Interview with a birth worker

My dear client Rachel at Healthy Chicks interviewed me for her blog long ago. I wanted to share that here and also crosspost because I often get questions like, “How did you get into this?” and “What’s your philosophy on X?” If you’re curious to hear more from me, read on…

R.K.: For someone who has never heard of one, what the heck is a doula anyway? In a nutshell, what do you do for your clients?

E.O.: A doula is basically an advocate and support for somebody in pregnancy, birth and postpartum – a strictly non-medical role. I want to clear up any misconceptions about the term – “doula” actually comes from the Greek word for “female slave.” A lot of doula training and certifying organizations water this down to say it historically means “women’s helper.”

The word “doula” only came into Western consciousness as a term for birth workers in the early 1970s. Truth is, throughout history, people have always had others (even just siblings, neighbors, family members) support their birth experiences. Given the state of modern maternity care, I think having a dedicated advocate in a hospital setting is pretty integral. In the U.S., healthy low-risk childbirth is actually the most common reason for hospital admission.

That being said, about one third of folks in the U.S. end up delivering surgically – a major intervention which has risks as well as benefits for both parents and babies. Studies show that just the presence of a non-medical support person lowers the risk of cesarean section, use of labor augmentation drugs or anesthesia, and also can potentially shorten the length of labor (wow)!

R.K.: What made you get into this type of work? 

E.O.: Basically, I became a doula when I dropped out of a college social work program in 2009. I was searching for a different path that still involved working directly with people, but didn’t require going into substantial debt. Before moving to Boston for school, I used to volunteer with a domestic violence organization that had a hospital advocate role for folks who went to a local emergency room after an assault.

This advocate role has turned out to prepare me really well for birth work. It’s all about improvising to support someone the best way they need it in that moment. This could include explaining hospital policies or medical procedures and what to expect, or changing the subject entirely and telling a distracting story.

It could mean grabbing a warm blanket or snack. It could mean calming down an anxious/nervous family member or friend. It’s making connections to support groups or other community resources.

While pregnancy and childbirth are incredibly inspiring to me, helping to prevent trauma by softening the edges around an intimate medical experience is really what draws me to this work.

R.K.: What’s the most gratifying part of your job?

E.O.: Seeing people totally in their own power. Too often, we’re socialized not to advocate for our needs or to “be polite” and not inconvenience others. Birth has a way of smashing through social conventions, and we get to witness someone who may normally be shy start to advocate, quite clearly, for what they need (peace and quiet, water, low lights, touch or no touch).

When that baby finally arrives into my clients’ grasp, and they realize, “I did it!” – I don’t think there’s anything more gratifying in the whole world.

R.K.: Do you have a favorite memory or crazy story on being a doula?

E.O.: I will always have a big warm space in my heart for the families I end up spending 30+ hours with in labor. That being said, some of my most memorable/crazy births are the super fast ones.

I once helped catch a baby on the sidewalk just outside of the hospital! My client’s partner had just walked away, about 90 seconds prior, to park their car. My client was so deeply sturdy in her labor that even I had no idea we were seconds away from this baby – I thought we’d at least make it inside!

Luckily, it was a warm/sunny day and the rest of the care team arrived quickly after. Baby pinked up and cried right away – everybody was perfectly fine. Just a little bit of chaos before they landed peacefully in their hospital room together. Phew! (Technically, doulas are not supposed to be baby catchers!)

R.K.: As we know, I had a full moon baby. So what do you think — old wive’s tale or are more babies really born around the full moon? Any other fun wives tales? 

E.O.: Your baby came in a memorable string of full-moon babies for me. I had an unusual three months in a row with back-to-back full moon babies. That being said, my sample size is quite small compared to a hospital or the general population of laboring families.

I think Labor and Delivery nurses have their own perspective, but the only correlation I tend to draw is with barometric pressure shifts. Sometimes a big storm hits New England and it seems like everybody’s water breaks…

R.K.: How about a birth plan, a do or a don’t? 

E.O.: Honestly, it depends. I think certain hospitals or regions absolutely require some kind of communication document to help you advocate for your needs and wants. That being said, in the greater Boston area, where I practice, most hospitals have basic policies and practices that support the “big picture” of what many people want during labor: freedom to move, intermittent monitoring for low-risk labors, no IV without a medical reason. Episiotomies are absolutely not done routinely anymore.

That being said, if you get weird vibes from your provider or practice or birth place, it’s always good to ask specific questions about their rates of intervening and when they find certain procedures (such as an induction or cesarean section) to be absolutely necessary.

Because most folks birth in hospitals with a group practice, we can’t always know who our provider will be that day — are they going to be more or less conservative than who you had prenatal appointments with? Perhaps you have a traveling nurse who isn’t as familiar with hospital policies and tells you that you WILL need an IV, regardless of medical reason.

I think having a birth doula is a great way to have someone looking out for your wants/desires/preferences regardless of the other circumstances, and creating a birth plan with your birth doula and partner can make sure everybody is on the same page ahead of time.

It’s also great to have a “preferences” sheet (because you can’t plan birth) in case of an emergency or change of plan – if baby needs to be separated for any medical reason, perhaps partner goes with the baby and doula stays with you. Maybe you request extra uninterrupted time skin to skin when you’re reunited. Even within an unexpected change of plans, there are still options and choices that you can claim.

My biggest tips for a creating a birth plan/preferences sheet are to keep it short and sweet. I mean a simple bulleted list on one page — your biggest preferences stand out more that way. And especially be sure to list “outlier” preferences that may not be on the staff’s radar, such as “we wish to keep the placenta” or “we do not consent to a blood transfusion.”

R.K.: What’s your #1 piece of advice to someone who is newly pregnant and navigating this journey for the first time? 

E.O.: It’s great to get informed and do research, but don’t get too “thinky.” As one of my clients’ friends wisely said during her birth, “Babies don’t come from your brain.” This especially applies to my Boston-area clientele.

A lot of self-identified type-A people who are really thorough researchers can get caught up in the theory/studies, and forget to “stop and smell the roses.” Taking time to slow down and tune into your own intuition can really help guide decision-making, and is just as valid (if not, moreso) as all the books, classes, etc. you can get your hands on. It can also help to tune out any of the negative birth stories that folks love to share when they know you’re expecting!

R.K.: I think it’s a misconception that doulas are these hippy dippy home-birth-only advocates. But you support all birth plans (natural, epidural, etc.). Are there any other misconceptions or something you want women to know?

E.O.: Doula support doesn’t have to be limited to birth. I know many doulas who provide postpartum support, or prenatal support in the case of bedrest, or support for pregnancy loss and abortion.

Doulas also don’t have to be cost prohibitive. In many states, birth or postpartum doulas are not covered on insurance plans, though some folks can get reimbursed through a Health Savings Account (if applicable). This currently makes doulas an out of pocket expense, and in a major metropolitan area such as Boston, an average doula fee can be anywhere from $1500-2000! If that’s in your budget, support from a doula can be absolutely worth the fee.

However, many doulas are flexible with their fees for families in need, and others who are looking to gain more experience may offer a lower rate as they build up a clientele. I’d never want folks to search for support, see a high out-of-pocket cost and just assume doula support can’t apply to them.

Some areas have doula collectives or volunteer-run organizations that work with families in need for low-cost. Many doulas list a fee, but have a separate statement on their websites about being happy to accommodate low income or high-needs families.

DoulaMatch.net is a good way to get started by seeing who practices in your area, and what the normal range of pricing can be. You deserve support!

Five Ways to Grow Your (Doula) Business Without Social Media

In 2011, I made a bold move. About a year after attending my first birth, I decided to quit Facebook. To this day, I’m one of the only self-employed millennials I know who does not have a Bachelor’s degree or Facebook account. I’ve lived in the Boston area this whole time, so my list is specific to things I’ve found helpful to building a practice around home. Many new or aspiring birth doulas reach out to me to gain a better understanding of how to get into self-sustaining practice. Here are five things I’ve found especially helpful in building my practice, without the surveillance and privacy issues of using social media websites.

  1. Networking events. This may be most helpful to newer birth workers in order to get out there, meet expecting families, and get practice quickly answering questions like, “What is your philosophy?” “Why did you decide to become a doula?” and “Can you describe how your style differs from others?” Local to Boston, both Mama & Me in Jamaica Plain and OmBirths via Down Under Yoga have “Meet the Doulas” nights that are free for parents (often drawing a large crowd) and $20-$25 for a doula to sign up. It’s valuable to meet folks who may potentially want to hire you, but also to meet other birth workers in the area who may have different skillsets or might be available as backup.
  2. Grow your referral network. In order to be an asset to your community, you need to know what resources exist in your area that serve the folks you hope to work with. MassBirth is a good place to get started. They have lists of everything from placenta encapsulation to postpartum and lactation support, to mental health counselors.
  3. Know other people who have your dream job? Invite them to tea. Take the fifty minutes you may spend on Facebook in a day, and actually get together with someone who does related work in your area. Getting to know folks on a more personal level makes for a strong network of backup support and will likely get you more referrals in the future.
  4. MassDoulas yahoo group. Created and moderated by the lovely home birth midwife Joyce Kimball, MassDoulas is a place where local birth workers are constantly sharing information, events, clients looking for support.
  5. Volunteer. Yes, birth work is often under-compensated and if you’re called to attend births professionally, you should be well supported in order to make it a sustainable adventure. That being said, if you’re new to birth and nervous to claim Professional Doula Status with confidence, Brigham and Women’s Hospital offers a volunteer birth doula program for teen moms, and you don’t need to be certified in order to attend. It’s a great way to get an idea of what local hospital policies and practices are, and informs work you’ll do with clients for years to come. Even if you don’t have the capacity to volunteer for birth support directly, you could spend time lobbying for initiatives like the Massachusetts bill to cover doulas on MassHealth.

Herbalism and Herbal Resources

Herbalism and Herbalists

Local gem Bellx of Semilla of Ixchel offers full-spectrum reproductive support, herbal wisdom and customized preparations, and herbalism apprenticeships for People of Color in greater Boston. Offerings include an herbal CSA, placenta medicine, and workshops about holistic healing.

Muddy River Herbals is the project of Jenny Hauf and her husband Matt. They grow and wildcraft local, organic herbs for folks in the Boston area, and can be found at the Roslindale and Melrose Farmers Markets. Much of the calendula in my postpartum sitz baths comes from these guys!

While not local to the northeast, La Loba Loca is an incredible herbalist and friend who offers consultations, workshops, skillshares, knowledge shares, and seedlingships.

Clair Moore is a clinically trained herbalist and professional private chef who provides medicinal food preparation services around Boston, especially allergen-free foods for folks with autoimmune diseases or chronic illnesses. She and Amanda of The Willow Witch have also teamed up to create Willow Provisions, a medicinal herbal food supper club.

Herbstalk is a growing community of herbal classes in the Boston area. Based in Somerville, this yearly conference brings together folks from many herbal traditions every June.

Founded by Katja Swift and Ryn Midura, the CommonWealth Center for Holistic Herbalism in Brookline offers classes, apprenticeships and a clinic for low-income folks who seek herbal care.

Tammi Sweet at the Heartstone Center for Earth Essentials teaches an AMAZING anatomy & physiology class for holistically-minded folks who would otherwise shy away from a science-heavy class. She frequently offers free webinars on a variety of topics from allergies and asthma to the endocannabinoid system.

Abortion and Pregnancy Loss Resources

Abortion and Loss

The Boston Abortion Support Collective provides completely free support for people experiencing abortion, miscarriage or stillbirth in the Boston area. We have a small availability of affordable birth doulas, as well!

Backline is a judgement-free resource for folks considering what to do when they find themselves pregnant. They have a free phone line to discuss pregnancy options, and counseling before and after any decisions are made. Backline also started the resource Faith Aloud, in which clergy from various faith traditions are available to non-judgmentally counsel callers through decision making around pregnancy.

The Eastern Massachusetts Abortion Fund provides small grants to folks who need to access abortion care in Eastern Massachusetts in order to make abortion care more affordable.

The Pregnancy Panic Companion is a teen friendly resource for accurate information about pregnancy scares and available options.

Holding Our Space is an interactive community based around supporting those who have lost a pregnancy in any way. Stories of infertility, miscarriage, abortion, adoption, stillbirth and more are all supported and welcomed.

Fatherhood Resources

Fatherhood

Diaper Lab offers a Becoming A Dad class series.

William James College in Newton, MA hosts a free support group for new dads.

The Fatherhood Project is based in Boston.

Transgender Dad Carving Path of Opportunities for Son, Future

Rad Dad blog, zine and book focuses on the overlaps of various identities with fatherhood.

Postpartum and Lactation Support

Postpartum and Lactation Support

Postpartum Progress and Postpartum Support International promote awareness, prevention and treatment of mental health issues related to childbearing in every country worldwide. They also have a Perinatal Mental Health Alliance for Women of Color

Rachel Hess is an experienced and LGBTQ-friendly postpartum doula who also hosts parenting groups around Jamaica Plain.

Sophie Davis is a dear friend and postpartum doula, serving areas surrounding Newton.

The Every Mother Project provides training & support to birth, postpartum, lactation, and women’s health professionals who work with women and families in the childbearing year in order to reduce barriers that women with perinatal emotional complications face when accessing care.

Jewish Family and Children’s Services Center for Early Relationship Support provides a multitude of free support for young families in the Boston area. You do not have to be Jewish to utilize their services. They have support groups, therapy, and experienced moms who visit new ones to help you get the hang of feeding and caring for your little ones.

One of my doula mentors, Maria Dolorico, started A Mom is Born as a doula business, and has branched out into life coaching, lactation consulting, and holding groups for new parents in downtown Boston. She also offers a free online support course for families on how to plan for the postpartum period.

Zip Milk is a search engine for lactation consultants (LCs) in your area by zip code.

LC Home Visits contains a list of Boston-area international board certified lactation consultants (IBCLCs). In Massachusetts, it is required for insurance to cover lactation support.

BFAR is a resource for folks who want to breastfeed but have had breast/chest or nipple surgery in the past. Whether someone has had a diagnostic surgery, implants or a reduction, this website contains information about increasing the best chances for a healthy milk supply.

Milk Junkies is the website of trans dad, Trevor MacDonald. Once famous for being barred from La Leche League meetings, he now leads them locally in Canada and continues to blog about queer parenthood.

A mini study (22 participants) on transmasculine folks, chestfeeding and gender identity.

Boston-area breastfeeding support groups:

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Home Birth Resources

Home Birth

The Massachusetts Midwives Alliance is a professional trade organization created by and for a dynamic and diverse group of midwives. The MMA was founded to build cooperation among midwives, and to promote midwifery as a means of improving health care for women and their families. Their website has a map of local home birth midwives around Boston.

Emily Bowler and Molly Geisler are continuing their local midwifery partnership, Modern Mama Midwifery. They attend home births, provide doula support and offer childbirth education classes.

Birth and Beyond of Jamaica Plain hosts the Mass Midwives Alliance training classes, as well as childbirth education and other events for parents and professionals.

Sarafina Kennedy and Jessica Patrone are midwifery partners supporting families from Greater Boston through Cape Cod.

Susanna Mauzy of Nightingale Midwifery attends births around Greater Boston and also helps families with home conception support.

Cesarean Birth and VBAC Resources

Cesarean Birth and VBAC

VBAC Facts is an evidence-based resource for information about the safety, options and factors involved in having a vaginal birth after a cesarean.

Julie Brill at Well Pregnancy teaches a class specifically for parents who are having a planned cesarean birth. It is based on Peggy Huddleston’s program, “Prepare for Surgery, Heal Faster.” It is free for folks who are going to Emerson Hospital.

ICAN is the International Cesarean Awareness Network. ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesarians through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC). There is also a Boston chapter that has meetings in Arlington, MA.

Cesarean Rates is a resource for the most up-to-date statistics of cesarean sections at hospitals around the United States. Here are the Massachusetts statistics.

Doulas and Birth Resources

Doulas and Birth Support

Jacqui Morton is a doula, writer and founder of Holding Our Space, a participatory project centered around healing from reproductive loss. She also backs me up for births.

Maria of That Darn Doula is one of my backups in the area. She currently apprentices with a local home birth midwifery practice, and has experience at all local hospitals as well. She also backs me up for placenta encapsulation!

Tuly Duprat is an experienced birth doula who I connected with at Mama and Me. She is based in Malden, and has excellent rebozo skills. Tuly also speaks Portuguese.

Teresa Vittorioso-Fortin is a birth doula who offers childbirth classes through her practice, Entera Doula. She frequents Mount Auburn Hospital and is also fluent in Spanish.

Sierra at All Bodies Birth is a local birth and postpartum doula who especially loves to support LGBTQ+ families.

Jen at Douladventure brings her public health background to her work as a birth and postpartum doula in Boston.

Birth Sanctuary Boston is a group working to create an out-of-hospital birth option for families in Dorchester and beyond. It’s not easy work, but stay tuned for updates from them.

Beantown Babies is the combined project of doulas Emily and Lindsay. This amazing community space in Roslindale offers many things to new and growing families. From meditation workshops with Sophie, to childbirth ed classes with Teresa and acupressure for labor workshops with Ece, Beantown Babies has offerings that can enrich and support the pregnancy and birthing journeys of many local families.

Spinning Babies is a resource for fetal positioning and how it can affect labor. Tips for daily exercises/movements for getting baby engaged in the pelvis, as well as supportive labor positions can be found online.

The Miles Circuit is another series of simple movements to gently move baby into optimal positions for labor and delivery.

Mama and Me in Jamaica Plain offers a wide range of prenatal, postpartum, and child development classes for families in the Boston area. They host a bimonthly “Meet the Doulas” event that I frequently attend.

Doula Match is a search engine for folks looking for birth or postpartum doula support. You can compare profiles, availability, skillsets and experience all on one site.