​Birth planning and setting up birth preferences can be a daunting task. To some, it may seem as simple as filling out a template that may or may not be provided by your medical team. As a doula of 18 years, birth plans are the main tool to ensuring improved birth experiences…when they are used correctly!

What is A Doula?

Let’s backtrack a bit to define the terms doulas and birth plans, so we are all on the same page. 
A doula is a birth professional, not a medical professional, who is trained and most often certified through a private or state organization to provide services that impact the full life and reproductive experience, this means from fertility to postpartum and all steps in between. They can sometimes be called birth workers, birth assistants, birth coaches, or companions. 
Doulas are not confined to the birth space itself. We assist with informational, emotional, and physical support every step of the way through the gestational journey. We are there when that journey has trouble starting or abruptly ends. 
There is a tenet of doula work that is considered controversial within some training organizations, that is whether a doula can advocate for you. Advocacy is rather crucial when it comes to enhancing your birth plan. When asked about their style or mission, some may feel advocacy is out of their scope of practice. NOT amplifying your voice during the most vulnerable time of your life may be a deal-breaker for you. I will discuss this in future articles about how to hire the right doula. 
We have the gist of what a birth doula is, but please note there are sex and “end of life” doulas too.

What is a birth plan?

A birth plan is more than just a piece of paper. It should represent the culmination of conversations between you and your birth team before the birth.
Imagine that you are an actor and have been given a script on the day of filming. The expectation that you will know your lines is extremely unfair. The same holds true with handing your medical team your birth plan on the day of your labor. It’s not fair to expect them to follow this when there were no discussions beforehand.  
Realistic expectations are often missing. That may be why some medical providers like the word ‘preferences’ instead of plan. We know the famous line; “when we fail to plan, we plan to fail.” Scribbling down a bunch of things that sound like a great experience is not creating a plan. 
What have you done to prepare your body for this plan? What conditions within your pregnancy will possibly prevent some of these things from happening? And is this just a list of “I don’t want this or that?” Birth planning should be a positive and thoughtful discussion that takes your current pregnancy condition into account from a realistic health perspective while honoring your values.
We encourage you to write one to two questions down during each prenatal visit with your provider to build the foundation of your plan. 

How Can Doulas and Birth Plans Be Beneficial? 

During your perinatal visits with your doula, most often beginning your 20-28th week of gestation, they are helping to orchestrate your birth. These meetings help ensure that your midwife or OB/GYN visits are most impactful by understanding the layout of the possibilities and limitations to your birth preferences. 
Developing a birth plan is like developing the best screenplay ever written, starring YOU and YOUR BABY! Who will be the main characters? Supporting actors? What are their roles? What happens when one of the characters can’t be there? Or if the health of the stars isn’t strong enough to perform the stunts required? 
In this analogy, YOU are the director. One would argue that the medical provider is the director, but they are supporting actors. YOU know the direction you want this movie to go. You need an assistant to be open and honest with you, to provide you with the latest information about the location, the process, and the team. That person can be your partner. However, a doula has more experience in these settings, knows the terminology, and offers a unique and objective perspective few people on set will have.
OK, OK…I’m moving away from movie analogies.

Your Doula As A Liaison!

Your doula has spent their career working in the latest evidence-based birth research, so you don’t have to spend the time on Google, in parent forums, or questionable apps. Your doula built their reputation on no judgment or bias and hovers in the space of facts not anecdotes. Here are just a few of the ways a doula can be a part of your pregnancy, birth experience and birth plan: 

1. 1. Nutrition and exercise information is shared to assist in maintaining good health for fewer interventions and better recovery. Your birth plan should take this information into consideration. 
   2. Your doula is the liaison between the medical team and your base team, they can help define medical terms and conditions and reduce the white coat syndrome that often occurs when speaking to medical professionals. Your birth plan will take into account all of the information gathered from each team member during your pregnancy. 
   3. Doulas are a source of support for the partner as well, ensuring their values and goals are heard. Birth plans may include agreed-upon ideas from your partner. 
   4. Doulas are empathetic, and when plans must take a turn we are there for the letdown, all while creating an alternative framework (in addition to a few extra hugs). A good birth plan takes this into consideration. 
   5. Lastly, in the space of advocacy, we can help to ensure you are receiving the necessary informed consent to make the best decisions before birth and in the moment. Labor (at some point) requires tuning into one’s inner self; your voice may be missing in those tender moments. Your partner may be wrapped up in the emotion of the now and your doula and your birth plan is there to help calm the waters and relay your wishes. 

Of course, there is the obvious form of doula support, the physical support. If you plan for freedom of movement, your doula is calculating and analyzing the best positions for you to be in based on your cervical dilation, the baby’s station, and your overall demeanor. Assessing the progress of labor is an art and skill that many doulas possess, as they do not perform cervical checks. Timing contractions/waves/surges, all while observing with a deep understanding of physiologic birth, is our claim to fame. We can reduce the need for pain medication by 10%, reduce the use of Pitocin by 30%, reduce surgical births by 25% and increase positive experiences by 30%. 
Not only will your birth plan be read and supported it has a greater chance of coming to fruition when hiring a doula.

Michelle Gabriel-Caldwell
Doula Agency Owner, CD, CBE and EBB Instructor

Let's talk about this global issue and the impact on birthing families.
There are a few factors leading to this shortage.

1) The actual Epidural Kit itself, the Epidural Catheter and the IV Contrast are in short supply in some locations globally as supply chain issues impact their availability. Read more on that here: Is There an Epidural Shortage? Pain Management in Short Supply (marketrealist.com)

2) Bupivacaine usually paired with Fentanyl to create the epidural "cocktail" used heavily in labor and delivery also had some supply issues dating back to 2018. Manufacturing delays, the pandemic and the war in Russia served to make alternative access more difficult. Pharmaceutical discussion here:
Drug Shortage Detail: Bupivacaine Injection (ashp.org)

This is currently a global concern with Canada and Australia being hit the hardest, presently. The USA is a mecca for pharmaceuticals and may be called upon to provide kits and/or medicine to other countries. Although the kit shortage is mostly due to a manufacturing facility in China that closed, this may also impact the US at some point as well. 

What does this mean to the laboring person who would have opted for an epidural in the US?

1) As of 7/25/2022, no US Hospitals are publicly announcing a shortage on epidurals like our Canadian counterparts. Again, we may be asked to come to their aid and the impact of that is not readily known.
Expectant mothers stressed as Sask. Health Authority braces for epidural shortages | CBC News

2) As with most things, access in the US relies on Capitalism. Knowing that there is a global shortage could spark price increases and the question remains how will insurance companies adjust? Some birthing persons may find they will be asked to pay more "out of pocket" for an epidural, while others may be denied access altogether based on systemic racism.  How Much Does an Epidural Cost? | HowMuchIsIt.org

The alternatives are obvious but not necessarily available to all! The cost or availability of an epidural does not affect the person who planned to labor without one. But this isn't a panacea as no or low access could increase the need for surgical births.

HOW DO WE PREPARE FOR WORSE CASE SCENARIOS?

We must have open conversations with our providers, understand our options in ALL cases and look for support in those options!

Below is another great article of epidural alternatives noting that hiring a doula and taking childbirth education classes are high on the list. We at Baby Please Birth Services Agency LLC, are happy to explore your options with you for the best comfortable and empowered birth experience possible.
6 Alternatives to Epidurals During Labor (parents.com)
​
Michelle Gabriel-Caldwell; CD, CPD, LE, CBE and EBB Instructor
Owner of Baby, Please Birth Services Agency LLC
​[email protected]

If you are pregnant or looking to get pregnant someone may have brought up the notion of hiring a doula. Many blogs, Facebook posts and even IG reels are tempting you to get a doula OR stay away from them! As a doula you might think I'm biased but as a mom who hired a doula for myself for both of my births, I'm going to share with you WHY I hired a doula and WHAT you get when you hire a doula. 

I'm the kind of person that needs data, I'm a scientist so that's not unusual. I took a childbirth class to gain more knowledge of the birthing process and to share that knowledge with my husband who was also very clueless about our first pregnancy. Back then (over 23 years ago) I wasn't fully aware of the maternal mortality issues for Black women, but I did know that my sister suffered a morbidity during her pregnancy. So that more than motivated me to ensure I was empowered and had the best resources for advocacy. Now, I'm going to admit that I was privileged to afford classes and a doula. But it wasn't just privilege, it was a necessity for me. I had a basic backyard baby shower that a friend threw for me, I never had a gender reveal party (those weren't the thing yet) and I didn't go on a babymoon. I saved my pennies for the things that mattered most to me during my pregnancy, education and support!

Let's talk about the worth of doulas. We can reduce the need for a cesarean by 25%, we can reduce the need for Pitocin by 30%, reduce the need for pain medication by 10%, and we can increase positive birth experience ratings by 30%. How do we do this...by providing continuous support and birth knowledge. Let's face it, many doctors do not equip their patients with the knowledge of physiologic birth. Just think about the details of your prenatal visits with your provider. Are you spending more time in the waiting room than in front of your doctor? Are all of your questions answered? Do you walk out feeling empowered about your birth choices? Do you even know ALL of your birth choices and options?

Here comes your doula. They can provide childbirth education classes if they are certified to do this. But they can certainly provide you with the ins and out of labor in layman's terms so that you feel confident about your discussions with your provider. That's the information part! The next piece is helping to set you up for success and whatever that means for YOU! Helping to create and review your birth plan with evidence-based information and realistic expectations based on your circumstances. Setting aside time for your questions as they arise and mitigating any previous trauma or stress. The labor starts with constant phone calls or texts to your doula and perhaps even home support in active labor, ensuring that you arrive in time to the birth space for your desired outcomes. Amplifying YOUR voice in YOUR birth space! Making sure you are seen, heard and respected! Honoring that sacred nature of birth and bringing all of your culture and rituals that you hold dear along for the ride. Your baby is here, and your doula support does not end at this point. Immediate postpartum care is critical to transitioning to parenthood and welcoming of baby outside the womb. Your doula is by your side after witnessing this miracle by guiding you into your new role. Nursing or formula feeding support is there for you too. Postpartum care, maintenance and in-home support planning can be centered. Creating this new space for your family. Serving you and your partner! 

What is all of that worth to you? To me, it was millions! The empowerment, trust, love and care that I received during the hardest work of my life left me whole. My husband was amazing for sure; however, my doula was for him too! He was nurtured and set up for success in ways he did not know he needed. 

Birth Doula fees will vary depending on geographical location, skill set and experience. These fees are decided with the idea of what it takes to prepare a person for labor, continuous labor support and postpartum closure. Transportation, tolls, parking, babysitters, supplies and back-up doulas all need to be allocated. Most doulas are UNDERPAID because this is a service industry, and many folks are led to believe that we are just magical angels who don't need to eat or sleep in a warm home nor support our families. 

We help you find the strength you did not know you had, we bring out the innate birthing wisdom that was there all along and we get to know you so that you feel secure and safe along the way.
My doula was worth her weight in gold to me! I strive to be worth my weight in rubies to my clients! 

Free consultations are always available. Check out the doula services page for the link to schedule yours. 
​We can't wait to serve you!

Do you trust the practice you are with to provide evidence based support? 

As I sit here waiting for my clients to leave their doctor's appointment at 41 weeks gestation, I'm wondering if they will be asked to go to the hospital for induction. This couple is ready for this conversation and they have just had their second BPP ultrasound to ensure all is healthy and fine. Yes, I said second Biophysical Profile Ultrasound (BPP) within 24 hours because the first revealed oligohydramnios at 4.6 cm, just shy of the 5cm or less standard cause for concern. Turns out the new BPP ultrasound reveals 6.0 cm. Whew...they leave the office, and go home. 

Did you know that ultrasound quantitative data can have a standard deviation of up to +/- 15%? So within 24 hours my clients found themselves nearly fighting with their medical staff to keep from being induced due to the only piece of data that showed a "problem". All previous medical tests, blood work and low risk status gave them the ALL clear to wait for spontaneous labor up to 42 weeks of gestation. This was the promise their entire pregnancy. This practice advertised being low intervention and holistic. 

Let's talk about that visit just 24 hours before and how terrible that experience was for them. They felt betrayed. You see they knew the standard deviation of ultrasound results because they took an Evidence Based Birth ® Childbirth Class. But the nurse practitioner decided that 4.6 cm was enough to schedule an induction THAT very evening due to risk of still birth despite no other indicators of an issue with the BPP. The doctor was unavailable for consult so the clients called me to help review their options.

Me: What's the medical reason for induction?
Them: Slightly low amniotic fluid
Me: Do you understand the risks involved?
Them: Not fully and the NP was not comfortable sharing her knowledge, but asked us to sign paperwork that we are going against medical advice if we choose not to go to the hospital.

I sat back to ascertain what I was hearing. I restated the information they shared with me.

Me: So you have not been fully informed of the medical risks but you are being asked to sign papers that claim you don't agree with the medical advice?
Them: Wow, yes that's correct!
Me: Is there someone else who can provide you the information you need to feel comfortable with this "medical decision to induce?".
Them: No, we have been sitting here for hours.
Me: Do you feel ready to sign anything saying you are going against medical advice if you haven't been fully given medical advice AND informed consent?
Them: No, we were pressured and made to feel as if we don't care about our health but no one is providing clear reasons why this is a danger. 
Me: She mentioned still birth; here is the data I know concerning risk from Evidence Based Birth ®. The risk of stillbirth rises gradually after 39 weeks and then increases more rapidly starting at 42 weeks.
39 weeks = 3.5 per 10,000
40 weeks = 4.2 per 10,000
41 weeks = 6.1 per 10,000
42 weeks = 10.8 per 10,000
So yes your risk of still birth has increased at 41 weeks gestation, but you and your doctor were comfortable with this risk when you all agreed to wait for spontaneous labor up to 42 weeks according to your birth plan? Right?
Them: Correct!
Me: Is there anyway to redo the BPP and wait for the doctor's opinion? (LONG WAIT)
Them: Yes! The NP agreed to wait for the doctor to return in the morning. We don't have to sign anything and can go home.

The next day, less than 24 hours later the BPP results were very different...

• 4.6 cm was now 6cm; acceptable fluid levels
• baby's weight significantly changed from 8lbs 6oz to 7lbs 13oz. 

So why the hyperbole? Not everyone practices or in this case even understands evidence based information and TRUE informed consent. This scenario turned out well for this family who birthed their baby 3 days later spontaneously at 41.2 weeks with no issues or complications. But what would have happened if they allowed themselves to be frightened by the data? If they were forced into an unnecessary induction?  Chances are they just would have had their baby earlier or they could have gone down the road of a cascade of interventions forcing labor that may have ultimately lead to a caesarean they really didn't need. That was definitely not part of the birth plan. 

What makes providers or their staff seem to "go against their word" at the slightest change? To not realize that even due dates are guesstimates and no egg timer is going off, especially when scans indicate proper placental function. The reason...Evidence Based Gap problems. It takes 10-15 years for the latest evidence to get into the hands of the provider...to be used as part of daily routine practice and looking at every INDVIDUAL case and not just data known to have variability (which can be skewed by human error as well). 

When providers don't have a full grasp of the latest evidence pertaining to birth or choose not to follow it (..."because we have better results doing things our way!"..) it can feel like a 'bait and switch' tactic. Or that they were telling tales about this perfect birthing experience they were offering as a service. "Yes we love natural births here"; only to find out natural births mean vaginal and all first time patients are often coerced into receiving the epidural because "this could take forever and we want you comfortable". How about when you take a tour of the hospital and see all the beautiful tubs but once in labor you are told you can't push there, it must be on the bed on your back. Even though evidence suggests that water birth is safe and hydrotherapy is nature's epidural? Or, and this is my favorite, you can't eat or drink during labor because there is high risk of aspiration death if you are on or might need to use anesthesia. Did you know that "high risk" is less than the risk of being struck by lightning (one in 500,000)? Whereas risk of aspiration death is 1 in 1.4 million! And what does that say for the persons not using anesthesia...why can't they eat? These 'nil per os' or nothing by mouth rules date back to the 1940's when general anesthesia use was very different. Again evidence suggests it's a basic human right to eat when hungry, especially when doing some of the hardest work of your life.  

When discussing risk, it's so important to understand the difference between absolute versus relative risk. For example, if you are told you have a 45% chance of increased risk of still birth at 41 weeks of gestation compared to 40 weeks, that sounds super scary! But that's known as RELATIVE RISK, a mathematical relationship between two risk factors. However, when you see the ABSOLUTE RISK, your personal risk assessment, you see the true risk relationship of data.  So instead of a 45% increased risk you see 6.1 occurrences of still birth out of 10,000 births at 41 weeks when compared to 4.2 occurrences of still birth out of 10,000 births at 40 weeks.  It provides you better data to make better informed decisions without harmful scare tactics. 

Listen not all doctors/ medical staff are intentionally playing games with you, some are just out of their comfort zone when it comes to data or are truly doing their best to keep you and your baby safe. Just be mindful of what YOUR non-negotiables are when it comes to YOUR birth. As you can see it doesn't hurt to take a childbirth education class to understand the evidence and informed consent. Plus hiring a doula who can help you navigate these sticky situations and advocate for yourself and your family. You aren't just a vessel for your baby, your birth matters too. When you are heard and respected a satisfying, empowered birth experience is good for everyone! 

Michelle Gabriel-Caldwell
Certified Doula and Evidence Based Birth ® Instructor
Evidence Based Birth® Childbirth Class - Virtual Experience- Tickets, Tue, May 18, 2021 at 7:00 PM | Eventbrite
(Teaching Virtual Classes Through 2021)

It's 3am on a Sunday morning and I am returning home from a birth, I now have to quickly shower and go to sleep so I can teach childbirth education classes in a few hours. In the same day, I have scheduled a session with a mentee and I start to review doula requests that came through my emails. Before dinner I visit a previous client for a non-emergent breastfeeding issue. I prep for bed and get my head ready for my full week of work as a scientist, while still being on call for a another birth. 

Multiple Microsoft Teams meetings later, I take a lunch break to join an Evidence Based Birth Interview or write another article for a newspaper on either virtual doulas or black maternal health. I've also signed up to take a few more classes on Birth Trauma that meets early Thursday mornings, so that means I'm working on my day job into the evening to catch up. Sure I have some flexibilty, but if I'm called to a birth that evening I'm screwed. 

THE WHIRLWIND OF THOUGHTS: 
I see a gap in training new doulas, I put a class together to fill that void. (Homebirth Doula Training, done!)  I do this on top of teaching parents childbirth education (Bradley, Evidence Based Birth Classes & my own Holistic Class) and a workshop for Nurses on labor & delivery comfort measures. (Maybe I need to put another one together for doulas needing certification?) I am also certain to make all classes and workshops affordable to BIPOC. Now back to providing training for the chemists on my day job, (hmmm...I wonder if they will need a hands-on lab component, better create that option too! But first I need to talk to the marketing department.) Some customers want a private presentation on our newest products, (Ok scheduled, wait the whole team?...great 45 people then!) Virtual school has started for my daughter, thankfully she's in high school... (but let's create a better space for "class" and try to have lunch together.) Hey I think I want to set up some new classes for The Birth Center of NJ, (let me reach out to the doulas and give them a nudge/support.) What's this email? Oh I need to review the new training curriculum for The National Black Doula Association since I'm on the Advisory Board, ok (check!).  So grateful for the program that we at the NJ Birth Justice Collective created to hold space for birthing persons! Did my husband kiss me this morning? (Yeah, I think so!)

For those of you who don't consider me a REAL doula because I did not quit my day job that provides full health insurance for my family, pays my mortgage and college tuition for my son...I beg to differ. My whole heart is in my doula and birth advocacy work and I submit I put in more than 40 hours a week doing it! I still enjoy the work I do during scheduled 9-5 hours and I'm pretty darn good at both jobs. I don't like the remarks and commentary reserved to "part-time" doulas who are seen as having hobbies. I have TWO full-time jobs AND I volunteer to teach 4th graders religious education at my church. 

Since COVID, I am working the most I have ever worked in BOTH jobs. Constant meetings, trainings and births. My birth schedule is booked through April of 2021. So put that in your "part-time" doula taunts and eyerolls. There are many of us in this boat who are strongly moved by the work needed in maternal health and MUST keep a toe in the pool of birthwork. There are others of us who are swimming daily and maybe drowning! There should never be labels placed on those who decide to keep their day jobs. There is enough work for us all, I promise! So while I applaud those who take a leap of faith and switch careers to work as full-time doulas, call me, I can mentor you on time management skills and keeping your calendar full with clients!

If you have been a doula in the last 10 years, the topic of certification has been a prominent one. It is met with varying opinions and discussions concerning philosophy and equity. Let's begin with the main point of training. There are many certifying entities in the doula market. Like religion there are many philosophies and scopes of practice. It is during the pandemic that the microscope on these differences is magnified. Why? 

As laboring persons struggle to have more than one support person in hospitals during these times, it often means either putting the doula on the back burner or seeing the doula as essential and limiting other family members. This has caused a bit of panic! Imagine not being invited into the birth space as a grandmother, sister or cousin if this was the original plan? Imagine being the doula who has spent months nurturing the relationship with a client only to be called "non-essential".  Many states have been flip flopping with the decision to allow doulas in hospital spaces. Just recently NY signed an executive order deeming doulas essential to the birth process. It is expected that NJ will follow suit eventually. This is good and bad news for some doulas. (But that is a different story).

SO why bring up certifications? Simply put the doula industry is expected to save laboring persons from disparities, to educate, to support, and to advocate for families concerning all things birth. Now that the word "essential" is added to the mix, ensuring a person who claims to be a doula is ACTUALLY a doula is paramount! There are desperate families trying to gain access to hospital and birth center spaces posing as doulas. There are also frauds who seek monetary gains to exploit families by claiming to be a doula. How do we differentiate between those persons and a real doula? Proof of Certification! It upholds the integrity of the profession and does not allow those who think it's just about massage and hand holding to do it a disservice. 

Doulas know we have come a long way when it comes to being called "essential". Many organizations have studies that prove the presence of a trained and professional doula can improve birth outcomes. We can not afford to take steps backward now that we have been given an arena to shine.  Many would argue that this leaves the doula in training on the proverbial side of the road. How will they ever obtain the necessary experience and births required if certification is needed to enter the hospitals? I submit that certifying entities provide these doulas with other types of completion certification.  Or some other official document that allows them access and that hospitals abide by these newly formed documents.  Or they should rethink their certification processes that require birth attendance before certification altogether. If a doula is properly trained he/she should be able to do their job day one! On the job training should not be left to the student who is paying hundreds or thousands of dollars to be certified. Reporting and obtaining evaluations can still happen, if necessary. But seriously,  simply taking a seminar or workshop does not make one a doula. The time to create a fully educated doula is one that most of these organizations do not want to invest in, thereby requiring "on the fly" training. This does not do the laboring person any good if their doula is asking questions on Facebook..."help, this mamma is....what do I do now?"  Where's the mentoring? What tools have they been provided? Some agencies just take their money, expect them to self-train and offer no support along the way. 

The other piece of this puzzle that needs to be addressed is the seasoned doula who decided never to certify with organizations because of some of the reasons mentioned. Where do they fit in? Here I think letters of recommendation from midwives or OB's could suffice. If you have been around the block, you are known! Your work may very well speak for itself. This category of doulas obviously does not like the requirement of certification. It's all tricky, I know. I am also not equating certification to regulation either. (Again that's another story) Doulas aren't medical professionals, we fall back on this often. We can't have our cake and eat it too, though. We want to have insurance companies accept our fees of service, we want to be viewed as essential but we don't want to be regulated or certified. Going back to the religion analogy, we want government funding but we don't want to pay taxes. 

As a certified doula with renewal fees each year and continuous education courses and exams, I proudly submit my certification when requested. Like my degrees, they hold a sense of pride and accomplishment. As the doula coordinator for The Birth Center of NJ, part of my job is to ensure that doulas entering the center are ready for the task at hand. That they understand the difference of their role in the Birth Center versus a hospital and that they have some experience. In protecting liabilities, it makes the most sense to choose doulas with certifications as well as experience. To reduce surprise at the hospital or birth center door, when hiring your doula please inquire about their certifications. It might be OK for you if they don't have them or they aren't up to date. But know that they may not be allowed to doula you in some places. So it is critical to be a savvy consumer. If you are a doula in training, ask if your certifying entity offers credible and reputable certifications. Ask if your certification is lifetime based and how will/can that be updated to show you are current? Not renewing every year may seem like a bargain but if you certified in 2020 how will that be viewed 10 years from now... If other organizations are updating annually? Also ask them how do they support you when you have questions at future births? Will you too have to resort to Facebook groups for help? A dear doula friend who counts every single birth she attends said that she felt she hadn't fully known all there is to know until she attended over 100 births. The moral of the story here is that there is always something new to learn.  Unless we have a sure fire way of weeding out those who pose as doulas, certifications will and should be required in many spaces. 

Doulas and doula organizations should want to do all they can to protect this industry. We should have a way to fast track those who have already taken doula trainings but want to certify with someone else based on philosophy and support. We should have a way to mentor and protect new doulas in the industry so they can grow and feel ready when that phone rings! And we need to do all of this BEFORE state regulations start to pick and choose specific doula organizations as the role models that do NOT serve all populations nor doula philosophies. There is no ONE right way to be a doula, all cultures and styles should be available. All certifications should have value. But all organizations should be held accountable when their "trained" doula is left hanging looking for answers. 

I welcome your respectful comments!

https://jezebel.com/what-to-expect-when-youre-expecting-during-a-pandemic-1842396162

When others doubted my suggestions, more are flocking to find a birth solution out of hospitals. COVID-19 is building panic in the birth world. Midwives are now overworked and birth centers at closing in on capacity. As policies change around support persons, doulas are left to wait in parking lots and support virtually if the partner is with the birthing person. I want to remember this time I was interviewed not even a month ago. Not as an "I told you so", but at how quickly views shifted. 

We will get through this, but we will need to ensure that families get the healing they will need once it's all over. Planning for birth in this climate will be a challenge but not impossible. I'm teaching childbirth education classes now more than ever as parents are forced to become their own advocate. As well as their own comfort measure expert with guidance from virtual doulas, if applicable. There was a campaign some years ago called "take back birth".
​This rings true to its core today!

Breastfeeding, postpartum care, anxiety and depression will all have new meaning during the pandemic. Different versions of the new normal with take place in parenthood. Lack of support should not be one of them. Creating a postpartum plan is CRITICAL, even if that support is virtual. Rethinking birth plans also means rethinking life after baby. There are many postpartum doulas, nannies and nurse aids who have redefined their support structure during these odd times. Reach out! 

I'll end by wishing everyone beautiful birthing journeys in the new landscape of birth. Know that your rights can still be preserved and patient centered care can still be obtained. I do wonder if that doctor in the article above still thinks it's overkill to suggest different birth options now? In addition, the couple on the fence did switch to a birth center birth!

There are many types of doulas! Fertility, Labor and Postpartum are just a few examples. As the benefits of having a labor doula are flooding the internet, creating panel discussions and influencing policy changes some parents still are not sure when to actually hire the doula. This blog serves to speak about LABOR or BIRTH doulas only, those whose primary function is to attend the birth itself.
So when is the right time to hire your labor doula?

The quick answer? As soon as possible!

Hiring a Private Practice Doula:
To gain the full benefits of having a doula, time should be spent getting to know each other. Of course, this is assuming you have completed an interview process with local doulas and chosen your favorite. One who aligns with your values, birth philosophy, target experience and budget. I am not going to get into all that here. But should you like more information on how to begin finding a doula here's a good link. 

https://www.parents.com/pregnancy/how-to-choose-a-birth-doula/

Once you have selected your doula, hiring is the next step.
Ideally, you should be about 5 months pregnant or less. This may sound early, but your doula is also trained to assist you during your pregnancy. Comfort measures to alleviate headaches, nausea, back pain and all other pregnancy induced minor annoyances can be handled with a simple text to your doula. Your doula could also be a childbirth educator; so you may need more time to either attend classes or have detailed prenatal visits with education as the focus.

Navigating the “lay of the land”, your experienced doula has first-hand knowledge working with local providers and can give you some background based on your preferred options. Sometimes this may mean changing providers to obtain your desired birth outcomes. So hire your doula the earlier the better to ensure getting this information in a timely manner. For example; you are currently with a practice that does not support homebirths, water-births, birth center access, or VBAC (Vaginal Birth After Cesarean) and you want your best chance to obtain one or more of these birth choices. Your doula also has a vast resource list, from doctors/midwives to pediatricians to chiropractors.

Sounds great, right? However, a great doula is usually booked well in advance, so do not miss your chance to hire them and GET ON THEIR CALENDAR!

​I'm a private practice doula who insists on childbirth education classes with me before hiring me as your doula. That's just my philosophy. It builds our relationship while you attend classes, creates trust and an overall sense of empowerment. My clients actually prefer it that way. Most say "you don't know, what you don't know!"

Hiring a Community Doula:
Depending upon the community program there may be several procedures in place that would warrant getting started early. There may or may not be an interview process.
Some programs will assign a doula to you. In any event, resources and information will still be available in this collective of Community Doulas. The beauty of this program is the community based aspect, culturally appropriate and usually low-cost or subsidized if you qualify. In-house back-ups! As birth is unpredictable having a community of doulas can ensure someone will be at your birth. With a limited amount of doulas serving a large community, these doulas can be overbooked as well.
Call early to GET ON THEIR CALENDAR and/or see if you qualify. 

​Here is a great community doula program in my NJ area!
https://spanadvocacy.org/programs/doulas/


Hiring a Doula from a Collective/Agency:
Almost similar to the community doulas, this is a private group of doulas covering a specific area or demographic. The likelihood of interviewing your doula is greater in this format with the option for an in-house back-up. Covering the same benefits and resource aspects as the private doula with a greater pool and maybe even some discounted services due to referrals and packages. The volume of work coming through this collective almost ensures the need to reach out early to GET ON THEIR CALENDAR!

I also coordinate the Doulas affiliated with the Birth Center of NJ :)
http://birthcenternj.com/doulas/

And Baby Please Birth Services is now a Doula Agency, covering NJ, NY, PA, MD and GA. 

Hospital Doulas:
There are some hospitals that will have doulas on staff. You are likely not able to meet them beforehand to establish a rapport but it would be handled similar to nursing staff. If you are able to select your doula, antepartum care is limited. How you pay for this service depends heavily on the individual hospital policies. Call ahead to determine if and how your hospital handles these services, they may be on a first come first served basis and might be difficult to reserve. 

These programs seem to come and go. Or they just aren't advertised well, so calling the hospital directly is your best bet!
 
The last thing a doula wants to do is turn away an expected parent because their calendar is full, we usually work with other doulas to ensure support and good coverage. The majority of my repeat clients almost as soon as they get that first positive pregnancy test! 

Doulas have specific "on-call" times, for some it's at 37 weeks until delivery. For others, it's as soon as the retainer is paid or some variation in between.  So, you have to be clear and READ the contract you are signing. Being "on-call" means that should labor begin they will answer their phone no matter the time of day to support you and be ready to attend your birth. 

Nevertheless, sometimes it is just too late in the game to help.

Signs you are NOT on the doula’s calendar!

·       Calling the day before your induction for a doula consultation is too late

·       Emailing about services near the end of your 8 month with a list of different  pregnancy conditions is too late

·       Setting up an initial consult, signing the contract, never paying a deposit but calling while you are in labor is too late

·       Talking about hiring your friend/colleague as a doula, never signing or paying anything or even talking about it anymore but calling when you are in labor is too late

·       Calling when you aren’t pregnant and looking for a ton of information via dozens of emails means you need to take my SAVVY BIRTH 101 Workshop or any of my Childbirth Education Classes. 

·       Having a great connection during the interview, then ghosting the doula and never paying a retainer,  but you call to “ask for advice” and then decide if the doula wants to “show up to the birth for experience” without pay you wouldn’t mind them being there ...is just plain wrong

I have been a doula for over 15 years and all of the above have happened to me, one of them just a week ago. This is a business and warrants business transactions and contracts, (to protect you and the doula).  I am certain there are some unprofessional doulas who just don’t show up for births.
They do not represent us all! 

This is not just a passion to serve but a career for many. If you want a doula at your birth, hire us at the appropriate time in your pregnancy so that we can be most beneficial to you! Provide great care and improve your birth outcome!
Reach out as soon as possible and don't wait until the last minute. If you are holding out for refund checks or lottery winnings you are missing your window of opportunity to find the best doula for you. Talk to them about payment plans or gift certificates your family/friends can purchase. 
We are worth every penny and so is your birth story!

Need a postpartum doula?
​You should start that process in your 7th month of pregnancy or less ;) 
 
Written By
Michelle Gabriel-Caldwell
Owner of Baby, Please Birth Services Agency LLC
Childbirth Educator and Doula
​Evidence Based Birth® Instructor