Angela Ivory 15/04/2020 Angela Ivory 15/04/2020

My Birth Doula Contract - What it is, Why we have it & What to expect

You may have had a friend recommend you invest in a Birth Doula, you may have read about what a Birth Doula can offer while browsing online, you may have even come across the role of a Birth Doula in a pregnancy or parenting magazine. Do you jump on google to find out more?

Perhaps the next step for you is to browse and see who is available in your area, or maybe you just have lingering questions and you are not quite ready to reach out just yet. One of these questions I am sure you keep tucked away while you ponder is ‘How do I know they are the right fit for me?”. I encourage you to pick up the phone and call the Birth Doula, or to email them if you prefer. Part of my service (and most other Birth Doula’s too) is to chat first and then arrange a ‘meet and greet’.

A meet and greet is offered at no charge (for myself & again most other Birth Doula’s) and is usually around an hour’s duration. We meet at a cafe or it can be in your own home, depending on what makes you feel the most comfortable. This is the opportunity to ask your Birth Doula all your questions, their philosophy around birth, where they trained, how many births they have attended, do they have a back up person they work with and if so, will you get to meet them?, what is their scope of practice? do they offer you a copy?, how many births they will attend per month, if they will attend births in hospitals, birthing centres or home births, or all of these options?

You may like to obtain references or testimonials. At the initial meet up, the Birth Doula is also considering herself whether she feels that she will be the right fit for you too - it is a mutual decision, and often both parties come to the same conclusion at the end of the meeting.

At the meeting my potential client/s receives a folder with a copy of my Birth Doula service contracts (I offer two), information about my other support services, a copy of my scope of practice and a handout on The Benefits of Birth Doula’s. Couples or individuals will then take this information away which gives them the time to talk over their thoughts and feelings before making a final decision.

Depending on the Birth Doula (and like a Midwife) you will need to make your decision fairly quickly as they may no longer be available if you leave it too long. Some of my Birth Doula friends will only attend one birth a month and another will attend up to 5 - so it does vary.

Once you have made the decision to go ahead - great. You will be asked to pay a deposit (that varies from Doula to Doula), read, sign and date the contract and then begins the wonderful journey of having them work with you for the duration of your pregnancy, birth and for some of your post-partum period.

What is in a Service Contract?

This can vary but typically you would expect to be offered:

Up to two antenatal visits
Devise and write up a birth plan (or two) together
Comfort measures for birth and labour
Support via phone or email for the duration of your pregnancy and birth (and some post-partum)
On call 24/7 from 37-38weeks through to 42 weeks of your EDD (so this on-call period can be 5 weeks to a month)
Stays with you from the moment you need their support when in labour, to approx. 2 hours post birth
Can take photographs if requested and keep family/friends updated via text/email if requested
Offer further services & this is individual to each Birth Doula (e.g pregnancy massage, aromatherapy oils)
Visit once or twice in the post-partum period to see how you are managing and whether you made need any additional support (light housework, cooking, help with baby)

What about the cost factor?

Each Birth Doula’s service fees vary, the majority asking for a deposit up front (approx. 50%) of total service fee once the service contract has been signed, with the final payment made at 37-38 weeks - this is so your Birth Doula can be on call for you 24/7, from this time on. Again, this may vary, but the usual expectation is that the last payment is made at the time (mentioned above), and some Birth Doula’s will enforce that they will not be on call until this final payment has been received.

Antenatal visits vary, I offer two which are a few hours in duration each, and this is where we discuss their concerns, thoughts, doubts, fears and expectations. We discuss comfort measures for labour and birth, offer our resource/referral list, what it will look like for them as I attend their birth, the roles of all those attending your birth (medical staff included) to name a few. A part of my service with my holistic health background is to discuss the use of Bach Flower Essences or Homeopathic remedies if this is something that interests them and, more often than not, the additional services (add-ons to my service contract) are taken up as they can see the benefits of non-medical pain relief options once these have been explored. However, I do have clients that are very aware of my training and background and tell me from the day we meet that they are not interested in my potions and lotions - they will be having an epidural and that is that! That’s all good! So, is it my role to ‘try to change their mind?”. No it isn’t. I will of course want to explore what led them to their firm decision, offer research and a discussion (the same which I offer in a Childbirth Education class) and if they are still firm with their decision, great. As long as I know they have made a fully informed decision, I am going to honour that.

When not visiting face to face I like to check in every few weeks to see how they are getting on and if the need any assistance in their decision making. This is where it is crucial to be careful - we cannot give our personal opinions about what we think they should do or “what I would do if I were you” scenarios, rather, we offer evidence based information (with up to date research) and allow them to make their own decisions - IF of course this is something they wish to pursue. Which leads me to the Standards of Practice/Scope of practice, and why it is so vitally important. It is in place so that you, as my client, understand services rendered, limits to practice, advocacy, referral process, continuity of care, training and experience.

A Code of Ethics outlays our rules of conduct, ethical responsibility to clients, ethical responsibility to colleagues, ethical responsibility to the birth doula profession and ethical responsibility to society.

I like to send an email to the Lead Maternity Carer to introduce myself, and I am happy to meet with them at one of the client’s antenatal appointments if this is something the client and/or the LMC requests.

Birth Plans?! Yes, plans. One for a normal physiological vaginal birth and one for a caesarean birth - consider both carefully and document your wishes as you don’t know for sure how your birth experience will unfold. There are differing opinions on birth plans e.g. they never go to plan, it just goes out the window anyway… some of it can, for sure. But…. just because some things don’t go quite as you had hoped - doesn’t mean the whole entire experience has been ‘wasted’. And, this is just what we go through - different scenarios & what is likely to unfold.

Birth - The time has arrived for you to birth your baby. You may go into spontaneous labour or perhaps a decision has been made for an induction - either way your Birth Doula is there for you with a toolkit of support measures. She will see you through side by side, hour by hour, minute by minute to ensure you can have the best birthing experience possible. When you feel ready, you will want to be alone with your new baby and your birthing partner - this is the time your Birth Doula says farewell and makes her way home feeling exhilarated, but tired!

Post-Partum - A visit or two to see you and baby will include (if offered & varies between Birth Doula’s) - a home-cooked meal, baking, picking up any items you may need, light house-work, helping with baby (settling & soothing techniques) and offer a listening, supportive ear.

Please know your birth experience is an experience the Birth Doula will cherish also. The connection and bond created lasts long after the birth of your baby so much so, that not only do our clients keep our number on their phone (‘for just in case’) we feels so privileged that you’ve invested the trust in us to be a part of your next birth experience!

Angela Ivory 14/04/2020 Angela Ivory 14/04/2020

What on earth is a Birth Doula and why would you hire one?

If I could give you a dollar for every time I have heard the question “What is a Doula?” well…….. you know the answer to that one……. But, seriously, let’s talk about what a Birth Doula is - because I sure wish I knew about them when I had my 3 children.

To understand the role of a Birth Doula first we must distinguish the role from that of others involved in the childbirth process as each has a defined role to play. Midwives and Obstetricians - are responsible for clinical and/or medical aspects in the care of the woman, it is their top priority. A Birth Doula is NOT trained to make any medical decisions, but that doesn’t automatically mean she is not medically trained. A Birth Doula can have a background as a registered nurse or midwife, but as such, is no longer practicing and has chosen to work as a Birth Doula. So, what do we focus on and what is our role to play as Birth Doula’s? Psychosocial and non-medical aspects of care. For those of us who don’t have a medical background we certainly gain a fair amount of knowledge during our training and each birth we attend this knowledge further expands.

Most Birth Doulas (but not all) have had children of their own. Having given birth before, you gain the innate sense of what the experience of childbirth is like and therefore, you hold the ability to feel and share your empathy with ease. I want to discuss for a moment the focus of the Birth Doula in relation to the mother-to-be and her birthing partner. Why would you need a Birth Doula when you have your partner? My initial thoughts too - until I thought back on my 3 childbirth experiences, trained as a Birth Doula back in 2018 and from then have attended many births.

The Greek word Doula means ‘woman caregiver.’ These days, this term describes a trained and experienced labour companion whose role is to provide the mother-to-be and the birthing partner continuous emotional and physical support, through massage techniques, use of a rebozo (a long scarf used in many different ways e.g. controlled movements for comfort during labour), helping with labour positions, breathing and relaxation skills, positive affirmations, educating and empowering women during their decision making & birth plans and may even be able to offer HypnoBirthing techniques (check their training).

This is where the beauty of a Birth Doula lies- we all have something unique to bring to our role, our life experiences, ongoing professional education (which we all do because we all get addicted to the many courses/seminars/ongoing training that is available in the birth world……!).

Here is what a Birth Doula does in a nutshell (From DONA Int What is a Doula Workshop Manual, 2017)

Recognises birth as a key life experience that the mother will remember all her life
Understands the physiology of birth and the emotional needs of a woman in labour
Assists the woman and her birthing partner in preparing for and carrying out their plans for their birth
Stays by the side of the labouring woman throughout the entire labour
Provides emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions
Facilitates communication between the labouring woman, her partner , her clinical care providers
Perceives her role as one who nurtures and protects the woman’s memory of her birth experience
I am humbled to write that the acceptance of Birth Doula’s in maternity care is slowly, but surely gaining recognition - this is of course our contribution to the improved physical outcomes and emotional well-being of mothers and their babies.

The World Health Organization recognises the benefits of continuous support during childbirth https://www.who.int/reproductivehealth/topics/maternal_perinatal/support-during-childbirth/en/ but the KEY takeaway message is this:

Women who received continuous labour support were more likely to:

Give birth vaginally
Had fewer caesarean, forceps or assisted vacuum births
Were less likely to use pain medications
Were more likely to be satisfied with their birth experience
Had shorter labours

How Does a Birth Doula and the Birthing Partner work together to support the birthing person?

Concerns we hear from potential clients when being interviewed are that they are concerned we might interfere with the couples intimate birth experience, the partner may be pushed aside, we have taken childbirth education classes so we don’t need any more support to don’t we get in the way of the midwife or obstetrician? They are all fair questions.

Firstly, The Birth Doula allows the partner to participate at their own comfort level. The partner can’t be everything, all the time and can often feel pressured into ‘getting it all right’ and worried they won’t know what to do or may have fears around their own behaviour (particularly in first time births - it is a new experience OR if they have attended a birth that may have been traumatic in one way or another - extra support for them is vital). We are able to supplement their efforts, during a long labour the birthing partner can take a break and know their partner is being fully supported. All in all it reduces stress - and this is what we aim to avoid from the start and for the entire duration of the birth experience. Combined effort and contribution of the birthing partner, Birth Doula and medical staff only serve to give the birthing person the best outcome. Why wouldn’t you want that?

Childbirth Education. It’s fabulous and so downright beneficial in so many ways (this will be a separate blog…). So is it enough to take the classes and then hit the dance floor so to speak? Yes AND No. As a certified ChildbirthEducator myself, I am the source of information, whereas a Birth Doula is the guide in helping the mother-to-be and her birthing partner to find further support, evidence-based information and resources specific to their own needs. We encourage our clients to not only gain knowledge, but to make their own choices and understand the reasoning behind it all. So, childbirth education + Birth Doula = an extensive knowledge base + added confidence and reassurance of the Birth Doula throughout the duration of their labour and birth experience. The best of both worlds!

What is a Birth Doula is a huge topic, and I feel I have only touched on it. My next article will go through my ‘typical Birth Doula’ contract which breaks down how I work and what my support service offers from the moment we meet to a few week’s post-partum. Take a peek at one of my birth stories (shared with client’s permission) so you can get a real insight into what the support ‘looks like’.