Shopping for a Doula? Here are 6 Steps for Navigating and Maximizing Your Doula Experience

Posted on March 23, 2017 by Shelby Miller, Doula

Considering Hiring a Doula?

Image © and used with permission

Do you need to find a doula? Maybe you are hearing the word ‘Doula’ for the first time, or have heard it, but are very unfamiliar with a doula’s role or why it is so important to have a doula as part of your birth team.

A doula (a woman standing by) is a labor support person who provides physical, emotional and informational support for families throughout their pregnancy, birth, and postpartum journeys.

Doula care is so much more than just support during your labor and as a first time mom, or a family considering doula care for the first time, it can be a bit difficult to know where to begin in your efforts of finding the right doula for your family’s individual needs, but also maximizing the care-to-cost-to-connection ratio with the doula you choose.

Here are six steps to help you navigate this new territory and maximize the kind of experience you can have in your search to find a doula, but also in your birth journey!

Step 1: Do you even want or need a doula?

Find a doula!? Doulas are hired for all different birth scenarios, and not just an un-medicated, out-of-hospital birth. They are beneficial in any setting and are a perfect compliment to the care provided by a midwife, the continuous support needed in the hospital room, or the calming presence often missing in the surgical room. READ HERE for more information on the differences between a midwife and a doula.

Doing a simple search online for “local doulas” or “find a doula near me” can be a bit overwhelming, depending on where you live! Knowing what kind of services are generally available from a doula, and matching that with what your ideal vision is for your birth, can help you gauge, not only whether you actually want / need a doula, but what services you would like for her to offer. Then you can narrow down your doula search right from the get go!

The advantage to finding doulas in your area who offer the services you are looking for means you don’t have to hire three different individuals for services which could have been available all in one place. Hiring several people for different services adds more people to your contact loop before / after giving birth, which can honestly become a headache during a time when you are simply wanting to snuggle in with your new baby, bond AND sleep! This also creates fluidity and connection throughout your pregnancy, during birth, and into the postpartum period in your relationship with your Doula. They will be able to handle everything while you just focus on your new baby and your growing family!

Generally, doulas provide care in many different areas and also offer an array of additional services which are cohesive to doula care and the support of families. Not all of them of course, which is why it is important to find a doula that offers services specifically to meet your wants and needs. Determining which services are, or might be, important to you, and then searching doulas in your area who offer those specific services can save a lot of time in the interviewing process of finding the right one!

Here is a handful (or two ;-)) of potential service options available to doula families…

Informational support throughout pregnancy
Antepartum care (need support while on bed rest?)
Education on all of the options and decisions to be made from the start of labor to immediately postpartum for both the mother and the baby.
Birth plan preparation & guidance
Natural childbirth education classes
Breastfeeding education, classes, and counseling / support
Placenta encapsulation (tincture, mother broth, smoothies, prints, cord keepsakes)
Lending library (guidance on book recommendations based on your needs, and then the ability to borrow those books!)
Continuous birth support at home, then the hospital or birth center (inclusion of partner, or in place of partner)
Advocacy of your birth plan (so you and your partner can focus on laboring)
Capturing occasional photo moments (usually non-professional) P.S. there are professional birth photographers!
Postpartum care (need support after bringing baby home?) Why is a postpartum doula important for every mother?
Extended care packages – (informational support through baby’s first year!)

Step 2: If so, what is most important about her?

This can sometimes be a difficult question, especially for first time momma’s who really don’t know what their specific needs of a doula may be. I mean, how do you know what you will need from a support person while in labor, when you haven’t experienced labor yet!?

I’ve broken it down into a couple of sections to help you navigate how to answer this question for yourself.

Consider your love language
- Considering your own love language can be helpful in determining, not only the character qualities you are looking for in a doula, but also, the kind of connection you will want to have developed with her before your labor. It is important to know whether she is experienced enough to know how and when to change gears with you, as your labor progresses, and have discernment in when to draw into you for support, and when to draw back and allow you space to find your strength and power.

Consider your partner
- Birth is not just about the laboring woman. All too often, partners end up feeling like the “third wheel,” with the primary focus on the mother and baby. But partners need support too, whether they want to be hands-on in the birth process or not. All couples function as one in a very different rhythm. This means that some partners will want to dive right in and be as much of a supportive part of the action as they can be, or maybe even catch their baby! Others want the freedom to hang back and draw in as they feel comfortable in each moment. Then you have partners who would rather be more of an outside observer (or maybe the birthing mother would rather her partner be an outside observer), if even present within the birth space at all. Knowing how the doula will support your partner in each of these differing scenarios is important to knowing the full extent of her experience and how well she will support your family dynamic and the needs of your partner through each stage of labor.

Dads are having a baby too! Many dads come out of their birth experiences feeling:

- Traumatized, having had no one to communicate with them in terms they could understand (getting away from medical terminology).
- Scared, having had no one to keep their internal thermostat in check and assured that everything is safe and normal
- Helpless, not having anyone there to guide them in ways they can help bring comfort and relief to the woman they love.
- Lack of Joy, as they watched the scene unfold around them, as they tried to protect, be understanding, advocate for the birth plan, process recommendations and make fast decisions. Dads are missing out on the joy of watching and participating in the births of their babies… This is not okay. You can read more about how doulas are for dads too, and how together, they make up the perfect birth team! Dads and Doulas Find a doula for the expecting father, just as much for the expecting mother.

Consider the doula’s energy
- The heart of doula care is in the connection, and the energy of that connection. You are bringing another energy into your sacred space of birth, and that energy should be welcoming of the unfolding process of birth. You should feel safe and comfortable with her and should feel confident that the advocacy she will provide represents your birth plan, and not her own.

Consider the doula’s experience
- There is simply no price that can be placed on experience in this field. Of course, every good and experienced doula had to start somewhere. The wisdom that comes from their experiences can be a huge benefit to your family in navigating every faucet of this adventure. From the pros and cons of each hospital / birth center within the realm of your birth vision, to recommendations on which care provider / midwife will connect with your family dynamic and be supportive of your wants and desires for your birth experience. In many ways, your experience can be the best reflection of her experiences, as she guides you through medical field protocol. And let’s not forget how important her experience will be to you and your partner once in the throes of labor. What touch will bring relief in this moment? Which essential oil can be emotionally uplifting? Which rebozo technique can get rid of that pesky back labor (or what even is a ‘rebozo’!?)? The list really does go on here.

Consider the doula’s character
- Client testimonials should play a crucial role in defining her real character and the passion she has for her profession and the families she is called into the service of. It is okay to request testimonials, and even ask to speak with a few previous clients about their experiences. Most doulas will know right away who would be willing to speak with you and share about that personal experience receiving their support. Ensuring that she is reliable, trustworthy, knowledgeable, but also, that working in this field is not just a “job” to them! All professions become “businesses / jobs” at some point. I mean we all have to make a living to support our families. But, that doesn’t mean that a business / job can’t still be full of heart! If the philosophy is “it’s nothing personal, it’s just business,” then the heart of this profession, for that doula, has been misplaced.
- Also, consulting with your chosen care provider on whether they have had any experience working with your Doula. Was it a positive experience and would they welcome their presence back into the labor and delivery room?

Step 3: Know what you’re paying for!

When first searching to find a doula, they are often compared first by their rates. This is a great disservice to the doulas being compared, as well as to the families seeking care. The doula who charges $1000 (20+ years’ experience), and the doula who charges $350 (who just finished a weekend training workshop and has completed the three free births she is supposed to attend to receive her certification), should not be compared by their rates. They should be compared by what the family’s needs are for their pregnancy and birth journey, and how the doula can meet those needs to the best of their ability. The rate has nothing to do with their compatibility to the family seeking care. Hey, every doula has to start somewhere to earn the “experienced” title. While cost and experience are important, they may not be as important as the connection you share once it comes time for your birth.

Also, be mindful that the rate the doula is charging does reflect her level of experience. If the average experienced doula rate in your area is between $800 – $1000, a new doula, with less than 10 births in her experience bag, shouldn’t yet be charging between that average bracket.

Be kind, and don’t schedule an interview, on the doula’s time, unless you are willing to work out a way to pay for her services. Show your potential doula that you value her time, her profession, the services she offers, her experience, and the benefits she can bring to your pregnancy and birth journey. Most doulas who are in this profession for the heart of it are willing to work with expectant families on payment plans to ensure that every family, regardless of circumstance, can receive the care and support they need, while also establishing a mutual agreement assuring that the doula herself is compensated for her invaluable time and support. If hired early in the pregnancy, a family can have 6 months or more, depending on arrangements made with the doula, to pay for the services. Hiring earlier is often better, and also offers more time for connection and more opportunities for your doula to provide pregnancy and informational support.

I have often heard that having a doula is a “luxury”… which is such an unfathomable concept to me. When did we get so far out of reach with what the act of giving birth really is, that having a person support the mother through the most challenging experience of her life is considered a “luxury” ??? Shouldn’t it be “common place” to expect her to be supported in the best way possible? Isn’t she deserving of that? Shouldn’t she be a able to find a doula to meet all of her unique and individual needs? Isn’t her partner deserving of enjoying the birth process, rather than having to stand there terrified and feeling helpless? How do we even get to a place where we can put a price or a value on something this important?

Dr. John H. Kennell has been quoted, “If a doula were a drug, it would be unethical not to use it.”

Doulas are not a “Luxury.” Doulas are a “Necessity.” Find a doula who makes you feel as valuable to her, as she will be to you.

For a generalized breakdown of what a doula really makes after expenses such as gas, food, taxes, supplies, childcare, etc., you can check out this article, A Breakdown of a Doula’s Fees and Why Doula’s Charge What They Do.

Step 4: Trust her to teach you

Over the years it has become apparent that the value in taking a childbirth preparation course has been forgotten. Birth is a joyous rite of passage that a woman takes. It’s a transforming journey from maiden to mother. Taking a course which provides knowledge on the anatomy and stages of birth, preparing the mind-body-spirit for the journey ahead, options & decision, natural coping techniques, and partner engaging (just to name a few…), reduces the fear surrounding birth in our society today and builds confidence in a woman’s ability and power to give birth, and also achieve the joy and satisfaction that can be found in the hard work that it takes to bring forth new life.

We wouldn’t set out on a voyage around the world by boat without first taking some courses on what to expect on the open waters, how to navigate the boat, what to do during a storm, and know what supplies you may need and recognize how and when to use them. Birth is the greatest and most incredible and unpredictable voyage a couple will ever embark on. Going in blind fuels fear of the unknown and leaves more space for unnecessary interventions to interrupt the safety of the birth process. Knowledge is power!

Look into starting a childbirth class between 20 and 30 weeks gestation. There are so many benefits to completing your course at least 6 weeks prior to your EDD. This allows time for the information to be absorbed. It also gives extra time to account for any potential classes which may need to be pushed out a week or two, should your doula be supporting a birthing family during a regularly scheduled class session, and you still complete the course before the arrival of your baby!

If your Doula teaches a childbirth education class, take her class. You are getting many additional hours with your doula to connect over the birth process. This builds confidence for both mom and her partner in their trust relationship with their doula, it builds a stronger connection, it means that the couple and the doula speak the same “birth language,” and the couple themselves have a much greater understanding of their doula’s vast knowledge base surrounding the unfolding of the birth process. Be sure the class you choose supports how you want to birth and includes education around the stages of birth, coping techniques, as well as partner engagement and preparing the mind, body, and spirit for the journey ahead.

If this isn’t your first birth, but it will be your first birth accompanied by doula support, taking your doula’s childbirth class can bring a refreshing of the soul and even help you bring your vision for this birth to the forefront.

Step 5: Pick 3

Meeting with several doulas means a better chance of finding the perfect doula for your family! So pick 3 doulas who match your criteria from above and schedule interviews.

Doulas offer a ‘free consultation’ to get acquainted. This ‘double interview’ time allows for both the expectant family and the doula to interview one another to see whether they are a right fit.

It is important to see if there is a connection and positive energy, and give you a chance to get a sense of whether you would feel “safe” and “comfortable” to birth with them by your side. Ask questions you have about their profession, business, character, experience, rates, etc.

The doula also needs to ‘interview’ the expectant family to determine whether they feel that they are the right support person to meet your family’s individual needs and vision for your birth experience. Whether they feel comfortable with both the mother and her partner, as well as the chosen care provider and birthing location is important to the kind of care and attention she can devote to that family. Checking in with your care provider and knowing that they are in favor of you having a support person present, and whether they have any doulas they are not comfortable working with. After all, you don’t want to be caught between your doula and care provider! So make sure that the doula you choose feels comfortable not only with your birth setting and provider team, but that your care provider team also respects your doula.

Your doula should be interested in what your vision is for your ideal birth, and they should desire to support you in striving for that vision, as medically feasible. This is your body, your baby, and your birth!

While meeting with 3 is ideal, there are those occasions when you just know right away, in the first interview, that you have found her! … and the feeling is usually mutual! Everything just fits and you know that she is the one that you want to welcome into your birth space, and support you during this miraculous journey!

Step 6: Use her!

You now have a support person whose entire profession, expertise, and knowledge base revolves around pregnancy, birth, postpartum, breastfeeding, newborn care, sleep cycles, etc. Use that resource! Reach out! Don’t be afraid to ask questions or request guidance. This is what they are here for!

Hire early! Repeat hire, early! Hiring before 16 weeks means more pregnancy support and more time to develop a close connection. It also ensures the doula’s schedule doesn’t fill-up without you!

Many doulas offer extended care packages during the postpartum period which gives the family access to the Doula’s educational knowledge base for guidance on sleep issues, teething comfort, sleep pattern guidance, breastfeeding support, referrals to outside resources as a need arises, and so much more, all accessible through baby’s first year of life! This is an incredible blessing, especially for first time parents. This gives continuity of care that doesn’t just end after the baby arrives. Babies don’t come with a manual, and having someone at your fingertips with evidence based information, rather than “forum opinions,” is such a blessing!

For additional thoughts, considerations and ideas, READ HERE!

Dad’s and Doula’s

Posted on October 26, 2015 by Shelby Miller, Doula

Dad’s & Doula’s

Preparing for childbirth is much like preparing for a voyage around the world by sea.

If you have never taken a voyage by sea, and have no experience sailing, it would be nearly impossible to set out without an experienced guide and know that you are going to have a smooth voyage from beginning to end, that you are going to arrive at you intended destination point having met all of your goals for the planned journey.

A doula is your guide to understanding the birth process, knowing where you are in each moment, what to expect around the next corner, how to handle each wave as it comes crashing your way, how to be supportive, how to meet the changing needs of the laboring mother as the weather out to sea changes and intensifies.

A doula is the voyage guide … the lighthouse on the shore … the whisper through the winds of change

Mom + Baby + Dad = “The Birth Team”

A Doula = “The Nurturer of the Birthing Process”

Giving “The Birth Team” the physical, emotional and informational support needed along the way.

A Doula is not only support for the birthing mother, she is also support for the birthing father.

This is a journey that mom and dad are taking together with their baby.

A Doula’s role is to facilitate that journey and protect the bond between “The Birth Team” as they work together.

A Doula is not a replacement for a dad’s role in the birth process. Quite the opposite in fact.

A Doula is an extra pair of hands in many laboring positions which require more than one support person attending to mom
A Doula is an extra pair of ears in recognizing the changes in the progression of labor and keeping dad informed along the way
A Doula is an extra pair of eyes in assuring proper advocacy of the desires and wishes of your birth plan, so dad can be completely focused on mom
A Doula speaks the language of birth and keeps mom and dad well informed about the stages of progression and the changes in care that mom and baby will need throughout each stage
A reduction in the amount of stress and confusion which can be caused by an often intimidating hospital room and staff who are not always available to answer immediate questions
The Partner doesn’t have to worry about remembering everything learned in the childbirth class because the Doula is there to provide guidance, reassurance and provide information on the ‘normalcy’ of the birth process

With a Doula present, dad will have his emotional needs met (ie. stresses, worries, concerns, etc) so dad can remain positively focused on mom and his baby and his role in “The Birth Team”
Having a Doula means dad can step away for a spell to use the restroom, have a light snack, take a brief power nap, or just catch his breath and have a moment to reflect, with peace of mind that mom and baby are being well supported in his absence
Doula’s provide comfort to dad’s and help them remain calm and collected during a time that might otherwise have felt stressful
Doula’s provide heavy doses of guidance & encouragement keeping “The Birth Team” feeling confident in themselves and the birth process
A Doula can help you and your partner have a more intimate birth experience by helping to set the tone in a non-intimate setting, such as in a cold hospital room, and help to protect the intimacy desired in a hospital birth

Understanding the Difference Between a Doula and a Midwife

Posted on January 10, 2014 by Shelby Miller, Doula

“What exactly is a Doula”?

“I didn’t know there was a difference between a Doula & a Midwife”

“I thought when I hired my Midwife, she would also be my Doula”

“My Midwife said, I don’t really need a Doula, because she will be there”

“I didn’t realize how much work my Midwife wanted me to do on my own before she will be present”

I often am asked about the difference between a midwife and a doula. It seems, that many are under the impression that you need to either choose a midwife or a doula, or that you do not need a doula if you have a midwife. However, a midwife and doula have distinctly separate roles when it comes to the kind of support and care you receive during your pregnancy, your birth, and during the postpartum period.

Let’s take a glance at some of the specific roles of a Doula & a Midwife during your very special journey…

Your Midwife: Personalized Maternity Care

Oversees the medical safety of your pregnancy and birth
Runs prenatal tests
Advises you on health & nutrition during pregnancy, birth and postpartum
Monitors you and baby during labor and birth
Clinical tasks such as, temp, pulse, BP, and FHR
Performs physical examinations prenatally, during labor and postpartum
Consults with an obstetrician if a medical complication arises which is out of the midwifery scope of practice

Doulas, on the other hand, are not medical professionals. Doulas provide physical, emotional & informational support during pregnancy, birth, and the immediate postpartum period.

Your Doula: Physical, Emotional, & Information Support

Establishes a prenatal relationship with you
Helps you and your partner articulate your ideal vision for your birth
Directs you to outside resources within your community for pregnant women and families
Ensures you and your partner feel calm, informed and supported during labor
Guides your partner in engaging and supporting during the labor and birth process
Uses natural tools and hands-on techniques to help you manage and cope with the intense physical sensations of labor and birth
Makes suggestions regarding laboring and birthing positions depending on how your labor is progressing
Makes sure you understand all of your options so you can make informed decisions every step of the way
Ensures you feel confident communicating your needs to your health care provider
Provides postpartum emotional support and help with breastfeeding initiation

While doulas do not provide medical care, research shows they do increase your likelihood of avoiding unnecessary medical interventions, greatly decrease your chance of a cesarean birth, and significantly decrease a woman’s need for analgesia, compared to usual care.

Do I need BOTH a Midwife and a Doula?

Doula support is an amazing complement to the care you will receive from your midwife. It is important to understand that the ultimate responsibility of your Midwife is the health and safety of you and your baby. Your midwife needs to be present, alert and at the top of their game during the active stage of your labor, pushing and the birth of your baby. If your Midwife were to provide 12+ hours of physical and emotional labor support, they are going to be tired, spent, and not have the level of alertness necessary should their be a medical emergency at any point of your labor and birth process.

Most Midwives want you to labor on your own as long as possible, and they only come (or check you into the birth center), once labor has been well established and you are nearing the home stretch. They call it the 511. When contractions have reached 5 minutes apart, lasting 1 minute or more in length, for 1 consistent hour. For many women, this can mean laboring for 12, 24, 36 hours on their own.

They will check vitals, asses Mother and Baby for the medical safety and progression of the labor process, and then hang back, and let you labor on your own. They will occasionally provide physical and verbal support, but it is not given in a manner that will hinder their role as the medical care provider of you and your baby.

Your doula, however, comes to you early in your labor, when you first begin to feel that you are in need of support and guidance, and she will stay with you until after the birth of your baby. Doulas love being part of the early labor stage and following your journey to the end. Their continual support can make such a difference on the overall experience of the birth process for both you and your partner!

When you seek out a Midwife, it is because you want to have a natural, un-medicated, un-intervened upon childbirth, with the freedom to birth your way, on your terms. Using both a midwife and a doula will give you the full spectrum of support and medical care you need, to achieve the birth you want, and ensure that you are able to naturally cope every step of the way.

Together, having BOTH a midwife AND a doula, means you will be supported and nurtured in every way as you birth your baby. Your partner, your midwife, your doula … They create your birth team, your village…

Midwives and doulas work hand-in-hand together, with a great respect for each other’s roles in supporting the birth you desire. However, they are very different professions, with different roles and responsibilities to you, as the birthing family.

55+ Questions to Ask When Desiring a “Natural Childbirth,” In a Hospital Setting

Posted on November 18, 2013 by Shelby Miller, Doula

“Natural Childbirth” … Well that can only happen in a birth center or at a home-birth… Right?

It is often easy to come up with an extensive list of questions when you are considering a home birth with a Midwife. We tend to think long and hard about the questions we want to ask to make sure we can trust her with our safety and the safety of our baby. During a standard home-birth Midwife appointment, you often get a minimum of an hour to sit and “interview” with a prospective Midwife. There is time enough to get a feeling for one another, a sense of whether she will provide the kind of one-on-one care you desire for your natural birth at home. Then you get an hour with them at almost every single prenatal visit, as well. This adds up to a lot of one-on-one time between you and your care provider to be on the same page, to know and understand one another.

For many families though, a home birth is simply not an option. Whether it is for financial / insurance reasons or for a health concern that puts them just outside the qualifying spectrum of the Midwifery Model of Care. Regardless of the personal circumstance, many women who either choose or need to birth in a hospital still desire to have a “natural childbirth.”

The kind of birth where there is no pressure to perform on a grid-line standard, and fit into a cookie-cutter diagram that has a one-size-fits-all approach. The kind of birth where they are free to listen to their bodies needs and respond to natural urges and do not need to feel stressed by the cascade of interventions which are routinely associated with a hospital birth.

Women do not often pause to consider what kinds of questions they would ask an OB or CNM, in the same way that they would ask a home birth Midwife. Women come up with a vast number of detailed and personal questions when “interviewing” for a Midwife, or even a Pediatrician for their baby, however, they do not usually do this when seeking care for themselves with an OBGYN. There is often this sense of, “this is what I am faced with, so I need to find a way to make the best of it.” Unlike Midwifery Care, you are not afforded an hour of time with an OBGYN, or hospital staffed CNM. Most visits are generally anywhere from 5-15 minutes, on a good day. There just seems to be this “rush” factor, which often times, flows over into the delivery room.

There are many factors involved in the lack of communication

between an OB and an expectant mother

Many women become intimidated and shut down by the sometimes rushed and rigid demeanor of an OB

There is a sense that they went to school for this,

they know what they are doing, “so who am I to question that…?”

An OB might have a response to a question which makes the woman feel inferior

or demeaned for even asking such a question. Just to name a few …

These situations often lead to a sense of not having ones own valuable input into the birth of their baby, whereby holding them back from really digging in and asking the probing questions necessary to build the kind of relationship where mutual respect is involved and a foundation of working together on common ground. Sometimes the connection between the two is so limited that neither even knows where to begin. It becomes a tedious process of coming in – doing checks – and going out – see you next time. Understand that an OB meets with countless women from day to day. Whereas a home birth Midwife, has a specific number of clients she will take on in a given month. An OB will often deliver multiple babies per day, and a Midwife, usually between 2-6 per month. The job of an OB can easily become a job that reflects the business of providing medical care, rather than a passion of providing health care. This is not their fault, it is simply the way that society has set it in motion.

It is important to recognize which care providers do and do not have the qualities you are looking for. There are OB’s out there who “trust birth” and have a great respect for the power within a woman’s body to birth her baby. They do exist and the numbers of them are growing as awareness and education grows, but also because women are finally being heard. Women are standing up and demanding better care, demanding that doctors recognize that they are capable beyond measure, and that birth is not an illness or problem which needs to be controlled, managed or fixed… and that a woman who is having a vaginal birth does not need to have her baby “delivered” from her body.

So how does one really know whether

they have the right OBGYN or CNM for them?

~ Or ~

Where do you begin in finding

the care provider that is right for you?

One of the first steps is recognizing that you are never “stuck” with a specific care provider. You have a wealth of options and choices available to you! We are blessed to have a society full of highly intelligent Doctors, Midwives and CNM’s, all of whom have individual qualities to meet the needs of each specific woman. You simply have to take the time to find what you are looking for.

Finding a Doula can be one of the best places to start! A Doula provides physical, emotional and informational support for women throughout their pregnancy, labor and birth, and into the postpartum, breastfeeding, and newborn care stage. A Doula also works with many different kinds of birth professionals, and in all different kinds of birth settings. It is one-on-one specialized care, at it’s finest!

When it comes to your care provider…

A Doula Can:

– Help provide you with guidance in making sure your care provider is the right one to meet your birthing needs.

You may have been referred to a friends OBGYN, because they had the perfect experience that they desired with that care provider. Every woman’s needs are different, and what is right for your friends, neighbors, church family, or sister, may not be the right fit for you.

Perhaps you have an amazing OBGYN for all of your gynecological needs, or maybe they even played a crucial role in helping you during the family planning stage. Some women find that while their care provider may be perfect for their gynecological needs, they are not necessarily the right care provider for their pregnancy and birthing needs.

– Help you in forming your desired birth plan, and giving you the words necessary to communicate effectively with your care provider about areas of your pregnancy and birth which are important to you.

Forming the right birth plan for you, means fully understanding all of the options which are available to you. A Doula has this knowledge base and they can be a wealth of knowledge about areas of birth that many have never even taken into consideration before. Some of them also teach their own childbirth education classes. If you have a Doula who teaches childbirth education classes, taking their class, rather than a hospital based class, can be helpful in many areas, including creating a closer bond prior to your birth.

Doula’s also understand the language that surrounds pregnancy and birth. They are good at reading between the lines, and recognizing “red flags” that might suggest your care provider and you are not on the same page in a particular area so that you know to address that with them ahead of time, rather than in the throes of labor.

– Give you recommendations of the best hospitals locally, with a known record for helping mother’s who want to have a natural childbirth.

They have watched and supported other women through their personal experiences with local hospitals and care providers. They can provide guidance in determining whether your wants and desires can be met in a specific location, or with a specific care provider.

It is also important to note, that our birth system is changing, slowly but surely, changing for the better. Many hospitals and OB’s who were not “natural childbirth” experienced 2- 5 years ago, are very experienced today. This is due in part to awareness being spread on natural childbirth, women speaking up for what they want, Midwife knowledge and recognition, the movement back to home-birth, and also because of the positive presence of “natural childbirth” workers, such as Doula’s, being present in the hospital birth place.

– Provide you with names of OBGYN’s or CNM’s whom they feel might meet your criteria in achieving the birth you want.

Again, they have watched and supported other women through their personal experiences with local hospitals and care providers. This gives you an idea of where to begin the “interview” process, as you search for the right OB or CNM, and the right birthing location for you and your personal desires.

– Give you resources to local natural childbirth / natural parenting groups within the community, where you can find support and build relationships with other women and families along the way.

Connecting with other “like-minded” women who have walked the path before you, or are currently going through their journey at the same time as you can be one of the most amazing blessings. Doula’s have many connections within the natural birthing community. Everything from breastfeeding support, essential oils education, alternative medicine, chiropractors, massage therapists, natural practitioners, cranial sacral therapists, and so much more!

Below is a list of accumulated questions which I have found to be very helpful for my Doula client’s to ask when “feeling out” a care provider, to see whether they can have their desired birth, while being under the care of that provider.

Already Have a Care Provider

You can take the questions which pertain to you from the list below, and Prioritize them according to which areas are of the greatest importance to you. Begin to ask a handful or two of those questions at each prenatal visit.

Do not shrug off responses which do not meet your qualifications. The list of available doctors is lengthy. Of course there is always going to be a give and take when choosing to birth in a hospital setting. So a certain amount of flexibility is often needed, but know going into the situation which items are your priority and are not subject to flexibility, and which ones you can take or leave.

Looking For a Care Provider

If you do not already have a care provider, or have made the decision to find a new one, you can request to do an initial interview with potential care providers. At this visit, go through your top questions first, and then have a second set should time allow.

In any circumstance, you should always listen to your care provider carefully. They will often tell you exactly how they expect your birth will be, even if it isn’t with their specific words. Always use your intuition. If it simply doesn’t feel right to you, then it mostly likely is not right for you.

Respectful & Attentive or “Red Flag”

Be aware of how the care provider responds to the question. Do they seem confident and knowledgeable? Is their response calm and collected? Is the tone warm and understanding? Did they not know how to respond? Did the care provide have no idea what you were talking about? Did the care provider seem agitated or respond defensively? Was your question put off… to be discussed at a later visit when you are “farther along?”

Don’t be afraid to go after what you want. This is your baby and your birth!

~ Important Questions To Consider ~

Professionally

Why did you choose this profession and what makes it so important to you?
How long have you been a practicing _______? (OB, CNM)
What is your training / education / degrees / certifications, etc. ?
How many babies have you /witnessed / helped bring into this world?
What is your philosophy on birth?
What does “natural childbirth” mean to you?
Where do you personally stand between medically managed childbirth, and natural childbirth?
Are you connected with a natural childbirth / natural parenting community?
Do you provide individual care based on the needs of each patient, or is care carried out on a standard protocol regiment?
Have you had experience with a Doula before?
Which methods of pain management do you recommend?
Will I be expected to progress through my labor according to a specific timeline?
What is your induction rate?
What is your cesarean rate?
Have you ever performed a “Family Centered Cesarean?”
Is laboring in a water pool or bath tub an option? Delivery?
How many births do you typically attend to in a month? Year?
Are you planning any vacations, trips or other events around the time of my estimated due date that would interfere with your presence at my birth?
Who is your back-up? When would I meet them? Do you work off a rotation schedule with other care providers?
What kind of follow-up visits will we have with you after the birth?
Have you had any loss of a baby or mother? If so, why and what happened?

Pregnancy

What role do you feel nutrition and exercise play on a healthy pregnancy and the effect on the labor and birth process?
What are a few of the top nutritional recommendations you have for prenatal health?
Is there a set of routine tests which must be done during pregnancy? Which? When?
Will I be required to do the Gestational Diabetes screening? What if I do not have any symptoms of GD? How is this test carried out? Will I eat a specific meal prior to testing or will I be fasting and drinking a sweet orange substance?
How many weeks of pregnancy do you feel are crucial to having a healthy baby?
If baby and I are healthy, can we allow labor to begin on its own? Even 1 week past our estimated due date? 2 weeks past our estimated due date?
Will you deliver a breech baby? Frank? Footling?
If so, what kind of training and experience do you have in the delivery of a breech baby?
If my baby were to be breech, what recommendations would you have for encouraging my baby to turn naturally?
What medical options would be available to turn my baby?
Do you deliver twins? Experience? Cesarean necessary within your care?
What risk factors do you look for when determining if a cesarean section is needed, prior to labor beginning?
What is your stance on VBAC births? Will you allow a VBAC (vaginal birth after cesarean)? What kinds of procedures will I be subject to during my VBAC, that would not be standard had I not had a previous cesarean? Is a scheduled cesarean a requirement for you after a previous cesarean?

Labor and Birth

What are your recommendations for a family who wants to labor at home for as long as possible before coming to the hospital?
Do you require a heparin lock to be in place?
Will IV fluids be necessary during my labor or may I be allowed to drink freely on my own?
How often do you feel it is necessary to have a vaginal exam during labor? May I refuse these checks?
Are you familiar with other ways of determining dilation, besides vaginal exams?
What risk factors do you look for in determining whether a cesarean section is necessary while I am in labor?
How often will my baby be required to be monitored through Electronic Fetal Monitoring?
Will I able to labor in any position I feel comfortable? May I move around freely?
May I eat while I am laboring?
Can I push in any position I choose? May I deliver my baby in any position I choose?
Is directed pushing typically done, or will I be encouraged to push with the urges of my body?
Will you delivery my baby? Would you assist myself or my partner in delivering our baby?
Do you provide perennial support while pushing to minimize the possibility of tearing?
Do you perform routine episiotomies?
Would you be accepting of allowing me to tear naturally, rather than have an episiotomy?
How do you handle a nuchal cord?
What is your position on delayed cord clamping?

Immediately Postpartum

Will my baby be given directly to me for skin-to-skin contact immediately at birth?
Can routine checks of baby be done while my baby is in mine or my partners arms?
Which test and routine practices will be necessary in the first few hours of birth (for myself? for my baby?). Can these procedures be delayed until after we have had several hours of uninterrupted bonding time as a family?
Which will be necessary in the first few days of birth? And the first few weeks of birth?
Does your practice / hospital have any standard procedures for families who desire to take their placentas home with them?
Will it be necessary for my placenta to be taken from my room for examination, or can the examination process be completed within my room?
Can I refuse to have my placenta washed, chemically rinsed, or pumped full of a preservative such as formaldehyde?
Is it possible to fill out the paperwork needed to accept or decline certain routine procedures for my baby, before being in labor and before baby is born? That way our time immediately after the birth can be focused on bonding and welcoming our new little one into the world.
How long will we be expected to stay in the hospital before being released?
Will my baby have to go to the nursery during our stay, or can my baby remain with me for the duration of our stay?
How long will it be necessary for us to stay in the hospital after our birth, before we can be released to go home?

A Breakdown of a Doula’s Fees – Why Doulas Charge What they Do

Posted on April 14, 2013 by Shelby Miller, Doula

Attending births and providing support to expectant Momma’s is one of the greatest passions in my life. Being in a position that positively encourages a Women’s desire to have the birth she wants while supporting her journey is one of the most humbling honors… educating, enlightening and empowering…

There are some AMAZING Doula’s from San Antonio to Austin. From the ones just starting out to the ones who have led the way for people like me, and even those who have taken the next step and passed over into Midwifery. It is such a blessing to be in the company of such incredible Women.

One of the biggest and most pressing questions potential clients want to know from the start is how much I charge for my services. There is always this lingering sense to me that Doula Services are just lined along the driveway of a garage sale and the one with the cutest look, lots of miles and cheapest price is the one that people are looking for. Lets examine that for just a moment.

Cutest Look

Okay, let’s be honest here. Everyone judges a book by it’s cover whether meant to or not. The look is the first impression. But what does the look really say about the care and dedication that will be provided when it really matters? No Doula is going to show up to a birth looking the way she did in the initial meeting anymore than she is going to expect her client to look the way she did after 10+ hours of intense labor. There is work to be done. Take the time to really search out the heart of the Doula, interview several, even the one you might consider to be the least compatible at first glance, and find the one that is right for you on every level, not just one or two. Also consider who their back-up Doula is, or their partner Doula, and make sure that falls in line with what you are seeking as your support system as well.

Lots of Miles

The Experienced Doula – I am not in any way knocking experience here! Not for a moment. I personally have 15+ years of experience working with expectant Mother’s. I am comfortable charging for my services and knowing that the care I provide is well worth above and beyond what I charge. I also want my services to be affordable to families. Every family deserves support and care, regardless of circumstance. The Doula with a great deal of experience is often scrutinized for what appears to be such a high fee range without really taking into consideration her training, experience, or how the individual services might add up.

The New Doula – When you move or take a break from Doula-ing to have more children and then begin to offer care service again, you often end up back at square one on the “New Doula Block.” It takes a lot of time and investment to get the wheels rolling. For the New-new Doula’s, It does sometimes hurt my heart a bit when I see new Doula’s cast aside for lack of experience. There is something to be said for the spirit of the new Doula, the tenacity, the excitement, the eagerness to learn. This should be bottled and used for every ounce it is worth! This eagerness is often taken advantage of by her feeling obligated to offer services for FREE, or at extremely reduced rates, regardless of training or her expenses to provide care services from pregnancy, through labor & birth and into postpartum. While I understand the viewpoint on this, (She can do the birth for free and gain experience), I also understand the cost of volunteering to be ones Doula. The time and the financial investment of that new Doula. In all honesty, the Doula’s with more experience and a greater client base are the ones who have much more wiggle room to volunteer services on occasion, often without such a pinch to themselves financially. Be understanding that while a new Doula is willing to trade the service for free to gain the experience, what she is really doing is paying to learn from that experience and then also providing you with a valuable service that she is also paying for. Yes, this means that the Doula is paying to be your Doula. New Doula’s who set a minimal fee are often just asking to break even and not really profiting at all.

Cheapest Price – The cheapest price really does not mean the best value with this kind of service. We are talking about birth here and the person you are entrusting to provide support and guidance through that journey, not the greatest bargain on the dollar shelf. It really comes down to understanding the in’s and out’s of the cost of Doula Care for the Client and for the Doula.

“Why do Doula’s charge so much?”

I think that when people often look into Doula Care, and are shocked by the cost, they are only considering the reflection of that cost as it pertains to the Doula’s presence at their birth ONLY. Not realizing the other services which are included in that cost. Let’s break it down.

Aside from the cost of education, books, workshops, continued education, and advertising (website, cards, brochures), we also take into consideration the time that it takes for all of these, as well as out of pocket expenses.

Let’s just break down one of my packages in terms of time that I spend with my clients during the course of their pregnancy, labor, and postpartum:

Pregnancy, Labor & Birth Package §

Initial consultation meeting – Approximately 2 hours (plus gas and drive time)
Two prenatal meetings (One can be at a prenatal appointment to meet your caregiver.) Approximately 4 hours (Plus gas and drive time)
Birth Plan Assistance – Average, off and on, 1-2 hours
ASAP telephone, text, and email support during contact hours (8am-8pm) Average 4 hours
24/7 On-Call period 2 weeks before/after your estimated due date – Typically 38-42 weeks gestation

This can be a 4 – 5 week On-Call 24/7

Can you really put a time on that?

Would you really want a Doula to put a price on that?

Around the clock Labor and Birth support once labor has begun – 10+ hours

This is a VERY low estimate. The duration of labor can vary drastically. While a comfortable average can be estimated at about 10 hours, there is no extra charge for labors which are 36+ hours, just as there is no less charge for a -2 hour labor.

Immediate postpartum support of approximately 2-3 hours, or until the baby has nursed successfully and the family is settled – 2-3 hours
Two postpartum visit to discuss your birth, share photos, dote over your new arrival, discuss options for additional support (breastfeeding, cloth diapering, baby wearing, etc.) – Approximately 4 hours (Plus gas and drive time)

With these approximations, we’re looking at about 25-30 hours, in the least, just for interaction with my clients, If you add in another estimated 3 hours for research, paperwork, etc., that goes into setting up each client, we’re well over 28-32 hours.

Travel

The average trip I make to meet with clients is approximately 30-40 miles one way. These estimates are based on this Miles Per Dollar Calculator and my vehicle.

Trip time (based on 5 trips) – 7.5 hours
Gas costs (based on 35 miles one way – 5 trips) – $94.34

Childcare & Food Costs

Childcare – Approximately $100 per client including visits and birth
Food During Birth – Approximately $10 depending on the length of birth

Miscellaneous Costs

Hospital Parking and tolls – Approximately $10
Materials for Clients – Approximately $5
Credit Card or Paypal Fees –Approximately 2%-3%

Total Time and Out of Pocket Expenses

Time – 38 hours
Childcare – $100
Food – $10
Gas – $94
Misc – $15

Total Out of Pocket Expenses – $219

Let’s do the Math

Remember the Taxes

Don’t forget that you’re looking at state or federal tax (depending on where you live and what bracket you fall into) and you also have the 13.3% Self Employment Tax (that’s the state of Texas – 10.4% for Social Security and 2.9% for Medicare).This is figured for the State of Texas and DOES NOT include Income Tax because that would depend on your tax bracket.

Doula Fee – $400

Less Expenses – (-$219)

Remainder applied toward hours of work (38) – $181

Approximately $4.76 per hour (not even minimum wage) – $53.20 Self Employment Tax

Doula Fee – $500

Less Expenses – (-$219)

Remainder applied toward hours of work (38) – $281

Approximately $7.39 per hour – $66.50 Self Employment Tax

Doula Fee – $600

Less Expenses – (-$219)

Remainder applied toward hours of work (38) – $381

Approximately $10.03 per hour – $79.80 Self Employment Tax

Doula Fee – $700

Less Expenses – (-$219)

Remainder applied toward hours of work (38) – $481

Approximately $12.66 per hour – $93.10 Self Employment Tax

Doula Fee – $800

Less Expenses – (-$219)

Remainder applied toward hours of work (38) – $581

Approximately $15.29 per hour – $106.40 Self Employment Tax

Doula Fee – $900

Less Expenses – (-$219)

Remainder applied toward hours of work (38) – $681

Approximately $17.92 per hour – $119.70 Self Employment Tax

Doula Fee – $1,000

Less Expenses – (-$219)

Remainder applied toward hours of work (38) – $781

Approximately $20.55 per hour – $133.00 Self Employment Tax

Again, this is based on my personal time and expenses. Of course, over the duration of my time with a client, I can spend more or less one on one time. This is all approximations.

In the grand scheme of things, you’re paying for an invaluable service during your pregnancy, labor, and birth. The difference a Doula can make during this time is often priceless. The least that can be done is to pay her asking fee.

Do you think that an OB or Midwife would lower his/her costs if a mom told him/her that the fees just are not in their family’s budget? This does happen on occasion with Midwives who are blessed with the ability or position to be a bit flexible, but you would never see this with an OB. Doula’s are a valuable asset to a mom’s birth team. A Doula stays at your side from beginning to end, while your OB watches from afar and only comes in right before baby is preparing to make their grand appearance. We Doula’s have bills to pay and responsibilities just as every other family. The electric company is not going to waive or reduce our monthly bill because it doesn’t fit into our budgets! Our time is valuable and we selflessly give of it to our client’s – just ask our Husband’s and children whom we have missed Holiday’s, birthday’s, and even High School Graduations to be with our client’s, selflessly. Mother’s labor in love for their babies and Doula’s labor in love for their client’s.

A Special Thank You

I want to take a moment and thank the very brilliant Doula, Lisa Johnston of “In The Beginning Doula Services,” for the time and effort that she put into putting this statistical information together for Doula’s to use as a resource for themselves and their clients. It has reminded me that I should not undercharge myself for all of the work which goes into what I do to provide the best of care to my clients and I hope that it will open the eyes of expectant families, to see clearly how and why Doula’s set their rates the way that they do, and the value of the care provided to them, even though a time clock is not punched.

This information was changed and altered to accurately reflect my personal time of investment and expenditures, as well as my own personal viewpoints.

Reference Resource

In The Beginning Doula Services

Recommended Additional Reading

What Makes Up a Doula’s Fees?