Doula 2 Doula - Why I Don't Offer In-Home Consults

I've had potential clients get miffed from time to time over me not offering in-home consultations. Sometimes they've even compared my practice to other local doulas who do offer in-home consultations.

I get it, it's more convenient to the potential client, especially if they have children. It's more private, intimate, etc...

But let's talk about the other side of things.

As a human, and a female human, I would like to think the best of people. But there's no denying that we live in times where we need to be considerate of our safety. If I were to meet a complete stranger in their home without any prior knowledge except an email and possibly a phone call, I have no idea what I am walking into.

There are a number of stories in the birthing community of doulas who found themselves in scary, and even dangerous, situations because they trusted the strangers that they were going to meet. In one, the woman backed out last minute and said 'go ahead and meet with my husband at our home, I have to go to an appointment.' (this was when the doula was literally on the front step knocking on the door). In another, someone blocked her ability to leave the home when she had to leave for another appointment. In yet another, the home was abandoned and a car pulled up to block her leaving the driveway, but then her husband (who happened to be with her for that day) stepped out of their car and the other vehicle drove off.

So please know, potential client, it isn't because I think badly of you. It's because I am thinking safety for all when I say 'let's meet here'. And doula to doula - staying safe in our field isn't difficult with simple boundaries and safe business practices.

5 Reasons You Don't Need a Doula

You hear me tell you a lot about why a doula is a great choice in any birthing setting... what I haven't told you in awhile is why you don't need a doula. Let me take this opportunity to do just that. This isn't a long post. It's short and concise - as truth often is - and without explanation. So here you have it. 5 reasons why you don't need a doula:

1. You are strong. You are. You don't need a high pain tolerance or be a marathon runner to be strong, you only need a uterus and a humble respect for it. 
2.  You are capable. You are. Your mind is sound and your body is able, the last part of that equation is to allow those two things permission to do what they need to to give birth. 
3. Your body contains ancient and primal wisdom. Cellular memory, your mother's mother's mother's mother's birthing wisdom and knowledge, they are coursing through every fiber of you.
4. Your body contains immeasurable power. Only a female body can create, grow, and birth. 
5. You have everything you need within you. Tap into that innate wisdom, power, trust, honor, respect, and knowledge. 

This is your birth. 

Bended Knee

I walk across the threshold into your room and see that you are swaying in the arms of your lover. Candlelight provides the backdrop for this sacred moment, and the scent of sandalwood and lavender waft from the warm water basin at the foot of your birthing alter.

As I step into your birthing space, I slip out of my shoes and quietly and humbly approach you. Your midwife sits on the couch to the left, her feet folded beneath her. Your photographer kneels on the floor at the foot of the couch, and your sister is cross legged on the hearth. Every knee is bowed and bent in reverence to the sacred work before us.

At first you dance to the rhythms of of your body - swaying and undulating your hips - while we silently hold

vigil. Soon, though, you move to all fours upon the ground as even you, the conduit of this powerful work, are brought to your knees in awe and deference of your bodies power and work. 

This is what we do. Every birth worker, whether she be hand maid, photographer, doula, midwife, or mother herself, should approach the sanctity of the power of birth on your knees; in humble reverence of the miracle of birth.

http://usthreebirds.blogspot.com/2011/08/elliottes-vbac-birth-story.html

Go to her blog to read a beautiful recounting of her VBAC birth story

Not placing ourselves above the birthing woman's powers - placing ourselves above her diminishes her power and resolve. This is the manner of obstetrics (from the root obstare - to stand in the way of). Adopting the attitude of bent knee is a mere reflection of the inner heart and mind. A servant to the ancient rhythms provide us the proper perspective to watch a miracle unfold. Following the conduits lead in a dance of ebb and flow, the perspective of 'with woman' is always on bended knee.

My Doula Suggested

If you haven't noticed, I am taking a bit of a comical relief break in my blogging.. This blog post is no exception. So, without further ado, I give you, "My Doula Suggested" (a compilation of suggestions made by doulas that I know and trust, or me).

The Tooth and The Birth

"Mommy, I have a loose tooth. Can you pull it out for me?"
"No sweetie, I can't pull it out, but you can."
"I don't want to mommy. I want you to do it for me."
"Then it's not time to pull it out, your tooth isn't ready."
"How will I know when it's ready?"
"When it's ready, and you're ready, it's time."

This has a conversation I had with the elder of my twins. She is a sweet soul, deep and feeling in ways that my other children may not recognize or comprehend. She wanted me to pull her not-quite-ready but mildly-loose tooth out for her. I wiggled it, smiled at her, pulled her onto my lap, and gave her the above talk.

This was a pivotal moment for her. She, my gentle spirit, wanted her parent, her caregiver, to do the thing that was hardest for her at that moment - take the responsibility and put it into their own hands. She, who prefers protection to bravery, wanted me to 'take the reigns' and rid her mouth of this wiggly nuisance.

But I placed that power back into her hands, and although she resisted it at first, she soon grew to cherish it. Daily, she wiggled that tooth, and then came to report to me what new sensations it gave her and how it impacted her. Daily, I applauded her for her intuition and her strength to wait until the right time. Some days it bothered her more than others - some days, like the day she jarred it painfully with an apple, she begged me to help her. And I did, but not the way she had expected. She wanted me to pull it - instead I gave her some warm tea with honey and cradled her jaw in my hand, kissing her nose.

One morning, without pomp or circumstance, she came to me and asked for my hand. She then dropped her tooth in my open palm, smiled with self-assurance, and sauntered off with a glint in her eye that only those who have climbed an impossible mountain can achieve. When it was time, and she was ready, she took herself to the bathroom, locked the door, and plucked that tooth from it's nest.

She later came to me and told me that she was nervous, but courageous. It was uncomfortable, but not nearly as painful or scary as prior tooth pullings that were done by others. She didn't want to tell anyone else what she was doing because it was 'her time, her tooth, and she didn't want to be watched'.

So it is with birth. Women come to me and other birth workers/keepers afraid to walk their journey in their own power. They are looking for someone to make the journey for them, do the work for them, or make the choices for them. But look what is lost when a birth worker/keeper takes on that role? If we can come along side of them and encourage them, give them information, and hold their space, they blossom into powerful, self-reliant, strong, capable journeyers.

Electronics in the Birthing Room

Yeah, I'll probably step on some toes here in the birthing field. Even with doulas. But I have a theory, and I operate in that theory.

Electromyography, aka EMG, is the the recording of the electrical activity of muscle tissue, or its representation as a visual display or audible signal, using electrodes attached to the skin or inserted into the muscle.

We know through medical advancements that we are, in fact, products and producers of electrical currents and energy. Muscles are stimulated by signals from nerve cells called motor neurons. This stimulation causes electrical activity in the muscle, which in turn causes contraction.

Radio waves, such as those used by cell phones, are forms of electromagnetic waves (RF radiation). These waves are present in our air/surroundings at all time. Who's to say that using our cell phones during labor does not inhibit or disrupt labor patterns?

Remember, this is only theory, but I can tell you one thing from my many years of doula work; the more cell phones in use during a woman's labor, the more her labor pattern is disrupted or intervened upon. This can take many different forms:

• irritating the mother as she is trying to work in her birthing space
• move attention away from the laboring mom and her partner and onto a device
• cause unnecessary discomfort and irritation to mother because of the above
• disfunctional labor patterns, including stalls in dilation and slowed pattern

Bottom line, while I am in the laboring room, I have resolved to hang up my note apps, my cell phone camera, my doula apps, my charting apps... if I need to take a call or a text, I head out to the hall. A woman in labor deserves my undivided attention, emotionally and physically.

Doula Seuss

Dr. Seuss; who doesn't love a rhyming philosopher? What I bet you didn't know is that his wisdom is as easily translated into how to be a good doula! So, I give you, Doula Seuss - lessons to doula by, from Dr. Seuss!

Optimism

You wouldn't believe how many times I have said similar things to the women I work with. The conversation normally goes something like this:

"Can I do this"
"You ARE doing this!"
"Please tell me I can do this"
"You are going to face this mountain and it will move. Just tell it to!"

Women need to hear that they are amazing, that what they feel is normal, and that they can overcome the obstacle that they are presented with. A doula should be the woman's best cheerleader, and most optimistic friend!

Perspective

So many times, women in labor will find that they don't fully comprehend what their provider is saying. Or, they don't have enough information to make a true and informed choice about the course of treatment being suggested to them. It can be very helpful to remember what Yertle tells us. 

This conversation normally looks like this (or some form of it): 

"I think what Dr. Yertle is saying is _____. I believe the reasons that he recommends that course of treatment is because of _______. Is that correct Dr. Yertle? Did I leave anything out? Mama, did you have any questions? I have a question, Dr. Yertle, sometimes I have seen ____ work to help this issue, could we have time to try that if mom would like?"

Never forget, we don't work for their providers, but the women we do work for have asked us to support their choices and their rights. Two of their choices were their place of birth and their provider. We have to balance supporting those choices, with reminding them of their rights.

Choices, Choices! 

Which brings us to our next lesson. As a doula, you should know her choices. As Diana Korte and Roberta Scaer said,  "If you don't know your options, you don't have any." Use the prenatal period to teach her about options. 

Her Brain needs choices to pull from during her pregnancy, labor, birth, and parenting time. When she can't remember those choices, your job is to gently remind her of them.

Her Feet need choices so that she can choose where she wants to take herself for prenatal care and for her birthing time. She might not have known there was in-network CNMs in her area. She might not have known that there was a birth center nearby that she would adore. 

Autonomy, this can be a hard one. Every doula is opinionated. But knowing when to share your opinions and when to help her simply steer herself in the direction she has chosen is a fine line to walk. 


Question Everything

Ask the hard questions prenatally. This allows families to really consider what they want during their pregnancy, birth, and parenting time. These questions might be hard for you to broach, but the more they consider it, the more parents will know what their hearts really desire!


Be Willing To Be A Birth Anarchist


This may only speak to some of you doulas out there, and not others. Some of you are natural born rebels, conspiracy theorists, and hippies. Some doulas aren't. I'm going to be honest with you. When I first chose to be a doula, I was afraid of being labeled a hippie or a conspiracy theorist. I worked hard on being politically correct and remaining in the 'main stream'. But the more I learned about the politics of birth and the violations of human rights that were occurring in pregnancy and birth to women all over the world, the less I cared about remaining in the good graces of friends, family, and peers when it came to my (out)spoken beliefs and knowledge of the facts.

Be willing to be a birth anarchist.



Remember to Balance The Body and Mind

Sometimes, we as birth workers can become so engrained in the facts and figures of birth, our education and training in how to talk to doctors and nurses, how to present information to the public, or how to teach left-brained childbirth classes, that we forget that birth is organic, it's meant to be done with the body, not the head.

Remember to fall back into your 'nonsense' when in the birthing chamber. Keep your own head out of her pelvis, and allow yourself to tap into the creative - after all, she's creating birth!


Protect the Babies Too!

Yes, we protect the woman's space during pregnancy and birth, but what about the babies? As doulas, we should keep a watchful eye, and tell partners the same, to make sure that the newborn is treated in a humane way, as the parent's have chosen for their welcome to be.

The best place for a newborn is in the mom's (and her partner's) arms. Well meaning extended family members, fussy nurses, and intrusive doctors can wait. A baby won't gain a huge amount of weight or grow very much in the first two hours, so routine checks can wait. Newborn procedures can also wait, as can excited family who want to get their hands on the moments-old baby.

Likewise, during pregnancy be sure to talk with them about their options like eye erythromycin, Hep B, Vit K, circumcision, breastfeeding, bathing, newborn capping, rooming in, suctioning, and the like. Remind them that a 'persons a person, no matter how small.'

It's OK to Do-Less

 Many times doulas will find themselves in the trap of 'what can I do?'. Sometimes, oftentimes, we need to DO less.


Many times, I find myself suggesting that mom goes in the shower, alone to have intimate time with herself during her labor. While there, she will sing her birthing song louder, become a more primitive her, and open easily. Oftentimes, she will invite either her partner or I in with her after awhile, but it's important to allow women the space and permission to labor alone.

This is Her Show

Remember, you cannot empower her. But, you can help her to become empowered. You don't do the empowering, this is not your job. Just as it's not your job to tell her what to do or how to birth. Your job is to give options, and then support those choices that she makes. Remind her that only she can control her future. Not you. If she chooses to let her doctor or midwife make those choices for her, she has STILL made THAT CHOICE. 

The Juggling Act

As a doula, you will be juggling. Juggling the hats of massage therapist, counter-pressure provider, acupressure administer-er, childbirth educator, cheerleader, medical translator, patient advocate, friend, maternal figure, and so much more. In the midst of that juggling - remember to hold the woman up high.

She can easily feel like she becomes lost in the whirlwind of what her birth is. Be her holder, her anchor, her witness. Be the one who pays attention to all of the little details and rallies for her.
Hindsight is 20/20

And finally... the after birth part. Oftentimes it is helpful as a birth worker, to have a peer review. This will help you to process what happened during difficult births, or births that left you befuddled. We need to be able to process, grow, mourn, and learn from births just as much as the women that we serve. For more information on peer review, see here.

Similarly, as a doula, you might become that peer reviewer for the mama at postpartums. If she wants your honest feedback, give it, tempered in love and compassion. Likewise, if mom is not ready to ask the difficult questions about her birth, then she is not ready to have that information. Don't offer it. Wait until she is ready to acknowledge the value of that moment and what it might mean for her and her baby.


Conclusion

And there you have it, how to doula Dr. Seuss-style! And to wrap us up...

Can I labour over there?
Can I labour on the chair?

No! Don't labour over there!
You cannot labour on a chair!
Lie on the bed and you will see
We have to insert this IV!

I do not like this sharp IV!

I need to move, to dance, to wee!

Obstetrician, let me be

Get your Pesce hands off me!

No! You can’t move, dance, or wee!
We must attach the ECG

Not over there, not on the chair,
Not with the ball, you’ll have a fall!

Can I labour with a doula?
Can I use some calendula?
Can I push on hands and knees?
Can I birth just how I please?

No! Not with a doula! What’s calendula?
Lie back, legs up and count to ten,
Hold your breath and push again!

No thank you, doctors, nurse, and crew,
I’d rather labour without you.
I’ll walk and labour here and there!
In the shower – everywhere!

I’ll labour standing, squatting, sitting
I’ll labour on my couch while knitting!
I’ll have a doula – I’ll have three!
They’ll let me eat and bring me tea.

Try them! Try them! You will see!
And you can shove that darned IV.

- Source Unknown

Doula Rule #1

Him:"I apologize for sending you out. I hope I didn't offend you. I'm sure you understan-"

Me:"... Of course I understand! I mean, what better way to coerce a woman into a major surgery that she neither needs nor wants than to remove her only support and full disclosure of information from the room (chuckle - ended with dagger-eyes.. walk away)."

Doula Rule #1 - I work for YOU. Not the hospital, and they know that. We are not in the business of making hostile situations, but we are there to advocate for your rights, wishes, and informed consent. If your doctor insists on your doula leaving, he/she either:

1. doesn't know what a doula does and thinks we can't be there for major decisions or
2. wants to coerce, bully, persuade, encourage, or threaten you into something you either don't want and/or don't need.
   

We cannot persist our presence, only YOU can. If YOU want us there, TELL your doctor and we stay. You, as a patient in a hospital located in the good ol' US of A, have certain rights. These rights include having an advocate there for you at all times to make sure that you are getting equal, fair, informed, evidence-based treatment and that none of your federal rights are being infringed on. That is a doula.

'nuff said.