Should We Have ONE Certification Organization for Doulas?

There’s been some talk lately (nothing new really) about having one national organization for certifying doulas. While it seems like it could be a nice idea, I have some concerns.

First, the good…

In terms of recognition, one doula organization could do some great things. Marketing and awareness for the consumer could be broadened. Recognition in media outlets may increase. We may gain respect as an industry – think of the recognition achieved by being an IBCLC as opposed to a lactation educator, etc.

Recognition for the consumer would be wonderful. With more women aware of doula care, it’s certainly possible many more women would be interested in exploring this in their own birth. If I fully embrace my idealist side, I’d even go so far as to say birthing practices would change en masse and we may see a turnaround in our cultural birth practices.

However, I think have one organization would certainly have some negatives. These negatives have the potential of out-weighing the positives.

Personally, I’m hoping to begin doula certification within the year. I’ve gone back and forth about doula organizations to certify with throughout my pursuit of this career. There is the possibility of doing a DONA training in our area in the fall; otherwise, I’m generally looking at doing distance learning or traveling three hours or more.

However, I’ve never been totally comfortable with certifying through DONA. I’ve had it recommended to me many times before (I’ve even blogged about deciding to certify with them). But it seems to be such an impersonal organization. I don’t want to join an organization simply because it is “premier,” (which is very true of DONA, and I certainly respect that), but there needs to be something more. Maybe I’m missing something, and more consideration will certainly follow before I make any decisions.

That little tangent discussion of DONA will be relevant later; I’ll come back.

I think for some, the biggest issue with having one certifying organization would be in the possible restrictions placed on its members. Most commonly, the restriction doulas complain about is involving “free birth” or unassisted birth. For me personally, I’m not sure I agree with having a doula (a trained support professional) at an unassisted birth, and I’m not sure I would take a client planning unassisted birth. However, there are doulas who would like to serve women and families in such capacity (I can think of one I know personally who is skilled in this area). And I think they should be allowed to do so (and encouraged! If you have such expertise and feel called to serve in such a way: do it!!)

I’m a little concerned that having one doula certifying organization would in some way “medicalize” the profession. Doulas are non-medical professionals, and I feel they should remain so. Doulas who are student midwives/midwives’ assistants walk a fine balance, and I don’t know how they juggle the two. But for the majority of doulas who are not in that situation, medicalization would harm the profession. I’d be afraid of “protocols” and “standard practice” and other such generalized guidelines that might interfere with the personalized care doulas are “famous” for. Doulas are uniquely available to hands-on at all times, without having to stop and chart or do a particular procedure. While many doulas do chart their notes, they typically wait until the birth is finished and the family is settled before hurriedly scribbling.

I’m not saying that I am afraid a certifying organization would begin to require doulas to do medical tasks. However, I do think that unfortunately some families already feel that doulas are part of the medical team, particularly in assisting the midwife. This assumption may cause them to not look further into the possibility of doula care. So many believe that doulas are only for homebirth, possibly stemming from that assumption of assisting the midwife.

So what should be done?

I honestly don’t know.

Back to my concern about DONA, one of the great benefits of the current situation in having multiple organizations is that there are many different philosophies. A common piece of advice for new doulas trying to pick a certifying organization is to “see which philosophy fits you best.” Losing this could be detrimental to the profession.

It also allows some to study and become experts in doula care and choose not to certify. There are a number who go this route, and they should be allowed to continue to do so. I think that families are able to interview doulas and decide for themselves who best to serve them, whether or not they are certified. I would be concerned that simply one organization would attempt to push out “rouge” and “uncertified” doulas.

Me, I’m choosing to certify. I do think that for me, especially among nursing professionals, having certification will be one step in showing my skills. But for all the other doulas out there, I don’t know that any one person/organization should be making that same call.

How do you feel?

FAQs about Doula Services with Healthy Mama Childbirth

What is a doula?
A doula is a trained labor professional who provides support during labor and birthing. The word doula comes from the Greek, meaning “with woman.”

What help do you give as a labor doula?
I provide emotional, physical, and informational care throughout the entire course of labor. I can give you information about labor and birth to help you make informed choices, reminding you of what you have learned in classes and of your desires for labor and birthing. I provide emotional support in the form of encouragement and constant presence. I can give you suggestions to help your individual labor progress well and help you have a healthy birth. I support you physically with comfort techniques, such massage and counter pressure. I also support your partner, giving him suggestions and help for taking an active role in your labor support, allowing him to take breaks, and giving him informational and emotional reassurance regarding the birthing process. I will help you labor at home if you desire. I may also help you know when to go to the hospital or birthing center, or when to call the midwife.

What support do you not give as a labor doula?
A doula never provides medical care. I am however trained in medical interventions and can explain how they work as well as the pros and cons.
I do not replace your partner; instead I support the couple.  I will help as much or as little as the couple desires. Your partner has emotional investment in you; a doula usually does not. This is both a pro and a con. Your partner’s emotional investment in you allows him to truly understand you and provide care. A doula’s lack of emotional ties allows her to be objective and unbiased in your care.

What are the benefits of having a doula? From The Doula Book  (Klaus, Kennell, Klaus).
“In studies of over 5000 women involving comparisons of outcomes with and without such support [as a doula], we have seen a major reduction in the length of labor, a greater than 50 percent drop in cesarean sections, [and] a remarkable drop in the mothers’ need for pain medication.”

Why can’t I just rely on my doctor for everything?
You can, and you should, rely on your doctor for medical advice.

Unfortunately, many doctors don’t seem to have the time necessary for support. Are your prenatal visits less than 30 minutes? Do you have long wait times to see the doctor? If these are YES, then you probably have unanswered questions. Most simply don’t have the time to address basic needs such as what you eat, how you manage stress, or how you plan to arrange life post-partum.

Many women find that their doctor is not present during labor. Most doctors do not come until the pushing stage.  Your doctor may not be on-call when you go into labor, and someone you may never have met may be catching your baby.

A doula is the only trained professional who will be present with you throughout your labor, birthing, and early postpartum period.

Aren’t the nurses there to help me? What about my husband/partner?
Yes, the nurses are there to help you, but the help they may be able to provide might not be what you need or expect. Nurses are responsible for a number of patients, limiting their time to spend individually with you. Additionally, their responsibilities also include a variety of clinical tasks and paperwork. A nurse will certainly help you when she is able, but you will likely find you need information, comfort, and support “NOW” rather than when the nurse is finished with another laboring mother.

As for husbands and partners – while many men feel confident before labor begins, they often find this confidence wanes as labor progresses. They may resent the fact that they have to put aside their own needs and fears to support a laboring woman. Additionally, most men lack the experience and training necessary to continually provide comfort, support, and coping techniques required for a laboring woman. Many men, no matter how well trained in childbirth education classes, find recall and actual practice of techniques more difficult than they imagined.

It is normal for men to feel this way, and doulas are there to both validate the partner’s feelings and give him the support to in turn support his partner, the laboring mother. A doula can offer the informational and emotional support the partner needs. Some partners become overwhelmed just when the laboring mother needs to most support; a doula can allow him to take a quick break while still meeting the laboring mother’s needs.

What if I want an epidural? Are you going to try to make me feel bad or talk down to me?
No! I firmly believe that each woman (and couple) needs to make the choices they are most comfortable with at the present time. I feel my job is to help you make an informed choice – I want you to know and understand all the benefits and risks “common” procedures (such as epidurals and IVs) have.

I do support natural, unmedicated childbirth, and I feel that every woman is more than capable of having that kind of birth. But I won’t think you’re a failure if you don’t have an unmedicated birth. The thing I believe is most important is a safe, satisfying, healthy birth. Some women have it with epidurals, some don’t. Some women have it with natural childbirth, some don’t.

How do you feel about hospital birth? Do you think all women should have home births?
I operate fully under ICEA’s motto of “freedom of choice based on knowledge of alternatives.” Therefore, I fully support women and families in the choices they make in childbirth from elective cesarean to home birth, whether I would personally make the same decision or not.

I fully support home birth. I also fully support each family as they make the decision of birthing location based on both the knowledge of facts and personal needs and comfort levels. Many women in the United States choose to birth in a hospital or birthing center.

Is doula support covered by insurance?
Usually no. However, some families have been able to use funds from their health savings accounts for doula services. Most families find that doula services are worth the price.

I offer payment plans for my services. I also offer some services at an add-on price. However, all basic doula services – prenatal visits, on-call period, labor and birthing support, postpartum visit, and phone/email consultation – are included in the basic price.

Also, because I am currently in the process of certification through ICEA, I offer my services at a lower price than a certified doula.

Servant Heart

Everyone questions their ability from time to time. I’ve been doing it a bit more often since last weekend’s Homebirth Meetup.

It’s easy to be intimidated. Many of these women are much more experience in birthing and breastfeeding than I am. Even the ones who may just be getting started at least have personal experience to lean on.

Now, I’m confident in my skills. I’m confident of my learn-while-doing abilities. I’ve been fortunate to acquire plenty of book knowledge and am just waiting to try it out.
 

But I have other experience that others don’t have. I’ve spent my life in the servant role.
 

My younger brother has severe autism and mental impairment. He now has 24-7 in-home care, but there were definitely some long hours when he and I lived at home. You do what you have to do so his needs are taken care of.
 

I’m a mother. We could, of course, leave it at that. When I think of the mother role, I often think back to a scene that happened a few months ago. We were at our friends’ home, having dinner, when an unexpected guest showed up. “I’m starved! I haven’t eaten all day!” And he sat down to devour some dinner with us. I turned to my husband and whispered, “what so special about that? I can’t tell you how many days I’ve had to do that with our son. It happens.”
 

But, of course, guys don’t deal with that kind of sacrifice as often or as naturally as women seem to do.
 

Women deal with those kinds of things all the time, whether we’re mothers or not. We’re the ones pitching in to take care of siblings, watching church nursery, working extra so our partners can go back to school, putting off our own dreams for whoever else needs them.
 

Those of us who find that this lifestyle comes easily often find ourselves in servant roles – teachers, nurses, caregivers, stay-at-home moms. I spent years, before becoming a stay-at-home mom, teaching middle and high-school students the finer points of English language and literature.
 

And I can’t discount those experiences. In many ways, they are just as valuable as personal birth experience.
I already know how to serve. I know to provide as much comfort as possible. I know I can’t take it personally when the person I’m serving rejects something I try – I just try something else. I can keep my cool through hours of crying. I’ve had students throw-up in front of me (while I was pregnant no less). I’ve changed countless adult diapers. I can put off my own bodily functions for an amazing amount of time. I know my limits, when I need take a well-timed bathroom break to breath, regroup, and keep going.
 

I can do this…

Certifying Organizations for Labor Doula - A Dilemma

Had a good conversation with a dear friend the other night about certifying as a doula and childbirth educator. I’ve been putting off certification primarily due to monetary issues – we just can’t afford to put me in a program right now.

But I’ve also put off certification because I’ve had trouble deciding which organization to go with.

Initially, when we could afford it, I was going to certify through DONA. The closest course was in Toledo, so I was going to drive the six or so hours, in February. Before I signed up and paid my down payment, I found I was pregnant. Driving to Toledo in February while pregnant is simply a bad idea.

While I was pregnant, I discovered CAPPA and liked that organization pretty well. CAPPA also seemed to offer trainings a big closer to home, so I began to concentrate my planning in that direction.

Then I stumbled across Childbirth International, which is still my favorite organization for a variety of reasons. Overall, I think their program is very thorough; it’s been described as a mini-midwifery course. I like it that the course is entirely distance based and offers a variety of payment plans. I appreciate that I’m not required to become a member of any organization or maintain that membership in order to keep my certification. Once I’m certified, that’s it – doula for life.

My only problem – Childbirth International is just not nearly as well know as some of the other organizations – think DONA and CAPPA.

So, back to the conversation with my friend, a midwife who practiced in our area before it was time for a family move. I trust her judgment in the birthing business. We talked about area midwives for me down the road when my husband and I are ready for another and the conversation of course turned to me becoming a doula.

“K---, I’m going to just go ahead and put my services out there as a doula and childbirth educator. I feel I’m ready even though I’m not yet certified. But I do want to be certified on down the road. Who do I go with?”

Almost before the question was out of my mouth, her reply – “DONA.”

She had good reason – if my aim for certification is so that I have more client recognition, then I should certify with the most well know organization. Otherwise, why certify? I’ve done so much self-study, and have personal experience, that I don’t need certification in order to get the basics needed to begin attending and providing my services at births.

(I do, just to be clear, feel that all doulas should keep learning and studying, even after certification. A good doula is always adding to her knowledge.)

My friend agreed that Childbirth International has a great program, but that the problem of being less well-known is a factor to be considered.

So I guess I’m back to where I started – DONA. Spent part of the morning downloading the certification information to read through. (Also downloaded the information for ICEA’s childbirth educator and to become a board certified lactation consultant. Aim big.)

Now if we can just get the money together, I’ll be content to drive to Charlotte or Cleveland or D.C. I just want to help women as they’re birthing babies!

BTW: What do you all think? I’m content with DONA’s program, but really like what I’ve seen of Childbirth International. Do I go with recognition anyway?

The Power of Suggestion in Birthing

Does anyone else believe in the power of suggestion?


Not necessarily hypnosis (that’s a whole ‘nother post…), but simple words uttered without a care that get stuck in your brain and circle around and around until you find yourself thinking them as well. I certainly had this with my son.


I knew before I got pregnant that I would have a big baby. My husband is 6 foot 5 inches and solidly built. Me – I’m only 5 foot 2 inches – we won’t talk about my build. I had no worries about having a big baby. I firmly believe that my body (and others’ bodies) will only grow a baby it is able to birth. I believed this before I got pregnant, I believed it during my pregnancy, I believe it now.


So what happened?


I always had a fear of C-sections. A fear that I would have one, not because I wasn’t strong enough or woman enough for a vaginal or anything like that, but that something would happen beyond my control that would force me into a C-section. I did what I could during pregnancy to avoid a C-section: eating well, educating myself, birth plans, planning to wait to go to the hospital, etc. At my anatomy ultrasound, I looked at my chart (as I carried it to check-out. It’s my chart and I have a right to know what they don’t think I’m smart enough to understand), and I found that I had an anterior placenta and that my son was breech. At nineteen/twenty weeks, I had no worry about the breech issue; he had plenty of time to turn. The anterior placenta worried me slightly – what if we needed to do an external version?


I think here that too much education got the best of me.


I’m not saying this would happen to everyone, that you should avoid being educated or anything like that. However, I know myself. I let things get worked in, and worked in well, until they burrow into my soul and consume my thoughts before I fall asleep or when I first wake up.


I’m not sorry that I knew these things. I’m sorry that I let them get the best of me.


By thirty weeks, I could tell he had settled into position. I was huge, but I felt great, and I could feel his outline through my belly. He was going to be big.

At thirty-two weeks, I consented to a growth ultrasound. Due to my clotting history, I was at higher risk for IUGR (inter-uterine growth restriction), but I knew I was not having a small baby. I wanted to peek to see if he was still breech – hey thirty-two weeks is plenty of time – and to ease any worries my doctor might have had.


He was still breech. I was devastated. I thought for sure he was head-down, that what I was feeling on the left side of my rib cage pushing that lowest rib was his bony little butt or knees or something, anything other than his head. It was his head. He was frank breech.


I threw myself into getting him to turn. I drank orange juice and put my butt in the air. I rocked on my hands and knees, over a birthing ball. I played music down low – he kicked the speakers. I swam. I walked. I had chiropractic massage and the Webster technique three times a week, nearly passing out each time due to the weight of my uterus pressing down as I lay on my back.


All the while, I was constantly things from others. “He’s too big to turn.” “C-sections aren’t that bad. Why are you so worried?” “My cousin’s friend’s mom’s sister’s baby was breech. He stayed that way.”


At thirty-seven weeks, he was still breech. We scheduled an external version – against my doctor’s advice. I was given a 10-15% chance of success – first time mom, low to average fluid, and anterior placenta. It didn’t work.


He was stubborn. I have that lowest left rib out of place and a nasty C-section scar to prove it.


I think that truly I let that first breech reading and those words get the best of me.


Yes, it’s certainly possible that he would have been breech anyway. I honestly feel he was meant to be breech. Maybe he needed that position for whatever reason. Maybe I needed that experience to better serve doula and childbirth education clients.


But I still feel I let it get the best of me. There at the end, I felt totally resigned to having a C-section. I knew in the back of my mind that he still had a chance to turn, even during labor, but I schedule a C-section anyway. I knew that I had a chance of a vaginal breech birth with a different care provider, but I didn’t even bother to look around. I scheduled that C-section, two days before my due date.

“He was just too big to turn,” I told myself. “He got too big too soon. If only I had seen it earlier.”


But that’s probably just a lie that I told myself. So what if he was big. There are other big babies, bigger than mine, that don’t get stuck breech. Breech babies that do turn during labor, if given the chance. Breech babies born vaginally.


Next time, I aim to counter those suggestions more often. Practice my hypnosis (again, whole ‘nother post!) more vigilantly, talk out those suggestions, surround myself with more natural birthers, change practitioners, whatever I need to do.


I need to protect the suggestions that get in so the only ones that circle and circle my brain this time are the ones that say, “I trust birth.” “Birth is a natural and safe experience, for me and my baby.”

When will doulas get the recognizition they deserve?

Now if only they could recognize that doulas should be able to easily bill insurance, we’d be in good shape.


I’m talking about this article – “Doula becoming a household name.” As part of the healthcare bill, doulas are going to receive $1.5 million for community-run doula programs. I’m honestly not too sure how I feel about this. Oh, it’s certainly great, no doubt about it. I think these programs should receive any assistance they should get, that private organizations and businesses should be funding these all over the place.


I just wish out of all that healthcare legislation that doulas were recognized as an integral part of the birthing process. Granted then midwives would also receive recognition, putting the U.S. in conjunction with developed nations across the world.


Are we ready for it? I hear all the time from women how they “just couldn’t do it.” Couldn’t breastfeed. Couldn’t give birth without epidurals. Without Pitocin to speed things up or get things started. Without being cut open.


It’s not that we can’t do it. We just don’t have the help. In countries where breastfeeding is the norm, there’s naturally more support, more encouragement, more information. Where birth is something women just do, women are strong and know it.


I’m not knocking women who have c-sections and don’t breastfeed. That’s me, honestly. My son was stubbornly breech – I have the rib out of place to prove it – and I wasn’t mentally or emotionally in the place where I felt I could switch providers to attempt a vaginal breech birth.


We attempted breastfeeding, and oh we tried, and never got the latch. After a month of pumping every two hours around the clock, constant engorgement, a bad round of mastitis that was originally dubbed the swine flu separating me from my son for three days, bleeding and bruised nipples, and the beginnings of post-partum depression, I just couldn’t do it anymore.


I regret it every day. I regret my c-section every day. Every time I make a bottle of formula, dog-food smelling stuff, I think that I wouldn’t be doing this to my son if I could have just stuck it out some more. But I couldn’t. I can’t change that.


I can move forward though. I can empower other women to have the births they want, to raise their children the way they want to. This is what I aim to do.


So I guess providing money to community-based doula orgs is a start. It’s certainly better than nothing.


Let’s get this party started…

An Introduction

Hello all!

Thanks for joining me in this journey! I hope that you find the words here inspiring, informative, and entertaining.

As I've gone on my journey into the pregnancy and birth business, I've found myself up against some very entrenched ideas regarding childbirth and what women are capable of doing. I can't count the number of times while I was pregnant when I would hear "And the doctor let you do that?" Let is a very funny word, and seems to imply that a pregnant woman is suddenly unable to make decisions regarding her care and the care of her unborn baby. It's tragic that pregnancy in this country (and of course many others) is viewed this way. I hope this blog helps you fight such ideas.

I used to be pretty mainstream I guess. At least it wasn't until I was in college that I was even interested in birth. I already knew that I wanted to marry young and have more than 2.3 kids (which I guess isn't too mainstream after all), but beyond that i was content to wait it out and see from there. I was engaged at 19 and between that and finished up my education I had enough on my plate.

However, soon after I landed my first job, it seemed there were other plans for me. I had been on the pill since I was sixteen, due to a diagnosis of irregular cycles. When I was put on birth control pills, my gynecologist ran no tests, did no exam. My mother was given the prescription, we filled it, I took the pills. It caught up with me when I was 20. I was only 4 and 1/2 weeks in to my first teaching job when I had a stroke. My only risk factors: chronic migraines and the pill. I wasn't even a smoker - we've all seen the commercials - and there I was in a hospital bed with no feeling on my right side.

Of course, post-stroke, the pill is permanently out of the question. Soon to be married, I was faced with finding something else for family planning - which we felt was important until we got settled and my husband could get work. I vaguely remember my mom saying she used to "chart her cycles" so I googled it and came across a fabulous book that should be required reading for every woman - Taking Charge of Your Fertility by Toni Weschler. (my copy is loaned out somewhere, a much loved book) This book began my wise woman revolution.

I started just charting my cycles. I got up diligently to take my basal body temp, I tried to decipher my cervical fluid, I search for my cervix. Soon I began looking at Ovusoft (oh how you have changed my friend) for answers. As I began to post and read regularly, a new world opened up. Here were women who birthed at home and had labor/post-partum support. They were highly educated and weren't afraid to ask their doctors - "WHY?" "Why that intervention?" "Why now?"

These women were empowered. I was to become one of them.

I read everything I could find and started the path (many times over) to doula certification. Of course, it seems life (and money) has constantly gotten in my way. The day will come.

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