Thursday, October 16, 2014

I Am Not the Doula For Everyone

At the beginning of our doula-in-training journeys, I think we all want to be the world's doula. We say yes to every potential client who comes our way -
"Yes! I WILL be your doula!"
- No matter who she is. We want those experiences so badly! And we know or recognize everything that we will come to know and recognize.

I am grateful when I interview with someone who asks me numerous questions that are only going to lead her to be disappointed in what I say, and she does not hire me.

I am grateful when I interview with someone who says they want an intervention-free birth and a doula because their friends did it or they saw it on TV, but don't really know what a doula is and just do everything their doctor says, doesn't hire me.

I would be grateful to not be hired by the woman who wants a cesarean section for convenience (though, thankfully, I've never encountered this), or a woman who has no interest in breastfeeding, or something else I believe in.

I am getting better at recognizing a doula client who will not be a good match for me. Luckily, I've had to say "I don't think I'm the right doula for you," only once. Sometimes I say I am unavailable (often true) and refer her to other doulas. Sometimes the client simply hires someone else (I assume)...

When a woman who I would like to hire me doesn't hire me for any number of reasons -
  • I'm too young and don't remind her of her mother 
  • I have not birthed a child of my own
  • Because I don't do aromatherapy/TENS/etc. 
She is grateful that she has not hired a doula that is not right for her. 

And I recognize that it is OK, because I do not want to be hired by a client that is not right for me, and am grateful. It comes from both sides...

I am not the doula for everyone.

Friday, October 3, 2014

Doula Re-Certification

This month marks 5 years since my DONA International doula training workshop, where I began my doula journey. Just a couple of months ago I renewed my CD(DONA) certification!

There are many doulas who choose not to re-certify, or to certify in the first place, for that matter. Certification is the effort to professionalize and legitimize the doula profession, to have it be recognized by health care providers and consumers as a trained role backed by a regulating body and a code of ethics.

There are some who say that doula work does not need to be professionalized or legitimized. Many doulas say they have no issues finding clients or doing their work as non-certified doulas, so it is not worth the cumbersome paperwork and cost of staying affiliated with the organization. I completely understand this perspective.

Others say that DONA's code of ethics and scope of practice are too narrow - they do not allow you to speak for the client, do not allow you to contradict the medical advice given by the provider, do not allow you to say that you are providing aromatherapy/other therapeutic techniques as a doula (you can do so as a trained aromatherapy practitioner, though). I personally think it is right that there be some boundaries that you do not cross in the role of a doula. The doula training is not medical training (if you have medical training, that's a different situation) and it does not make a professional with essential oils. I strongly believe that in order for doulas to remain allowed to come into the delivery room, we do have to play nice with the doctors and nurses (its common courtesy, anyway - just be friendly not combative)! Also, we shouldn't ever presume to put words in someone's mouth, especially someone who is about to become a mother (one who we hope will be a strong and confident mother, which often starts with birth).

DONA is ensuring that no doula ever oversteps her bounds, for the safety of the woman and her family.
I respect any doulas choice for certifying or not certifying. I will not judge you for doing so or not, as I hope whether or not you spend the time and money for the credentials that you still follow a scope of practice and a code of ethics that only helps women and other doulas, and does not hurt them. Doulas need to make sure that we build a positive reputation and never make any bad press for one another.

I chose to re-certify, and it really was not too rigorous. I started very soon after I became certified initially - I brought some papers to clients for them to sign to prove that I was at their birth, or had them fill out evaluations on me. I took my CLC training, and that knocked all of my continuing education credits out in one fell swoop. As my re-certification date neared, I did realize that I was missing a signature from one more mom, and asked a recent client to sign a form for me. Piece of cake! Submission wasn't too hard, and a couple of months later I received my new certificate.

I have clients ask me if myself and my back-up doulas are certified. I've had clients say they don't want a back-up doula that isn't yet certified. I've had clients specifically ask me about DONA.  Being certified proves that you are trained (not just calling yourself a doula), and therefore can associate yourself with all of the research-proven benefits of having a doula!

I am thankful for DONA International because the organization has:
  1. Legitimized the profession of the doula, leading many childbirth educators to refer parents to DONA's website to find a doula, and hospitals to allow doulas in the labor room,
  2. Worked hard to get doulas the ability to have an NPI number so we can help clients submit for insurance reimbursement,
  3. Spoken and written (Penny Simkin and colleagues) on numerous topics that are now growing in evidence-base and popularity for the good of the mother and baby (e.g. the positive impact of the doula on labor experiences, delayed cord clamping, etc), 
  4. Celebrated doulas and provides resources for both parents and doulas all over the world.

Wednesday, September 24, 2014

Birth by the Numbers Update

Eugene Declerq and the team at Birth by the Numbers have very recently updated their statistics and their video!

Two years ago I posted the video Birth by the Numbers, a fantastic resource for mothers, public health professionals, students, and teachers. If you haven't seen it yet, I highly recommend you check it out.

This brand new updated Birth by the Numbers covers several maternal and infant health indicators, including maternal mortality and neonatal mortality, compared to other countries. This may sound dry, but he makes some jokes to start you off.

Dr. Declerq then covers Cesarean sections, with a great overview of trends in primary cesarean section rates. He even discusses cost savings of reducing these rates.

Are we doing better? Worse? Tune in to find out this answer and more!

I really like this slide:

I also recently saw a graph elsewhere showing the c-section rate rise with the introduction and push of the electronic fetal monitor. And of course, the decrease in the rate during the period in the 90's when Trial of Labor after Cesarean was promoted.

For further information, I highly recommend the Birth by the Numbers website, or any of the sites he references at the end of the video.

Also, if you're into the research on c-sections, here is an article on the variation in cesarean section rates across the country and in each hospital, and some analysis of why:
Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues
"We found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals."

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