Dear mothers of Houston,
If chosen as your doula, I promise to:

*Inform you of all of your birthing options
*Help you gather all of the information you need to make the best decisions for your growing family.
*Support you in your decisions.
*Refer you to other needed and/or wanted professionals in the area.
*Encourage you to trust your own intuition.
*Believe in your ability to birth and mother your baby.
*Connect with you emotionally, mother to mother.
*Engage you in discussions and activities for a healthy pregnancy and birth.
*Empower you to take responsibility for and control over your care.
*Comfort you with expert labor support.
*Serve you with loving, intuitive, knowledgeable, professional doula care.
 
For your birth in 2017, choose Amber Piller.
Choose to be Stronger Together.
Choose to Make Birth Great Again. 

​It’s time for another Pro Tip!

It’s normal to feel afraid when thinking about what lies ahead of you…..what will labor be like? Can I do it? What if something goes wrong? Will I be a good mom?
These feelings will affect you, your baby, and your birth. But, I have good news! There is a way to keep them under control! Having a provider that you trust is a good start. Taking a quality, independent childbirth education class is another big step in the right direction as is hiring a doula to support you. Having a team around you to support and educate you will help relieve some of your anxieties of what labor and birth will look and feel like. Staying active and eating well is good insurance that you will have a healthy and satisfying birth with a healthy mom and baby at the end. Spending time practicing self care and nourishing and preparing your soul for motherhood is also important. Pray, meditate, talk to friends and family, create art, journal….find whatever it is that works for you and do it regularly.
 

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Oh friends! Don’t keep all this information to yourself! I made a little graphic below for you to share on your social media and let all your friends and family in on these pro tips! And be sure to check out the other tips in this series! 

I don’t often get so personal on this blog, but I think this topic very much ties into birth so it’s going here. And I am interrupting my Pro Tips series to get something off my chest that has been weighing me down for a good long while.
 
I am sick, sick, SICK of being ignored, friends. As I chatted with a couple new doula friends a few weeks back, one brought up this topic and she mentioned a personal experience of her own. She said that when she had moved to Houston and needed to get a Texas driver’s license, she looked up what she needed online and brought everything to the DMV. She waited and waited in a long line only to be told she was missing something once she finally got her turn. She asked if there was some way they could help her so that she didn’t have to go back home and gather what was needed and wait in that awful line again and was told no. Then she cried. And you know what happened next? They helped her. Why did they not just help her in the first place?

And since that conversation, I have been paying attention to my interactions with both my kids and my husband here at home. And you know what? The vast majority of the time, I am ignored the first time I say something. And often even the second and third. It is not until I either get crazy mad or really upset and cry that I am taken seriously. WHY???? I am not into the business of husband-bashing. Truth is, my husband is incredible and I love him dearly. But, he doesn’t often take me serious the first time I tell him something. Actually, he doesn’t often even hear me or register that I have said something to him the first time I say it. And it’s not that he’s insensitive or mean or whatever. It’s a strange phenomenon, really. He truly has no recollection of me telling him many of the things I say until I’ve said them two or three or four times and often not until I make a big fuss about it. And you know what? My three kids do the very same thing to me. Just now, as they were doing their chores in the kitchen after lunch and I was doing some work at the computer in our bedroom, I hear the younger two arguing. I listen for a minute and finally call out “What’s going on out there?” Nothing. So I try again, “What’s the matter, kids?” Again, nothing. This time, I just burst. I am MAD. And I go flying out to the kitchen and shout “EVERYBODY STOP WHAT YOU ARE DOING NOW!” They all stop and stare at me and I calmly say “Raise your hand if you heard me calling from the bedroom asking what was going on out here just now.” Friends, all three of my dear children raised their hands. And then they all three confessed that they did in fact hear me call out not just once, but two times. And I. Lost. It. Whatever “it” is, is now spattered and sprayed all over my kitchen as I turned into a screeching and screaming monster exclaiming that I am DONE with everyone ignoring me and will not be ignored any longer. Then I took away their screen time indefinitely. Now I have their attention. They’re all crying. But not because they feel bad for ignoring me all the time. Nope, they feel bad for themselves because they can’t watch their favorite TV show today. But I’m going to talk to them once I cool off and explain the very important lesson that I want them to learn here: Everybody’s thoughts and feelings matter and you need to pay attention to them, especially when it is a loved one.

And this is where I can relate this to birth. How many pregnant moms out there sit in the OB’s office with a birth plan only to be refused some of the things they want for their birth? How many expecting moms out there feel like their provider brushes off their concerns, isn’t really listening to or understanding them, is rushed, disconnected, or just too busy? How many pregnant moms out there feel that their OBs talk down to them and treat them like children when they express their desires or concerns for their birth?How many expecting moms out there feel that their husbands just don't understand why some things are so important to them? I am not a betting woman, but I bet it’s a huge number. And I bet it’s a pretty large number of these expecting mothers that just politely shut up at that point. Why? Why is our culture devaluing what women have to say about an event that is so incredibly important and sacred, an event for which we were given the ability to instinctually know what is best for us? Why does our culture generally encourage women to always be quiet and polite and not make a fuss while simultaneously conditioning everyone else to not take women seriously if they are being nice and quiet and polite?
​
I am telling you that I have had enough. And I’m asking you to join me in that. That doesn’t mean we have to get mean or lose “it” all over the kitchen every day. But, be firm. Don’t just shut up when you’re ignored or talked down to or brushed off. Especially when it’s about your birth. Who cares if everyone around you thinks you’re crazy and doesn’t understand why you want what you want? If it’s important to you, get it! And if you need help in that, or need to have someone totally on your team, who will support you in what you want even if everyone else thinks you’re crazy….hire a doula. That’s what we do. I will support you giving birth hanging from the chandelier if that’s something that’s important to you. You are worthy of being listened to. Your thoughts and feelings are important.
 
Make yourselves be heard, mamas. 

Welcome to my new blog series: Pro Tips! This will be a series of short, simple, but incredibly helpful tips from a birth pro….me.

Today’s topic is that of your physical health. Moms, I’m going to level with you here. Pregnancy is not an excuse to put your feet up and eat whatever, whenever you want. Absolutely listen to your body, eat when you’re hungry and even give into those cravings sometimes. But, you need good, nourishing food while your body is working hard to grow and nourish your baby. Get plenty of good protein, fruits and veggies. You also need lots of water; at least one ounce for every two pounds of your body weight. And remember, that as your pregnancy goes on, you will gain weight, therefore you will need to increase your water intake. Lastly, keep moving your body. It doesn’t have to be super strenuous or intense. Take a walk while enjoying the company of your husband, go for a swim, try out a yoga class with a friend. The act of labor and giving birth is often likened to running a marathon. Would you stand on the starting line of a marathon without having done any training at all and after having eaten nothing but junk food for the last 9 months? Not likely. Take care of yourself, mama. You deserve it. Learning and practicing self-care now will be a valuable skill for the rest of your life. You will not be able to take care of your family well if you are not also taking care of yourself.
 
 
Psssssssttt........
​Don’t keep all this great information to yourself! I made a nifty graphic for you to share on your facebook, Instagram, pinterest, twitter, and whatever else you’d like so you can let all your friends and family in on these awesome pro tips! 

For fun, I sat down and figured up my stats for several birth interventions today using every birth I have attended in the last 3+ years. And then I compared them to the national rate of that same intervention for the most recent year I could find. Doulas really do make a difference, folks. Just see for yourself.

♥Epidural
National: 61% (2008) (http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf)
Agape Birth Services: 22.7%
 
♥Labor Induction
National: 23% (2012) (http://www.cdc.gov/nchs/data/databriefs/db155.htm)
Agape Birth Services: 9.1%
 
♥Episiotomy
National: 25% (2004) (http://jama.jamanetwork.com/article.aspx?articleid=2089343)
Agape Birth Services: 2.3%
 
♥Assisted Vaginal Birth (forceps or vacuum)
National: 5% (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672989/)
Agape Birth Services: 4.54%
 
♥Cesarean Birth
National: 32% (http://www.cdc.gov/nchs/fastats/delivery.htm)
Agape Birth Services: 4.54%
 
♥VBAC (Vaginal Birth After Cesarean)
National:60%-80%(http://www.uptodate.com/contents/vaginal-birth-after-cesarean-delivery-vbac-beyond-the-basics)
Agape Birth Services: 100%

I’ve been thinking a lot about my business and my services lately. Really meditating on the quality of services I provide and want to provide and the reason for which I do this work. As I was telling a friend yesterday, I think I can safely say that all doulas begin this work because of a strong desire to serve other women during pregnancy and birth, helping them achieve safe and satisfying birth experiences and often to help push the pendulum in the direction of normal birth becoming more of the norm. We understand just how very important it is to be loved, supported, encouraged, and empowered during our births. We understand the imprint birth leaves on the heart of mothers.  And we want to make a difference. We want to be world changers, pendulum pushers. _

I can’t think of a single person who started in doula work with the desire to make a lot of money doing it. Many families may see the price tag of doula services and think “Gosh, that’s a lot of money!” And I get that, $700 is a large amount of money. But, once you subtract all of our expenses of childcare, gas, website, printed material, education, certification and training, and supplies for our doula bag then divide the remainder out over the amount of hours we spend with the average family during prenatal visits, answering emails/phone calls, supporting the birth, the postpartum visit, and all of the time spent with our own lives sort of on hold during the on-call period, that large amount of money is suddenly not so large.

Doulas are constantly trying to balance their personal with their professional lives and being fairly compensated for the time and energy they give to their clients while still being affordable enough for as many families to be able to hire a doula as possible. And of course to be charging a fee comparable with other doulas in the area who have similar levels of training and experience.

A few weeks ago, I was introduced to the H.E.A.R.T. doula pledge. And it really touched my heart that was already thinking something needed to change with my practice. I am now proud to say that I am officially a HEART doula business. And with that, I have decided it was time to make a change to my services offered and their fees. A year ago, I introduced 3 packages of doula services in the hopes that I would be more accessible and affordable to more families. But, after much prayer and thought, I have decided it is now time to simplify and pear down those packages. So, as you will see by visiting my services page, I have made some changes.  It was time to simplify and “get back to my roots.” The core of my doula work has been and will remain to be the things the HEART doula pledge stands for. Honest. Ethical. Accountable. Reliable. Thoughtful.

It is truly my desire to lovingly support families during pregnancy and childbirth. 

While interviewing with potential clients, I am asked a lot of questions. Some are sort of bizarre. Some are creative. Some are repeated often and asked by many. There are some questions that definitely have a common theme:
“How will you work with my husband?”
“Will you replace me?” (asked by the husband/father)
“Will I have anything to do with a doula there?” (aked by the husband/father)
“What about my husband? How will he be involved in the birth with you there?”
“Will you support my husband, too?”
See the theme? Both moms and dads are sometimes curious about how dads and doulas work together and worried about a doula taking dad's place in the birth of their baby.

I'm here to assure you, I do not and will not take dad's place during a birth. I have no desire to do that. (Although I have supported a couple moms who did not have her husband/the baby's father at the birth.) I support BOTH mom and dad.

What does that look like? How do I support both mom and dad? How do I work together with dad? I'm a list maker, so here's a list to answer those questions.

Dads and doulas play very different but equally important roles on the birth team. Dad knows and loves mom best. I know (and love!) birth best. I work for and with dad as he supports mom. And I love it. 

Dads, what do you think was the most helpful thing your doula did for YOU? Comment below!




*Photo credit: Traci Greve and Kara Holden

For me, the story begins on Monday, January 20th around 5:00pm, when I would normally be getting off of work and heading home. However, I was in an extended meeting with my manager. I received a text from my wife asking if I was coming home soon. I replied, “No, why? What’s up?” She simply said, “Oh nothing. I just think I might be labor. No big deal.”

NO BIG DEAL?! I quickly wrapped things up with my manager and left work as soon as I could and called Megan. She assured me she was okay, and that it was still early on.

When I arrived at home, Megan was packing her “go bag” with clothes, snacks, baby gear, etc. The contractions were pretty far apart still, and not too strong. We both realized that we didn’t quite have everything we needed, so...we took a trip to our favorite place: Target :) We walked around for a while, stopping while mild contractions too place every five minutes or so. Eventually heading back home.

Once unpacked at home, Megan said I could go ahead and go to bed since it could be a long night if things got more serious. I went ahead and got ready for bed, and was only laying down for a few minutes when Megan yelled my name from the living room. I went to her and she said her water broke while she was shifting on the couch! Wow! Here we go!

We contacted our doula (Amber) to let her know what was going on. She told me to call the midwife to let them know we needed to come in for Megan to get her antibiotic for Group B Strep. We packed up the car and took the 20 minute drive down to the Midwife’s Place. It was around midnight, and a very cold, January night. Luckily no snow!

Once we got to the Midwife’s Place, we brought everything in (thinking we were going to stay there the whole time). Megan got checked out by the midwife and hooked up to the IV. I thought I would be nice a strong and handle that simple thing okay, but I ended up getting pretty queasy and needed to go sit down before I passed out.

Megan’s contractions started getting stronger over the next hour or two. I stayed with her, helping her through contractions, until I was too weak to help out anymore (like I was doing anything near as hard as she was!), and went to grab Amber so she could step in and help for a bit. While I was laying down, I heard Megan throw up (a normal/good thing when in labor), and that normally wouldn’t bother me, but it did...so I followed suit and did the same sadly. Some strong dad I’m gonna be ;) 

After a while, the midwife checked Megan’s progress and suggested we go back home to labor there since you’re generally more comfortable and relaxed in your own home and can progress better there. So, despite not wanting to pack back up and go home, we agreed and did so. It’s now just after 2:00am or so. 

Once home, Amber ran Megan a bath right away, while I went and laid down on the couch (sad, I know. I still can’t thank Amber enough for helping out. This is exactly what a doula is for!!) I rested while Megan labored in the tub for a while, and eventually they moved to our bed and continued laboring for a couple hours. By about 5:30am, Amber though Megan had progressed enough to the point where we needed to go back to the Midwife’s Place. So we got ahold of the midwife and let her know we were coming back. 

Funny story: As Megan and Amber were getting ready to leave, I knew I had to take care of our dog Millie (feed her breakfast, let her out, etc.) since we wouldn’t likely be back home for several hours. Megan didn’t see that as a very critical/important thing to do at that exact point in time, and shared some friendly, laboring words with me to let me know that we needed to go and that I shouldn’t be worrying about the dog :) You can use your imagination to figure out what may have been said. 

We get in the car and take the drive back down to the Midwife’s Place - again, still pitch black outside and below zero temperature. Megan was having some back-labor pain, so Amber placed her rebozo in a big knot behind her back to push on the car seat as we drove (so smart!) which helped Megan out. 

Once we got there, Megan felt like she was so far and was in enough pain that she wasn’t wanting to get out of the car! I told her, “we’re right here, just get out and have the baby inside.” We made our way in and the midwife checked Megan once more - telling us she was still only at about 6cm. 

We knew going in to this that we wanted to attempt to have a water birth. So, we ran a bath right away and got Megan ready. While she was sitting on the toilet, Megan said, “I think I’m ready to push.” Just a few minutes after the midwife told her she was only at about 6cm! Gotta love those maternal instincts :) 

So we get her in the tub and Megan starts really pushing and the contractions are strong and very close together - barely giving Megan a chance to rest in-between. I had complete confidence in Megan the whole time. It was so exciting seeing her do this all on her own. 

Once Megan sat back I handed the baby to her and just sat there weeping with absolute joy and amazement. I knew my wife was a strong woman, but to go through the whole process from start to finish without any pain medication, drugs, etc. at all makes me respect and appreciate all that she just went through SO much more. An AMAZING accomplishment.

Besides that, our daughter was just the most beautiful, sweet thing! What’s neat about a water birth is that the baby doesn’t really cry too much right away, because she goes straight from amniotic fluid to water, then air. So it’s a gradual thing. Megan just held her skin-to-skin, while I held the baby’s foot.

We waited for the umbilical cord to stop pulsing to ensure all the cord blood got into the baby’s body, and then I cut the cord (another awesome experience). And then I took the baby so that Megan could get cleaned up and out of the tub. This is probably my favorite part of the whole experience, where I was able to hold the baby skin-to-skin with myself. It was such an amazing bonding moment right away. We went and laid down in the bed and waited for Megan to join us. Just such a sweet experience.

There's no such thing as TMI for a doula. And we are known for being totally unaware of our surroundings while on a phone call with a client or discussing birthy stuff with doula friends. To those who have overheard these conversations, I'm sorry. Sort of. To my doula friends, comment with your funny quotes!

20 Funny Things I Have Said to Clients (Or my husband or a friend)

“Was there blood too, or just mucous?”

“You're throwing up?! Yay!!!”

"Can I show you your placenta?"

“Your butt is not ripping apart. I know it feels like it, but it's not.”

“Most women poop. Poop is good!”

“Stick your butt waaaaay out. Like this.....”

“Your nipples are perfect.”

“You were making noise when this baby got put in there. It's OK to make some noise while this baby comes out.”

"Hey, babe. I just got home. There's a placenta in the fridge in the garage."

“You can take it orally or insert it vaginally, whichever you prefer.”

“You feel like you need to poop? That's what we're waiting for!”

“May I touch your breast?”

“Try holding your boob like this...”

“Don't put the phone down next time. I want to hear the noises you are making.”

“What did you see when you wiped?”

“You should probably bring some towels to sit on.”

“I promise you the baby is not coming out of your butt.”

"I need to get going. I have a placenta in the van."

"Pushing feels sort of like throwing up, but in the other direction."

"Semen can really get things started. Orgasm is good, too. Oh! And nipple stimulation."


And to balance it out.....
20 Things that aren't so funny, but that I say often during a birth.

“You are amazing.”

“You are such a good mom.”

“I know it's hard, but you are strong and you can do this.”

“Great job.”

“You are doing so well.”

“Take a couple big breaths for your baby.”

“What a beautiful belly.”

“I can't wait to see you holding your baby for the first time.”

“Wow. You are incredible.”

“Good, mama. You are doing so good.”

“You were made to be the mother of this baby. Whatever decision you make is the right one. I will support you with whatever you decide.”

“Let's have a birthday party!”

“Your body is working perfectly.”

“Listen to your body.”

“This contraction will go away just like all the others have.”

“Stay with it. Almost there.”

“You will never feel that contraction again.”

“You were designed to do this.”

“Would you like me to pray with you?”

“Can I get you something to eat? Drink? A cold washcloth for your neck? A warm blanket? Turn the lights down? Turn on some music? Draw you a bath? Massage your back/feet/hands? Try some counterpressure? Get you anything?”

Let's talk more about a doula's fees. I sometimes get messages asking me to give a discount or take on a client for free. I understand that money is tight for many and I strongly believe that every woman deserves a doula. However, I just can't afford to do those things. I love doula work. I really really love it. Really. I feel so incredibly blessed to be able to do something I love so much while making a small financial contribution to our family. I spend a lot of time and energy immersed in the doula world. And my time is valuable. Especially when it's time away from my husband and three young children. Some feel that a doula's fees are expensive. I'd like to show you a breakdown of those fees and why I charge what I charge. 



Total fee - $450

Childcare - $75/client 

Gas - $25/client

Printed materials/handouts/marketing/website - $20/client

Bag and Supplies (includes snacks and toiletries for myself during the birth, essential oils, massage tools, etc) - $20/client

Phone and internet costs and PayPal fees - $15/client

Lending Library - $5/client

Training, education, certification and organization/membership fees - $25/client

Remaining fee after subtracting expenses - $265

Average amount of time spent with client (3 prenatals, the labor and birth, and one postpartum visit ) – 22 hours

Average amount of time spent driving to and from meetings and the birth place – 3 hours 

Average amount of time spent reading, researching, creating and printing handouts, continuing education, and doing other prep work – 2 hours

Average amount of time spent answering phone calls, texts, and emails – 2 hours

Total amount of time put into each client - 29 hours

Average amount of money I make for each client - $9.14/hour

This doesn't include time spent in interviews (which are free of charge), time spent marketing and networking (doula speed dates, the baby fair, and other events), time spent keeping up with my website and business facebook page and pinterest page, and the time I spend on call for each birth, which can be as long as 5 weeks. It's hard to place a value on needing to be packed and ready to drop everything and leave at a moment's notice (even if I'm at a birthday party or a wedding or having a date night) for weeks at a time. This also does not include taxes, which I do file and pay yearly as needed. 

Doula work is time consuming, physically exhausting, and emotionally draining. And I love every minute of it. I love to serve birthing families. I love witnessing a mother and father working together to bring their child into the world. I love making a difference in the lives of growing families. And if I want to continue to do so, I have to charge a fee that fairly compensates me for my time and sacrifice from my family.


Stay tuned for my next blog in this 3 part series, The Luxury of Doula Care! In Part 1, I discussed The Value of a Doula. And coming up in Part 3, I will discuss just How to Afford the Doula of Your Dreams. 

**Update** My fees have changed since I wrote this blog to allow me to be more fairly compensated for my time, resources, and skills. And in an effort to meet the needs of families with lower incomes and/or different needs for prenatal support, I now offer three different packages of doula services and individual birth plan assistance and labor support training. Please see the services section of my website for more information. 

The number one reason I hear from parents for not hiring a doula is the cost. I hear and read things such as, “a doula isn't in our budget” and “a doula is a luxury we just can't afford” or “I'd love a doula, but they're too expensive.”

Bologna. If you see something as valuable, you will find a way to pay for it. I'm going to inform of you why a doula is not a luxury, but in fact a necessity.

Let's start by just addressing the financial side of this. Bear with me as I go through some sorta dry statistics. I promise you these numbers are super mega important, though. You need to know them.

In the Omaha area, the average doula costs $450 (price varies a bit by experience...$450 is the average and is my current fee, so we'll go with that.)

According to a Cochrane review published in 2012 by Hodnett and Colleagues, women who receive continuous labor support provided by a doula experience:
28% decrease in cesarean
*The average out-of-pocket cost of a cesarean in America is $15,000
31% decrease in the use of pitocin
*I'm not sure of the average cost of pitocin, but considering that hospitals are notorious for charging a half a day's pay for an aspirin, I'm certain it costs more to have it than not to. Pitocin is administered by IV, so there will be costs associated with having the IV placed, as well as just the medication itself.
12% increase in the likelihood of spontaneous vaginal delivery
*I'm also not sure of the cost of either vacuum or forceps assisted births (despite my amazing google skills) but would imagine it costs more to use them than not to.
9% decrease in the use of pain relief medication
*The price of an epidural is in the neighborhood of $1,000-$2,000.
14% decrease in the risk of her newborn being admitted to a special care nursery
*There are a lot of variances to this one. It depends on whether it is a level II special care nursery or a level III NICU, how long the stay is, and the reason for admittance. Have you ever heard of a $450 NICU stay? Me either.
34% decrease in the risk of feeling dissatisfied with the birth experience
*The ability to be an active participant in my birth while feeling loved and supported by everyone around me coupled with the feeling of intense joy and empowerment after my two VBACs attended by a doula is priceless. Priceless.

Doula care has also been shown to:
Improve breastfeeding success
*The average price of one can of infant formula is $25. One can per week for 52 weeks (one year) comes out to be $ 1,300.
Decrease the risk of postpartum depression
*We can't put a price on mental health. We could put a price on antidepressants and counseling services, though. Let's say you spend $10 a month on prescription antidepressants and see a counselor twice a month at a cost of $40 per visit (after insurance, of course) for six months. That comes out to a total of $540 for six months.

My $450 fee can potentially save you tens of thousands of dollars.

Now, let's look beyond the financial side of a few of these areas.

Cesarean
Nebraska's current cesarean rate is 32%. I said above that the evidence shows that doula support decreases a woman's risk of cesarean by 28%. That is a pretty big number. I also said above that a cesarean costs around $15,000 out of pocket. That's for an “uncomplicated” cesarean. A cesarean is major abdominal surgery, folks. So, of course it comes with risks. Things like infection, blood loss and damage to other internal organs like your bladder. It also increases your risk of placental abnormalities in future pregnancies like placenta acreta or placenta previa. Some of those abnormalities can be deadly to either mom or baby. Take a minute to let all of that sink in...the financial cost, the emotional cost, the health cost of a cesarean can be astronomical for some, especially those that experience some of the complications that I mentioned.

Pitocin
As I said above, doula support decreases the risk of mom receiving pitocin by 31%. Pitocin is a drug used to either induce or augment (speed up) labor. It is a synthetic form of oxytocin which is a hormone mom releases during labor. Oxytocin is referred to as the “love hormone” as it is the hormone released (in different levels) during hugging, kissing, orgasm, labor/birth, and breastfeeding. It is the hormone responsible for mother-infant bonding and those overwhelming warm, fuzzy nurturing feelings moms have towards their children. Pitocin effectively causes contractions, but does not have the same emotional effect that oxytocin does. A mother who receives pitocin does not make as much of her natural oxytocin as she would have otherwise. A price can not be put on all of this. But, think about the possibility of not reaching the full potential of bonding with your new baby. Pitocin also carries with it risks such as hyper-stimulation of the uterus. And moms receiving pitocin are required to undergo continuous fetal monitoring. No walking the halls. No baths or showers (which have shown to decrease mom's discomfort by up to 60%). Mom is now on a leash.

Spontaneous Vaginal Delivery
As I mentioned above, I'm not certain of the cost of births assisted with vacuum or forceps, but I would imagine it costs more than a birth without. And it certainly has more risks than birth without. There's increased risk of tearing for mom and increased risk of injury to baby, including some pretty serious things like bleeding on the brain. Doula support increases the likelihood of spontaneous vaginal delivery by 12%.

Pain Medication
Any intervention given during birth messes up the natural physiologic process. Birth was designed with an incredible cocktail of hormones flooding the mother's body as she works to birth her baby. Adding any kind of artificial drugs, whether it be pitocin or some kind of pain medication changes that cocktail. IV pain medications are narcotics. They do affect the baby which can cause difficulties with breastfeeding. They can make mom feel sleepy or loopy or even sick. I know that I'd much rather be fully present for such a milestone moment, not only in my life but in my husband's and baby's lives as well. Epidurals don't affect moms or babies the same as the IV pain medications. But, they severely limit mom's mobility. A glimpse at pelvic anatomy will confirm that women were not meant to give birth on their backs in bed. And of course, epidurals don't come without risk. There is a possibility of nerve damage and spinal headaches, which are awful. Imagine spending the first week of your baby's life with the worse headache of your life. And if you buy the epidural package, there are other things that come with it, of course. Things such as an IV, continuous fetal monitoring, a pulsox clippy thing, and a catheter. Mom will be stuck in bed, tangled up in all sorts of wires, belts, straps, lines, cords and machines, with no control over her bladder, needing someone else to empty it for her. And sometimes no control at all of her legs, requiring help to even roll over.
AND, it has been shown that once mom receives an epidural, her partner and other support people sort of check out. Mom doesn't need help focusing or breathing any longer. Mom doesn't need counter-pressure or the physical support of certain labor positions any more. Plus, it's now hard to even get to mom through all of the straps, wires and belts to do just offer a hand to hold. Mom is often now laboring alone while dad gets a nap, facebooks from his phone or watches TV.

Feeling Dissatisfied With the Birth Experience
No monetary value can be placed on this, but let me assure you, it is of paramount importance. The birth experience will impact you more ways than you realize and for the rest of your life. Birth is the beginning of the mother-baby relationship. The way in which you birth your baby and the circumstances under which you first meet your baby set the tone for your postpartum period, and really your entire parenting journey. Imagine beginning that journey feeling as if you failed. You may be set up for failure. What impact would beginning that journey feeling as though you were trapped, cornered and had no options or as though nobody listened to you or took you seriously have on your parenting? Beginning that journey feeling as though the baby being healthy is all that matters can potentially set a new mother up for an incredibly emotionally hard postpartum period. That mama matters, too. This issue can piggyback off of the decreased risk of postpartum depression that mothers who receive doula support during their births experience. Birth matters.
In my experience, dads have been particularly grateful for my doula services. It helps take the pressure off of them to do all and be all. Even the most prepared dad will forget some (or most) of what he learned in childbirth class once contractions start. Even the most calm, even-keel guy can panic once he sees his lady in discomfort. A laboring woman isn't always able to verbalize what she needs/wants. I've been trained in that area. I've given birth before. I've doula'd for many other mamas. I have been blessed with a motherly instinct and a servant's heart towards birthing women that I tend to follow more often than not.

Mamas, you deserve the love, undivided attention, education, encouragement and support of a doula. 
Daddies, you deserve the help that a doula can give you so that you can be all you can be for the woman you love.
Families, you deserve to have the best chance possible of starting your new relationship, your new family off on the right foot in a loving, gentle, educated, and supported way.

You get one shot at this one birth. There are no do-overs.

How can you afford NOT have a doula?


This is Part 1 in a 3-part blog series about the cost of a doula. In Part 2, I will discuss a thorough breakdown of my fee and explain how I came that amount. In Part 3, I will discuss ways in which you can afford a doula for your birth.
Thank you for reading! 

One of my recent clients blogged and shared her birth story yesterday. What a lovely birth that was. I'm so honored to have been a part of it. I'd like to share it all with you, too. Here is the story of Lucy's Day. Enjoy! 

The birth world has been a buzz about the newly released consensus statement on preventing primary cesareans from ACOG (American College of Obstetricians and Gynecologists) this week. And rightfully so. This statement includes things that the scientific evidence has been supporting for some time now, but that have not been widely practiced by maternity care providers. Some of the new recommended guidelines in the Safe Prevention of Primary Cesarean Delivery statement, and what I believe are the biggest game changers include:

• Slow but progressive labor in the first stage of labor should not be an indication for cesarean.
  For nearly 60 years, maternity care providers have used a graph, known as the Friedman's Curve, published by Dr. Friedman of Columbia University to define a “normal” length and pace of labor. The Friedman's Curve is based on a study about the average amount of time it took laboring women to dilate and has been used to govern how providers manage a woman's labor. It is now recommended that the Constium on Safe Labor should be the new standard of managing labor. In short, this means that evidence is suggesting that laboring women don't always, or even often follow Friedman's Curve and should be given more time before performing a cesarean for “failure to progress.” Rebecca Dekker of Evidence Based Birth has put out a a great article, “Friedman's Curve and Failure to Progress: A Leading Cause of Unplanned C-Sections.”
  
  
• Adverse neonatal outcomes have not been associated with the duration of the second stage of labor.
  The second stage of labor is the pushing stage. It has previously been advised that first-time moms be given up to 3 hours to push their babies out and a multiparous woman (a mom who has already given birth before) be given 2 hours and to add an hour onto both of those numbers if the mom has an epidural in place. The evidence has not shown however, that longer pushing phases are affecting babies negatively. There is also discussion about whether the second stage begins simply at full dilation or once the mother begins to feel the natural urge to bear down. There also needs to be discussion about positioning during pushing.
  
  
• Instrument delivery can reduce the need for cesarean.
  There are concerns that many obstetric residents do not feel competent in doing a forceps delivery. Yes! More training and better training on the use of forceps can and will save many moms from going under the knife.
  
  
• Recurrent variable fetal heart decelerations appear to be a physiologic response to repetitive compressions of the umbilical cord and are not pathologic.
  There is a discussion of fetal heart-rate patterns and solutions other than cesarean. My opinion: maybe we shouldn't be continuously monitoring healthy, low-risk women. Read more about Evidence-Based Fetal Monitoring and Intermittent versus continuous electronic monitoring in labour.
  
  
• Induction of labor increases the risk of cesarean.
• Unnecessary induction of labor increases risk of cesarean section and other complications. Inductions should not be done prior to 41 weeks gestation without medical indication. (The previous recommendation was 39 weeks). There are also new guidelines about when induction should be considered a failure. Some babies need a bit more time on the inside than others and that's OK. Everybody knows that children develop at different rates. Two of my kids walked at 11 months old and one didn't walk until 14 months old. It was no big deal. Babies also develop at different rates in the womb. We need to stop forcing them out before they are ready. 
  
  
• Ultrasound done late in pregnancy is associated with an increase in cesareans with no evidence of neonatal benefit. Macrosomia is not an indication for cesarean.
  Macrosomia is the medical term for a big baby. Those who know me, know that I am a big believer that your body will not grow a baby too big for it to birth. Ultrasounds in late pregnancy are not a good indicator of baby's size. And even if they were, cesareans should not automatically be done just because the baby is big. Your body grew it, your body can birth it.
  
  
• Continuous labor support, including support provided by doulas, is one of the most effective ways to decrease the cesarean rate.
  A Chochrane Review published in 2012 by Hodnett and colleagues states that when continuous labor support is provided by a doula, a woman experiences a 28% decrease in the risk of cesarean. Improving Birth's fact sheet titled Doulas and Healthcare Providers: Working Together for Better Maternal and Infant Outcomes lists other benefits of doula support. And Rebecca Dekker of Evidence Based Birth has an article about the the medical evidence of a doula's presence titled What is the Evidence for Doulas?
  
  

These new guidelines offer great hope for lower cesarean rates and safer births for both mother and baby. But, it will be a big challenge to change the culture surrounding birth and obstetrician's attitudes about labor management. History has shown us that once new guidelines have been posted, it takes anywhere from 10-20 years before they are widely practiced. I don't want to wait that long. I'm afraid to wait that long. Our cesarean rate has been increasing steadily. Our maternal mortality rate has doubled in the last 25 years. We are ranked very low among developed nations in infant mortality and morbidity, yet we spend an obscene amount of money on maternity care...the most in the world.

We need these changes to happen soon. How can maternity care consumers facilitate these changes?

• Hire a doula. If I am unavailable or not the right doula for you, the Omaha Doulas Association has many lovely doulas.
• Have a discussion with your provider about things such as their cesarean rate, their induction rate (and reasons for performing both of them), their practices of labor management (do they expect their patients to follow the Friedman's Curve?), their practices during the second (pushing) stage of labor, their competency in the use of forceps, their policy about continuous electronic fetal monitoring, etc. The Coalition for Improving Maternity Services has put out a great list of 10 Questions to Ask your provider. 
  
• Stop giving your business and money to providers that are unwilling to practice evidence based maternity care. There are providers in the area that practice evidence based care. If you change providers because of their practices, write them a letter to let them know why you've left. 
  
• Own your birth. Realize that you are ultimately in charge of your birth. Your doctor/midwife is an educated consultant for your care. Your doctor/midwife and the hospital staff work for you. You are the boss. This is your body, your baby and your birth. With that ownership comes responsibility. Educate yourself. Research. Take a good quality private childbirth education class. Learn your rights as a patient and consumer of maternity care. Advocate for yourself and your baby.

There are a lot of things I love about being a doula. A lot. One of those things is the support and friendship within the doula community here in Omaha. We have so many fabulous doulas here. And we're all friends. Seriously. We don't view or treat each other as competitors, but as colleagues. I belong to a facebook group in which most (maybe all) of the doulas in the Omaha area are members. Most of the conversations in that group are doulas helping each other out....providing backup for a sick or exhausted doula, sharing handouts, resources, articles and studies, offering suggestions for those harder labors, helping each other with website design, sharing opportunities for continuing education, inviting each other out for doula dates, doula parties, and doulas' nights out, cheering each other on, and offering a shoulder to cry on after those particularly emotional births.

We all have one common goal: safe, healthy and supported births. We all understand that no doula can be the right doula for every mom and genuinely want every mom to have a great birth. We work together to raise awareness about the benefits of doula care and refer to each other to make sure that every mom who wants a doula, finds one that is a good fit for her needs, desires, and personality. We deeply believe in this work. It's not about the money or the number of clients on our calendars. It's about moms and babies. It's about love. 

Thank you, fellow doulas for your love and support not only for the mothers and babies of Omaha, but of your doula colleagues. It is a blessing to be a part of this lovely little community.