Tag Archives: doula

Natural Disaster Labor

In the wake of hurricane Irene, the US’s East Coast is riddled with anxiety and fear. It’s been a tough week for us, given that natural disasters really aren’t our thing. The last hurricane to threaten the eastern seaboard was over 20 years ago when Gloria gifted us with a tropical storm in 1985. Add to that Virginia’s earthquake earlier this week that sent risidual tremors along the East Coast and many southern states, and we’re in panic mode here. News reports tell us what we should have on hand in the event of an emergency, but what about women who are full term in their pregnancies?

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Lakeisha Dennis, of Lighthouse Birth Services @DoulaonDuty, brought natural disaster births up on Twitter this morning. What happens to a mom if she goes into labor during an earthquake, hurricane or snowstorm? What does she do if she can’t get to her support, or if her support can’t get to her?

Here are a few things you should consider including in your emergency birth kit in case you go into labor without the ability to head to your birth place (or have your team come to you).

1. 3 gallons of water – mom will need to stay hydrated during labor, and will need extra water for cleaning both during and after the birth if she desires. Keep an additional gallon of water for each person present.

2. Canned fruit, nuts, vegetable chips, and other non-perishable healthy foods to last at least 3 days.

3. Disinfectant – in the event that you have no running water, you don’t want to waste your drinking water washing your hands.

4. Dental floss – you can use dental floss to tie off the umbilical cord once it stops pulsating if you choose to detach it.

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5. Large garbage bags – aside from their normal use, plastic bags can be used as lining for your furniture or floor as a protective layer against fluids.

6. Sheets that you don’t mind ruining – you can use these on which to labor, in addition to staying dry and warm. Old sheets are also great for cleanup, because you can toss them when it’s all over!

7. Towels – have several on hand for cleanup and staying dry/warm for both mom and babe.

8. A few sets of clothes – there’s nothing like searching through a dark, flooded or otherwise damaged home to find clean clothes in an emergency. Keeping protected, clean sets with your emergency birth kit will help you greatly in your time of need. Remember to include baby clothes and diapers

9. A mirror to go with the flashlight you’ve already got in your emergency kit. During labor, you may need to see what’s happening around your vulva, especially if you are birthing alone. With a 40-week belly, a mirror will help you get a handle on what’s going on down there.

10. An extra fully charged battery for your mobile phone – in the event that you have service, but no electricity, you’ll be happy that you set this aside to be able to reach out for help!

Although these are some great things to keep in your kit if you can, you’ve also got to be prepared to use them! Check out Penny Simkin’s Birth Partner; she’s got great advice for what to do during an emergency birth.

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Also, speak with your provider about a contingency plan. If you’re birthing at a hospital or birthing center, what happens if disaster strikes if you are either already there in labor or in labor at home en route to your birthing place? Speak with your midwife about what to do in the event that neither she nor her backup can make it to you during a disaster. Ask your doula about how her services might change during an emergency.

What Not to Ask Your Doula

There are many lists and resource guides about what to ask your prospective doula when you interview her. I’ve even included a post here about asking whether or not your doula can help you apply for reimbursement from your insurance company for her services. I can’t say that I’ve seen any lists advising parents what not to ask their doula, however. I’m happy to have the honor (grin).

Every woman comes to her birth filled with experienes that have gotten her to this point. Because of her experiences, she expects her birth, and conversely, her birth team, to pan out in a particular fashion. Birth plans are an important part of birth that are often overlooked, and I can’t think of one doula that I know that doesn’t promote them in some way. Women also want the members of their birth team to have a certain level of experience, whether professional, personal or both. For some women, that means being surrounded solely by other women. For others, it means hiring a doula that has attended a certain amount of births. Still, there are many women who prefer to hire a doula that has labored and given birth herself. These are all valid desires. Birth is an extremely vulnerable situation, and a woman absolutely deserves to have her needs met during labor.

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Part of our training as doulas includes effective communication. We learn to be aware of our facial expressions so we don’t offend clients as they share personal information. We learn to be active listeners so that, even if we have given birth ourselves, we allow our clients to have their own experiences. We even learn to keep our own tempers under control when something happens that would, under different circumstances, drive us crazy.

So, why this post? It’s been my experience that women who are TTC form bonds and support each other through the turmoil. However, it’s also been my experience that women with successful pregancies sometimes forget (and rightfully so!) the ups and downs they’ve shared with their sisters in the struggle for what, for some, has been years. Pregnant women have graduated TTC college, and have every right to enjoy their pregnancies with other pregnant women. Along with that, they have every right to want a doula who has experienced pregnancy and labor herself. But mamas, please consider the following.

A childless doula may not have children because she simply doesn’t want any. The doula you’re interviewing may not be able to conceive. The lovely woman sitting across from you at the coffee house as you feel out her qualifications may be overcoming the heartache of a miscarriage. She may be a single woman who wants children, but can’t afford artificial insemination or IVF. The woman who scores high in every area on your checklist except for whether or not she has children may have given birth to a baby that didn’t survive.

Does this mean you should stop caring about whether or not your doula has children? Absolutely not! Your desires are yours, and you deserve to have your needs met by all means. Do continue to ask ask, “Do you have chidren?,” as you interview. Please do not ask, “So, why don’t you have kids?” It may seem like a harmless question, but it’s one that could have devastating effects on a doula who planned to have a lovely afternoon chatting with you.

“Mother is Worthy to be Praised”

This Memorial Day Weekend I went to see Dance Africa at the Brooklyn Academy of Music.  As usual, the dances were amazing.  What stood out to me most, though, wasn’t the dancing at all.  Through the clapping, shouting and audience participation, I noticed the stretchmarks on one of the dancer’s bellies.  Things suddenly began to move in slow motion for me, almost like when Maria and Tony see each other at the dance in West Side Story.

I realized that I was watching a mother, and suddently felt some cosmic connection to her.  I began to wonder whether her children were in the audience, how old they were, or if any were possibly sharing the stage.  I wondered how she was able to find time to do something so magnificent with herself while conducting a family.  I wondered whether or not she raised her children, or if they knew how talented their mother is.

At the end of the show I stood in applause. Of course, the round was for all of the dancers, musicians and singers who graced the stage.  There was, however, a special beat in my heart in praise of the woman I had identified as a mother.  I’m sure she wasn’t the only mother on the stage.  In fact, the audienced was sprinkled with mothers holding small – and not so small – children.  If I was surrounded by mothers, what made this one so different?

During a time where it’s almost impossible to watch television for an hour without a cocoa butter or other stretch creme commercial promising to help women either prevent or erase their stretch marks, I found it amazing that this mother proudly bore the marks of her birth(s).  Just as waist beads, hair style, or jewelry denote status and rites of passage for women in traditional African cultures, so, too, do stretch marks. 

Watching this mother’s belly flap to and fro across the stage brought me back to the precious moments immediately following birth where a woman bonds with her baby face to face for the first time, and took me to the moment that I observe in so many women when they realize their bodies have undergone an amazing change; she not only birthed her baby, but she birthed her motherhood as well.  So, I stood and clapped that Monday afternoon in praise of motherhood.

These last few days I’ve been in reflection mode.  In reviewing both business and personal goals, the one thing that keeps coming back is the Yoruba proverb that’s the inspiration for my doula practice:

Oria bi iya ko si, iya la ba ma a bo

There is no Orisha like mother, it is mother who is worthy to be praised.

Praise mothers.  Praise them for the weeks they carry and nurture their children in waiting.  Praise them for the sleepness nights they endure for so many years of their lives.  Praise them for the decisions they make that often leave them holding the shortest stick in the bunch.  Praise mothers, simply because they are worthy to be praised.

Preconception Planning III: More Trying and Less Conceiving

TTC can be the most emotional time of a woman’s life, especially when trying for several cycles. The moment your uterus begins to shed its lining you feel that nature has betrayed you. For some, it feels as deeply as the loss of a child.

We’ve all memorized Taking Charge of Your Fertility, and know by heart which links to click on Mayoclinic.com. We can read basal body thermometers in the dark, and chart temperatures with our eyes closed. And when we realize that we touch our cervixes more frequently than scratching our noses, it’s clear that we’re experts in knowing what’s going on with our bodies to recognize ovulation signs.

There’s advice about the best time to take your temperature, how often you should check cervical mucus (CM), how to interpret your charts, and the best time of day to use an ovulation predictor kit (OPK). But what happens when these things aren’t coming together like the beautiful celestial chart that they’re supposed to form? Shouldn’t these methods be fool proof?

Here’s what you don’t get along with the advice: not every woman has egg white cervical mucus (EWCM), and the OPK may not detect your hormone levels clearly.

I can’t stress enough how important it is to begin charting your temperature months before you begin actively TTC, especially if your cycle isn’t very predictable (I hate to think of my cycle as irregular!). Become comfortable with analyzing your charts, and seek expert help when things don’t make sense to you. Pay attention to the moistness of your vulva the days following menstruation, and try to notice whether or not you feel any slight cramps the more moist you become (without stimulation). Before you know it, you’ll be able to feel your body releasing an egg (or two!).

Learn to differentiate between your own CM. Recognize that as your body matures your CM can change (I haven’t had EWCM since my early twenties!). Some women go from dry, to watery to creamy and never experience sticky or EWCM. Some women go from dry, to watery, to EWCM, to creamy then sticky. Some women’s bodies may do something different all together. If you’ve been paying attention to your body for months before trying, you’ll know your cycle and won’t be waiting for EWCM when watery may be your ovulation sign.

Practice peeing on different brands of OPKs. You may notice that as you approach ovulation a faint pink line appears, grows darker over the course of the next 3-4 days, but never quite matches the test line. Does that mean you’re not ovulating? It could mean a number of things, and you should speak to a specialist to help you understand what’s going on. Some women never match the test line, and the faint line is their ovulation sign. I’ve only tested positive once with an OPK, and the positive result appeared after my temperature had already spiked. Go figure!

Sometimes we end up trying so much (unsuccessfully) because we aren’t interpreting our signs accurately. Sometimes we don’t trust our bodies enough to believe what they’re telling us instead of an OPK or someone else’s assessment. There are also times when this isn’t so cut and dry, and that may be a sign of something else going on. It can be hard to stay positive when you try cycle after cycle, especially when it seems like people around us get pregnant without even trying. But staying positive is a must!

Here’s to more conceiving after so much trying.

Don’t Give Your Voice Away, Not Even to Me

Every once in a while during a consultation a mom will ask me, “…and you’ll be able to speak to the hospital staff for me, right?” In response, I smile and tell her that I do not speak for her, but rather show her how to advocate for herself and her baby.

Communication is key in everything we do. Sometimes, as women, our voices have been silenced – by our families, society at large and even by our partners. Someone often thinks they know better than we do, and can show us the best way to handle a situation. A lifetime of learned helplessness doesn’t vanish when we become pregnant. If anything, our insecurities are multiplied. We learn to distrust our instincts and our bodies.

What does mom need to speak up about?

I always tell moms to research any information they’re given, even when it’s coming from me. All too often, we listen to “experts” without using our critical minds to question what’s being said. We spend more time researching the kind of car we want to buy than we do research regarding our health and wellbeing. It’s important for moms to question and ask for more information from their care providers, because care providers often turn questions into statements or commands.

For example, “I’m going to break your water now, because this will really help things get going.”

This should be a question: “You’ve been at 7 centimeters for 5 hours now. I think breaking your water will help to speed things up. What do you think about that?”

See how the latter asks mom for her input? She even has a chance to decline. The former, on the other hand, leaves no room for discussion. This is where mom has to feel empowered enough to advocate for herself. She could stop and ask for more information – risks vs. benefits. She could also ask what other interventions, if any, the recommended intervention may lead to. Breaking the sac before mom is 10 centimeters often leads to a fetal scalp monitor, an intrauterine pressure catheter and a foley catheter to channel urination. These interventions are often left out when the care provider walks in with a smile ready to rupture your membranes.

Why can’t the doula ask these questions?

There are some doulas who offer to speak for their clients. I think that’s just as much of an injustice as the rest of the world taking away a woman’s voice. The issue with asking or expecting your doula to speak for you is simply that she isn’t you! You run the risk of turning your experience into someone else’s when you give up your voice. You may be opening the door to allow your doula to relive her own birth experience through you. You create an atmosphere where it’s possible to not have your best birth when you give up your voice. If you relinquish your voice during labor, with what voice do you plan on raising your child?

So what do I do?

During your prenatal visits with your doula, ask her to help you role play different scenarios. Start simple with things like drinking and going to the bathroom, to more complex like negotiating interventions and holding your baby. Create code words with your doula so she knows if you need help making a decision (and by help I don’t mean the, “What would you do?” kind of help – but asking the doula for more information about a topic to help you make your own decision). Write a birth plan so you can see on paper what you’re expecting from your birth. Use your birth plan to ask questions of your care provider during prenatal appointments so you have clarity before you go into labor.

Don’t be passive-aggressive about your desires, discuss them upfront. I’ve seen too many moms simply email their birth plan, or bring it to the hospital while in labor; these types of plans often go unread, and mom is displeased with her birth experience. Your care provider works for you! Have the necessary proactive conversations before you go into labor. You should also register for an out of the hospital childbirth education series to help you resolve communication issues.

“Birth is powerful, let it empower you.” author unknown

Outsourced Womb

Call centers, customer service, adopted North American names and conversations about the weather from around the world. Outsourcing, no matter how you feel about it, is part of our lives and looks like it’s here to stay. But I’ve never, in a million years, imagined that we’d be outsourcing wombs. story deliverying test tube

International adoption is, by now, old news in the U.S. Adoption is, after-all, a long and tedious process here. Not to mention the many states that make it impossible for would-be LGBT parents to adopt. Going overseas to make one’s dreams come true is sometimes the only option. But now we’ve taken our import/export endeavors a step further, and international surrogacy is on the rise.

Bargain Birthing

Instead of call centers, India is seeing an increase in boarding homes for women who have wombs for rent. Compensation of about $5,000 is the exchange for becoming a surrogate mother in India. International surrogacy is becoming popular in the Ukraine as well for North American families looking for women to carry their babies.  Compare that to the $20,000 to over $100,000 it can cost to attempt IVF or surrogacy in the United States.

Baby in a tubeBecause the trend is so new, little legislation exists to regulate the process. Who would be deemed responsible, for instance, in a case of infant or maternal mortality? Or biological parents who, for whatever reasons, decide they no longer want the baby? Such was the case of an abandoned child of Japanese parents born in India. The parents divorced while the surrogate carried their child, and neither party wanted to care for their baby. Luckily, India will begin to regulate international surrogacy.

Although LGBT relationships have been decriminalized in India, hopeful LGBT parents will not be able to pursue parenthood through international surrogacy.

One other aspect of regulation will be placing a limit on how often a woman can rent out her womb. Most outsourced babies are born via cesarean delivery, putting the surrogate mother at risk. Cesarean birth is major abdominal surgery that becomes more dangerous and risky with each new pregnancy/surgery.  Sometimes, when we want children and can’t have them without medical intervention we’ll attempt whatever is possible to bring us that bundle of joy.  There’s still so little known about the long term effects of the drugs involved on both the surrogate mother and the baby, that I’m not sure I could take the risk.

Zippi Brand Frank’s HBO documentary Google Baby delves into the issue and sheds much needed light.

Get Your Insurance to Pay for Your Doula!

Every once in a while I get a call from a mom who is really interested in having a doula attend her birth, but she doesn’t think she can afford it.  In NYC the average experienced doula charges around $1,000 per birth.  There are doulas who do frequent volunteer births, and others who work on a sliding-scale or a flat-rate low fee.  Wouldn’t it be great if women could interview doulas and not have to worry about money?  There are tons of lists floating around online about the questions you should ask your prospective doula, but very few remind you to ask if she has an NPI number.

What’s an NPI?

It’s been about a year since doulas have been able to apply for National Provider Identification (NPI) numbers.  The NPI number tells insurance companies that an individual is an actual service provider, and is used to process payments and/or reimbursement.  If you interview with a doula who is out of your price range, ask if she has an NPI number.  Having the NPI number alone doesn’t guarantee reimbursement, but it’s one major step in the right direction.  If you’re searching online and have come across doulas with whom you’d like to set up consultations, you can check to see if they have an NPI number here.

How do I know if my insurance covers doulas?

With this big advancement in the doula profession comes big confusion.  Coverage and reimbursement by insurance companies are different areas.  Coverage means that your insurance company will pay your provider’s fee when services are rendered.  I’m not aware of any insurance companies that cover doula services.  Reimbursement, on the other hand, requires that you pay your provider’s fee when services are rendered and your insurance company sends you a check after the fact.  Reimbursement can be in full or for a portion of what you actually paid.  I’ve heard of moms being reimbursed $375 of the $400 their doula charged, and a few other instances where reimbursement was within $200 of the doula’s fee.

Getting reimbursed

Get in touch with your insurance company and ask what the process is for reimbursement.  Your doula may be able to give you this generic form, but if your insurance company prefers that you use their forms it would be good to know that beforehand.  Your doula will provide you with the necessary information like the NPI number, and her S.S.# or EIN to help you complete the form.  In addition to the claim form, ask your doula for an invoice and a letter that describes her services.  The letter is helpful, because it shows the insurance company how the doula may have actually saved them money.  Many moms report having to submit twice before being reimbursed, so don’t desist in the process if you’re not approved the first time around!  Your doula does not have to be certified by any organization in order for her services to be rendered reimbursable.  However, if she is a member of a certifying organization she may be able to get advice from them with regard to helping you get some money back.

When expectant moms get in touch with me, but have concerns about how to pay for a doula, I remind them about the possibility of being reimbursed by their insurance.  Usually, they feel more at ease knowing that they may be able to get their insurance to pay for their doula!