out to the age of 27. The number seemed fairly accurate to me since by this age most people have had a childbirth experience (whether personal or a family member) that has led them to the path of birth work. But when I started to dig deeper, I started realizing how high the burnout rate of birth support professionals really is.
Most women who train to be a doula only average 2 years in the field. The worst part about this is that I am not the least bit surprised. The idea of birth work is largely romanticized in my opinion. It's easy to think of being with birthing families and babies during one of the most important and transformative times of their lives, and look right over the not-so-nice things, like the long hours -- and I'm not talking 2-hours overtime type hours. I'm talking about the births that last 22-57 hours from start to finish.
The exhaustion after long births is felt on a cellular level. Emotionally you are too tired to care about anything but the next step you are taking, and physically, well let's just put it this way, along with your arms being sore from the double hip squeeze that you did for 17 hours, and your legs being sore from standing and supporting another human for that long, even your teeth and your hair hurt. But it's even more than that, it's the expectations of an ideal birth that fall just a bit short for whatever reason. It's the looks from resentful hospital staff. It's watching a family's entire world fall apart in front of them. This is what I think causes a large number of doula burn-out -- we are not prepared to handle the true exhaustion of body and spirit. I don't want to take away that magic of birth work, because I wouldn't trade this job for anything, but it's anything but easy. And when you start out in this field without anyone to help guide you, it can be impossible to continue going without feeling disheartened along the way.
I have been extremely fortunate -- I was taken in by a fantastically wonderful circle of experienced doulas and together we created a (totally kick-ass) Doula Group. Being the youngest in the group, it’s a bit different for me sometimes, in the sense that my birth approach is different. I learned after those first initial births that instead of "Mothering the Mother" I "Sister the Mother." I try hard to get on a sister/friend level -- someone that is along for the ride with them no matter how many bumps there are in the road. More peer, less authority. I have been told on more than one occasion that I am an assuring presence in birth because, "seeing someone so young and knowing that you have done and accomplished what I am trying to accomplish is comforting." I have gotten out of the nervous mindset of working with a clientele that is older than I, because it doesn't help anything.I go in confident in not only myself, but also the laboring mama and the process of birth, and this is what helps.
I have come to realize that there are definitely some up-sides to being on the young end of the doula age-spectrum, at least for me. Before getting pregnant with baby number two, I was actively training for my black belt in Kung Fu. To say that I have the physical stamina for this job is an understatement! Not only that, but I love the physical demand of birth work. If I don't feel sore after a birth I wonder if I didn't do enough.
Another thing that was brought to my attention by my favorite midwife in conversation about this particular topic of age was: "The earlier you start, the more years of service we can get out of you, and the longer period of time you can commit to the long-term vision of radically changing our maternity care system. There is no end to the benefit of young women going to births. Of course all women at whatever age they start get my vote and I'm excited about it, but I look at young women like, great! So we can get close to 50 years out of you!" And its true! The younger doulas start, the more of a difference they can make. The more experience they can gain. The more knowledge they can spread.
The fact is that no matter what your age, if you are a dedicated doula, you will find a way to practice that works for you and your mamas. You're always the right age to help provide evidence-based care and support.
Melissa is Birth Doula certified through Still Birth Day. She is one of the doulas in the Modesto Doula Group. She is an experienced Bradley Childbirth practitioner and assistant instructor. Melissa has a background in Child Development, Education and Psychology, and an interest in special-needs and high-needs children. Melissa brings to her clients her personal experience and expertise with premature labor and birth, the challenges of parenting in the NICU, and breastfeeding a premature baby. She has excellent skills in communication and listening, massage, visualization and meditation practices to help during pregnancy, birth, and the postpartum period.
There is a lot of talk about what your ecological footprint is -- meaning, what impact do you have, because of your lifestyle, on the earth and its resources? Being in the world of moms and babies as a doula and an educator, I have seen a different footprint we can leave, a Birth Footprint.
Basically, your birth footprint is a combination of your personal experiences, beliefs, biases, and philosophies that could be projected onto other women and families -- instead of the pressure you put on the earth, it's the pressure you put on others.
Here are a couple examples of exerting your birth footprint (and they happen to be mine!):
Giving clients opinions instead of actual facts. We don't try to do this intentionally, but rather, we give anecdata from what we have seen or experienced, versus evidence-based information that comes from reputable sources such as Cochrane Collaboration.
With my second pregnancy, on my due date, my midwife asked if I would like my membranes stripped. I was tired of being pregnant (who isn't by 40 weeks, huh?) and I willingly agreed. Nothing happened, not one thing -- I was pregnant for another week. In my mind I equated membrane-stripping with a low-risk intervention, not inclined to do much.
Back when I was certifying I had a client who was offered a membrane-stripping by her practitioner. She agreed, and immediately began contracting every 9 minutes. This was the start of hours of uncomfortable, non-progressing labor. She went to the hospital after 12 hours with contractions still no closer together or longer in length. She begged her practitioner to allow her to stay the night and he agreed. The next morning, 24 hours after the membrane-stripping with still no change in contraction pattern or cervical dilation, her practitioner broke her water, offered her an epidural, and began induction procedures. This mama hadn't slept all night, her epidural wore off three different times, and by six pm, she was offered a cesarean birth -- exhausted, she agreed.
I had no part in her decision, we had not discussed this topic beforehand; but if she had asked me about membrane-stripping, I might have said, "It's no big deal, it doesn't do anything anyway." My answer would not have been true! While Cochrane states, "to avoid one formal induction of labour, sweeping of membranes must be performed in eight women," it goes on to mention "sweeping can cause discomfort during the procedure, bleeding, and irregular contractions" -- all of which my client experienced. Her contractions didn't change her cervix, but they did wear her down, diminish her spirit, and factor into the making of decisions she previously wanted to avoid.
Letting personal biases interfere. As we work with different practitioners in the birth world, we get good ideas about who we like, and who we would like to avoid. A woman sought out my doula services, and I was thrilled when she shared her midwives were my midwives. An assumption came from this: I knew these women well, I valued their skills and their style, and I had two of my babies with them in amazing-to-me births -- I guessed my client felt the same. But guess what? I was wrong. My client was having doubts about her connection to the midwives, and while she tried to process her own feelings, I was trying to talk these women up, in the hopes that my client would feel better about her choice to birth with them.
What I didn't realize was, this chipped away at my ability to be the non-biased sounding board my client deserved. My attempts to smooth the rough feelings my client had were actually setting us up for division, as I was supposed to be on the mom's side, and it seemed like I was on the midwives' side. Before things got to an uncomfortable point, I saw my job wasn't to fix the situation. Instead, I offered communication strategies my client could implement, including role-playing with her so she could practice conversations before her appointments. She had a memorable birth with just the right midwife, and I had a memorable lesson in my client's needs and feelings coming first.
Questions to ask yourself if you are a birth-worker:
1-Do I bring up my own experiences of birth and share them readily with my students or clients? No doubt having babies is exciting and life-changing. We do have a need to share our stories, this is human nature. I have joked that every woman has to share her birth story 78.4 times before she can move past it to help another woman. If she tries to move into birth work before she is ready, her expectations can be either to help women avoid an experience like she had (if it was less-than-satisfying), or to share a formula that other women should follow to have an experience identical to the one she had. This is the client's experience, let it be shaped by her education, desires, personal beliefs, and choices, and she will come out with an incredible story of her own to share.
2-Do I encourage her to find her own way? Another trap if you already have children is, when your client is presented with a decision, she asks, "What would you do?" It can be the easy way to just simply answer -- you have experience, you know what you are comfortable with. But that would be taking away this family's experience of facing a tunnel of indecision and coming out the other side with an answer they feel fits for them. In the short run, you can look like a hero with the solution, but in the long run, that doesn't help this family build up their confidence in parenting and making choices for their baby.
3-Do I have strong feelings about choices families make regarding birth and parenting? I have a close friend who admitted she couldn't work with pregnant or new moms because she can't handle when they make choices she feels are wrong. Instead of trusting parents to make their own educated decisions, she wants to "bully" them into parenting as she does. For example, she has always co-slept with her babies, and it drove her mad to see parents put their babies in cribs. Instead of offering evidence-based information such as Dr. James McKenna's research, she wanted to jump to scare-tactics to push parents into making their decisions. This is not choice, this is force fueled by strong statements full of fear. We must trust families to make the choices they feel are right for their situations.
4-Do I include myself as an integral part of their birth story? I admit, it feels good when a family says, "We couldn't have done it without you!" And it would be great if I could really believe that and walk around with that feather in my doula cap. Maybe it's altruistic (more likely, insecurity!), but that doesn't rest well with me. I once read a birth story where the doula went on and on to list all the things she did (10+, all numbered and acknowledged) to make this birth experience amazing for the mom and dad. Did the parents walk away feeling the power of themselves and their baby? Or did they walk away feeling like without their doula, they would not have been equipped with the tools and strength to have their baby? My response in situations like these is the same: "You could have done it without me -- I could not have done it without you."
5-Do I have specific requirements for parents? I had a former doula client who moved states away after the birth of her first baby. She was pregnant again and interviewing doulas. She texted me: "Is it normal for doulas to say they will only take you as a client if you agree to specific things?" The doula they interviewed said, she taking them as clients would be contingent upon them taking "approved" childbirth classes, committing to breastfeeding, and signing a statement to say they would agree to "nighttime gentle parenting." This family already believes in breastfeeding and the family bed, but they weren't prepared to take additional classes. Equally upsetting was, they were prepared to interview the doula, and instead they felt they were the ones being interviewed. "This was not what we were looking for, it kind of goes against the reason we wanted a doula in the first place." After a few more interviews with different doulas, they were able to find one that better fit their family. Of course as doulas we need to take clients we also feel fit our needs, I understand that. The process, though, can still be about the parents while we quietly assess how the fit feels for us, and then act accordingly after the fact if we know we aren't the right doula for this family.
There are many ways we can shape the births of our clients, these are just a few to consider. Doulas, what other ways can we impose our birth footprint on our clients, and how can we best avoid these roadblocks? I would love to hear from you.
Q. Why would we want a doula? Wouldn't that be like having a stranger at our birth?
♥ four young boys and a boy dog (offspring)