This week I’m celebrating World Doula Week and sharing suggestions I give doulas at my trainings.
- Find your niche. No one can be all things to all people. What families are you best at serving? Do you have a passion for working with single or teen moms, moms who are VBACing or working with a midwife, moms who are having scheduled cesareans? Do you want to work with military families? Are you fluent in another language?
- The thing about continuing education is you’re never done. New research is continually coming out and we all must be reading, researching, and attending continuing education events. We also have a great deal to teach each other. Check out Round the Circle: Experienced Doulas Share What They’ve Learned, my new doula anthology that combines advice and information from twenty-three experienced doulas.
- You know enough to be of service now. The most important part of being a doula is showing up when you’re needed with a loving heart and helpful hands. Don’t wait for the moment you know enough to begin. It’s wonderful to learn all you can, but doula work is heart work, not head work. And we all learn as we go.
- Work on marketing. Polish your elevator speech and your website. Get the word out. Connect with doctors, midwives, prenatal massage therapists, chiropractors, yoga instructors, childbirth educators, and other doulas. Our families use our services and move on. For birth professionals marketing is like laundry; it’s never done. It’s probably not your favorite part of being a doula, but it’s necessary. And stay in touch with your families with an annual birthday card; referrals are the heart of most doula businesses.
- Consider expanding your services. Train so you can add childbirth education, postpartum doula services, lactation support, or placental encapsulation. The more you diversify, the more you’ll have to offer your families.
- Network. Attend conferences in your area and beyond. Be active on doula Facebook groups. Connect with other local doulas so you have a community to back you up, refer to, and support you.
- Charge what you’re worth. Think about what you spend on continuing education, childcare, gas, certification.
- Give back to your community when you can. Mentor a newer doula or take on a volunteer or low pay birth from time to time.
- Taking time off is necessary. Schedule time when you can go away with your family, go to sleep with your phone turned off, or buy tickets to a play or sporting event. This will help protect you from burnout so you’ll still be doulaing for years to come.
- Be part of a doula organization that truly supports you. You need an organization that does more than just train doulas. You deserve ongoing support as well.
Julie Brill, CCCE, CLD is the author or the doula anthology Round the Circle: Doulas Share Their Experiences. She trains doulas and childbirth educators for CAPPA, teaches independent childbirth classes, and volunteers as a La Leche League Leader.
- You’re already doing informal childbirth education in person, and by phone, text, email, and Facebook message. Offer formal classes and you’ll get paid to spend more in person time prenatally, getting to know your clients, and less time answering questions piecemeal.
- You’ll know your clients are receiving top quality childbirth education.
- Being able to offer childbirth education is a great selling point at interviews. You can offer doula/cbe packages.
- Your childbirth education students may hire you as a doula.
- Diversify your birth business! Earn money for work that doesn’t require you to be on call. Prevent burnout.
- There is much overlap between doula and cbe certification requirements. Your doula births can count towards cbe certification. Many of the books on the required reading list are the same.
- Your doula experiences will enhance your ability to teach cbe. You know firsthand what really works during labor, and the birth practices in your community.
- Childbirth educator training and certification is an investment in you and your business. Doulas with cbe certification can earn more for births because they have more to offer clients.
Julie Brill, CCCE, CLD, has been teaching CAPPA-approved childbirth educator and labor doula trainings in New England since 2003. Her next childbirth educator training is April 30-May 1 in Westford, MA. Registration is at www.WellPregnancy.com.
In traditional cultures around the world, new mothers observe a lying in period for weeks after they give birth. During this time they rest and recover from birth, nurse their babies, and eat nutritious foods. The community comes together to cook and clean for them, care for their other children, take over whatever daily tasks they normally do. Mothers who enjoy this postpartum rest experience lower rates of postpartum depression and greater breastfeeding success.
I know you probably don’t have a village coming to help you when your baby comes, so consider cooking and freezing before baby is born. For ideas, do an internet recipe search for meals that freeze well. Tell friends and family who offer to help that you’ve registered at Meal Train, or ask them to bring a meal that freezes well to your shower. And take some time before the baby comes to hire a postpartum doula.
When most people hear the word doula, they think of professional labor support. But doulas also provide in home support after the baby comes. They can help with household tasks, provide reassurance and emotional support, and teach the skills that you need when living with a newborn: how to feed, hold, swaddle, diaper, and bathe your little one. ”Our doula was a calm, supportive, kind, loving presence who knew tons of wonderful tricks to soothe our little girl,” remembers Kelilyn McKeever, who shared with me how her doula helped after the birth of her first child. “After her first visit I felt so comfortable I scheduled another visit, and the next time she came I was able to sleep! It was wonderful. I learned so much from her, and it was fantastic to be able to talk things over with her since I only have one baby as my frame of reference and she has so many!! I would highly recommend a doula to other new moms. As it turns out, hiring a postpartum doula was amazing for us. It transformed our lives – my life especially.”
No one prepared me for how lonely you can feel as a new mum even though you’re never alone,” Lesley Walsh, a new mother told me. “I didn’t really know myself as I was adjusting to this new role. My doula gave me the confidence I needed that despite my inexperience, my parenting choices were right. She helped me feel like all of this was totally normal. I would TOTALLY recommend a doula to new parents without doubt. I’ve said to so many people that the greatest gift you can give a new family is a few hours of a doulas time. My doula is the best. I am incredibly grateful for the time she and I spent together.
Kimberly Bepler who runs ABC Doula Service in Portland, Oregon described a postpartum doula to me as “someone to teach you all about your newborn, help you recover after birth, fill all the gaps you are neglecting in your home and kitchen, and help you and your partner learn to navigate new parenthood with confidence. Doulas make life better for families with newborns, with skills, education and experience.“ If a family needs additional support, for example a lactation consultant or help with postpartum depression, their doula can make referrals to community providers.
“Postpartum Doulas are trained professionals that care for postpartum families physically, emotionally and spiritually,” Jodi Krentzman a doula at Hip to Heart in Massachusetts, explained to me. “I try stay ahead of the game by anticipating the wants and needs of the family before they have to ask. I also troubleshoot any issues that arise with the baby (non-medical) and give them the tools to do the same when I am not there.”
Postpartum mothers are recovering from pregnancy and labor, and they are not sleeping through the night. Acclimating to life with a newborn is sometimes overwhelming. There are blissful and beautiful moments, but it is not all unicorns and rainbows. I spoke with Ann Tohill of Mountain Mama Doula. She sees her role as something that is “based on the family’s changing needs and varies day to day. I show up ready to take on whatever the family needs at that moment, whether it be a beautiful home cooked meal, fresh sheets on the bed, or someone to hold their baby while they shower or nap.”
Word of mouth is a great way to find a supportive, reliable doula. Ask your friends with kids who they recommend. Ask your childbirth educator, local La Leche League leader, prenatal yoga instructor, midwife, or pediatrician for suggestions. You want your doula to be certified with a reputable organization such as CAPPA or DONA, so checking their sites for help in your area is also a good strategy. Kimberly suggests, “call the doulas you are interested in and talk with them on the phone. Trust your gut. You will need to feel safe and nurtured and if your doula isn’t that way on the phone, she might not be a good fit for you.” Another doula I spoke with, Jill Reiter, who is known as The After Baby Lady, recommends “asking during an interview, ‘If we encounter an issue you don’t have experience with how can you support us?’ The answer should be something like I don’t have all the answers, but because of my training and/or certification I do have a network of resources I can tap into to help support you during different situations.”
“In addition to being wonderful with our daughter, the doula was looking out for me,” remembers Kelilyn, who describes her doula as incredible. “Home alone with a difficult baby my basic needs – like eating! – could get lost in the shuffle. Whenever our daughter napped, the doula would help with prep for the family dinner, laundry, unloading the dishwasher; it was another weight off my shoulders so I could relax and grab some desperately needed rest. As a new mom at home alone it’s easy to feel isolated and a doula really helps on that front as well. I wish we’d known so we could have had a postpartum doula come help us sooner.”
Julie Brill, IBCLC, CHLC, CCCE, CLD, CAPPA Faculty teaches independent childbirth and breastfeeding classes in the Boston area and via Skype, provides lactation consultations, and trains doulas and childbirth educators in New England for CAPPA. Her doula anthology, Round the Circle: Doulas Share Their Experiences, is available at Round the Circle and at Amazon. Julie is a La Leche League Leader and the mother of two teenage girls who were breastfed into toddlerhood.
“The best way to learn to do something is to hang around people who are already successful at what you want to do. Ergo, if you want to breastfeed, La Leche League (LLL) meetings are a great place to be!” says Dawn Burke, a La Leche League leader in Georgia, who I spoke with about her experiences at LLL meetings. “Pregnant moms benefit by learning ahead of time how to avoid or overcome things that can derail breastfeeding. Everyone spends so much time focusing on the birth. That is just a day or two out of your life. Breastfeeding goes on much longer. It’s important to spend some significant time before the birth focusing on breastfeeding, too. “
La Leche League was founded in the 1950s, a time when very few American women breastfed. Hungry for support, seven young mothers in Illinois began meeting regularly to provide each other with breastfeeding support, and to share information and tips. They called their group La Leche League because at the time saying breastfeeding was considered indiscreet. Today LLL is an international organization with meetings in sixty-eight countries.
La Leche League is a single mission organization, whose goal is to provide mother to mother support for nursing women and to promote a better understanding of breastfeeding. Leaders are all mothers with personal breastfeeding experience, who have also gone through additional training on providing breastfeeding support. They volunteer to provide support over the phone and through monthly meetings. Support is always free.
La Leche League also provides a wealth of breastfeeding information on their website, and through their publications including The Womanly Art of Breastfeeding and Sweet Sleep. Meetings are held in a variety of locations including libraries, churches, hospitals, and private homes. A meeting usually has a specific topic, but all breastfeeding questions are welcome and there is always the opportunity for mother to mother support.
There is something almost magical about the support that comes from sitting in a group of other nursing moms, who don’t mind if your baby is crying, or you feel like you don’t know what you’re doing. At meetings a lot gets said, but often a mom goes home with one tip that makes life a bit easier. Maybe it’s something about how to get more rest at night, become comfortable nursing in public, or prepare for going back to her job. Maybe she gets a view of an older baby, and what’s going to be coming along for her in a month or two. Maybe she passes along a suggestion to a new mom, who wonders how she’ll make it if mothering means permanently being this tired, this overwhelmed.
Shannon Vyff, a leader in Massachusetts I spoke with, remembers attending her first meeting with her jaundiced, colicky two week old. “It was my first time seeing other babies latch and I learned easier ways to do it, and how to feed ‘on-demand.’ I realized I didn’t really need to keep notes and time how often my baby nursed. I relaxed a bit. I loved being able to talk to other breastfeeding mothers since no one in my family breastfed, including my mother. So I kept attending and eventually became a leader. At meetings there is support for the duration of breastfeeding, and even natural weaning if one wants it.”
“Meetings put tools in your mothering toolbox.” Burke, the leader from Georgia, says. A mom can come to a meeting and say, ‘My baby is doing such-and-such, and I don’t know how to handle it.’ She’ll get five or six other moms who will say, ‘Oh, I went through that. Here are some things that helped me.’ Then she can choose the suggestions she thinks will be a good fit for her family. It’s OK to show up even if you didn’t manage a shower that day or your socks don’t match– we’ve all been there and understand that the early weeks with a new baby are intense. It’s a way to get out of the house with your baby for a bit and talk to actual adults.”
Meetings are not just for first time moms. “Although I’d successfully nursed two children, my third was a challenge from the start.” remembers Brandy Late, a leader from Kentucky who spoke with me about her breastfeeding experiences.” I had trouble getting him to latch. Once we were well established in nursing, I developed a very painful infection. My husband is in the military, and we had no family nearby for help or support. I’d never been to a La Leche League meeting before, but I knew I needed to be around people who understood how important breastfeeding was to me. Without La Leche League, I’m not sure that I would’ve been able to persevere through the difficulties we encountered. Now I love sharing information with moms and being part of their breastfeeding support system.”
You can attend a LLL meeting if you’re pregnant and thinking about breastfeeding, if you’re breastfeeding and supplementing with formula, if you’re exclusively breastfeeding, if you pump but only give your baby your milk in bottles, if you weaned your baby but want to relactate, or if you want to learn about breastfeeding or get mother to mother support for any reason. You’re always welcome to bring your baby and there’s never a cost. Visit the La Leche League International website to find your local group.
Julie Brill, CCCE, CLD, CAPPA Faculty teaches independent childbirth classes in the Boston area and trains doulas and childbirth educators in New England for CAPPA. Her doula anthology, Round the Circle: Doulas Share Their Experiences, is available at Round the Circle and at Amazon. Julie is a La Leche League Leader and the mother of two teenage girls who were breastfed into toddlerhood.
- Make sure you have your labor bag with you in the car (not the trunk) so you have access to your pillows, snacks, drinks, music, focal point, etc. Have a hot water bottle or ice pack handy. Since moving around and changing positions in labor makes labor easier, sitting seat belted into your seat during the car ride can be challenging.
- Eat something cold and sweet just prior to being admitted. This will help ensure that your baby is awake and active for the initial fetal monitoring, which can help you get off the monitor sooner. Continual monitoring increases the risk of interventions without improving outcome.
- Your labor support person can help you get back to doing what was working for you at home. Do you want to get back in the shower? Walk the halls? Rock on the birth ball? Slow dance? Finding your way back to these types of activities will enable you to relax, lower your adrenalin levels, and let your oxytocin levels get back to rising. It is common for labor to slow down when you come into the hospital, as finding your way, answering questions, and getting settled can pull you into your left brain. Adrenalin blocks oxytocin, the hormone that drives labor, so the sooner you can return to the labor rituals that were working at home, the sooner your contractions can pick back up again.
- Make your labor room home-like in the ways that are important to you. Playing music can help you find a rhythm, provide positive associations, and give you privacy. A special picture of your wedding, vacation, family, or pet can make an effective focal point. Smell is highly associated with memory. If you associate the smell of lavender essential oil with relaxation or the smell of a coconut scented sun tan lotion with a day at the beach, place a little on a cotton ball (not your skin). Some women find the scent of peppermint essential oil helps with nausea. Citrus smells such as lemon, orange, and grapefruit can be invigorating during pushing.
- Dim the lights in your labor room. Some families bring battery operated tea lights for this purpose. Melatonin, which we make in the dark, aids in raising oxytocin levels.
Julie Brill, CCCE, CLD, CAPPA Faculty teaches childbirth classes in the Boston area and trains doulas and childbirth educators in New England for CAPPA. Her doula anthology, Round the Circle: Doulas Share Their Experiences, is available at www.RoundtheCircle.com and at Amazon.
- In labor, continuous monitoring increases the risks of many interventions, including pitocin, epidurals, and cesarean birth, without improving birth outcomes for mother or baby. Asking a woman in labor to be still (and often in bed) so the monitor can do its job is not a benign request since it can result in a longer labor and more painful contractions. The American College of Obstetricians and Gynecologists (ACOG) doesn’t recommend routine continuous monitoring in labor.
- It is sometimes possible to be monitored near the bed (sitting on a birth ball, standing and swaying, leaning on the bed, etc.) rather than in bed, to increase comfort and encourage the labor to continue to progress. When mothers or babies need to be continually monitored, it is sometimes possible to get a telemetry monitor, which can be worn and allows the mom to walk the halls during labor.
- Babies are expected to have periods of sleep and wakefulness during labor. They will usually have a flat (steady) heartbeat during sleep and a baseline variablity during the times they are awake. Only the variable heartbeat is considered reassuring, so more monitoring is often done when a baby is initially asleep.
- Cold and sweet foods make babies move. Eating something cold and sweet prior to monitoring will help ensure a variable heartbeat and a shorter period of monitoring.
- Normal fetal heart rate is 110 to 160 beats per minute. A heart rate that is below 110, above 160, or flat for long periods of time is considered non-reassuring. The old term is fetal distress, but the wording was changed to acknowledge that no one can say for sure that a baby is in distress based on heart tones alone.
- Monitors can distract support people’s attention away from the laboring mom, and some families choose to turn the audio off and cover the monitor. Electronic fetal monitoring will show the length and frequency of contractions, but not their relative strength.
- Women birthing in hospitals can expect a period of monitoring of about twenty minutes when they are admitted in labor. Those birthing in free standing birth centers and at home will not have to meet this requirement.
- Interventions such as pitocin (used to induce or augment labor) or epidurals, and conditions such a premature labor, require continuous monitoring because of the increased risk.
- There are alternatives to electronic fetal monitoring. Fetoscopes can pick up the babies heart rate without exposing mother and baby to ultrasound. Since dopplers are handheld they are usually not used for more than a few minutes at a time, and thus are usually more comfortable than electronic fetal monitors which are held on with belts. If you are on the electronic fetal monitor, consider asking the nurse how long you’ll be on, and buzzing her after that amount of time if she’s not with you in order to be taken off the monitor.
- Internal monitors are both more accurate and more invasive than electronic fetal monitors. They are often accompanied by a fetal scalp blood sample, which gives additional information about the state of the baby. They require the bag of waters to be ruptured if it hasn’t released on its own, and once placed are usually used for the remainder of the labor. They are used when there is a concern about the baby’s heart rate, or when it is difficult to get the heart rate. Because they are less likely to produce a false positive reading, they can help to avoid an unnecessary intervention.
Celebrating National Kangaroo Care Day (May 15) by talking about baby wearing in this blog about newborn needs, and giving away a free NuRoo to one lucky winner, to be chosen at random. To enter the drawing, please send a message to me at WellPregnancy’s Facebook page by May 26. Let me know your mailing address, size preference, and if you prefer a black or teal NuRoo.
Your newborn’s wants and needs are the same. Later she may want a smart phone or a pony, and you’ll have to decide if that’s reasonable, but for now, if you can figure out what she wants you always get to give it to her.
Your baby’s behavior will make more sense if you think about what his life was like during pregnancy. For example, he was never alone for a moment. Many new parents are surprised that their babies will be happy in their arms, but begin to cry the moment they are put down, even when they are sleeping. Being alone is new for your little baby, and it will take some getting used. Hold him as much as possible to show him the world is a safe place, and before you know it he will be crawling away from you, walking away from you, running away from you, biking away from you, and eventually driving away from you. Enjoy the time when he’s little and wants to snuggle.
Baby wearing is a great way to be able to meet your baby’s needs for being held, while keeping your own hands free. It is an ancient way of baby care that is universal among traditional people. Babies that are worn frequently cry less, and so are able to put more of their energy into growth. Babies should always be worn facing towards the adult, not out. Some popular tools to wear your baby include the NuRoo, the Ergo, and the Mobi.
When a newborn is held or worn, his heart rate and breathing will synchronize with the adult he is with, and you may notice his breathing is more regular. Holding your baby skin to skin (he can be in a diaper) is a great place for him to acclimate to life as a newborn. When your baby is skin to skin, it’s easier for her to regulate her body temperature, a job she didn’t have to do as a fetus. If the room feels cool, you can put a blanket over both of you.
In utero life wasn’t silent; your baby could hear your heart beat constantly, as well as your digestive sounds, the swishing of the placenta, and sounds in the room. That’s why babies show a preference for familiar voices once they’re born; they’ve been in their listening and learning for months. Moms have noticed that if they play the same music while relaxing in the bath or during a massage during pregnancy, that playing that music for their newborns will calm them. That’s because during pregnancy mom and baby constantly converse hormonally. Therefore when you relax so does your baby, and he will learn to associate feeling calm with the music he feels at that time. Learn more about how you communicate with your baby prenatally in The Attachment Pregnancy.
While most parents know that crying is most commonly caused by hunger, I have heard many say that their crying baby isn’t hungry because they “just fed her.” However, just fed to a newborn and to a parent are often very different. Because your baby was fed constantly from the placenta down the cord, she doesn’t experience hunger until after birth. It’s a new sensation and she doesn’t like it. Because her stomach is so small, she can’t take in much at a time, so frequent feeds are key. It is normal for babies to need to feed ten to twelve times, or more a day. Keep her with you and feed her at the first signs of hunger (making sucking motions, rooting (turning her head), wiggling, touching her face with her hands). It will be less frustrating for both of you if you can feed him before he gets to the crying stage.
Have you heard that the days are long, but the years are short? The early days of parenting are intense, but you will soon be nostalgic for the tiny baby you child once was. Rest when you can, take pictures, and try to notice the details of this short but important time in her development.
Julie Brill, CCCE, CLD, IBCLC
Julie (at) WellPregnancy.com