• Home
  • Subscribe
  • Articles
  • Submission Guidelines
  • Advertisements
The Birth Mag

Midwives and Doulas: The Promise We Make

December 8, 2020

birth photography by natalie broders
by Juli Tilsner

This article initially appeared in Vol. 1, Issue 1 (Winter 2020) of The Birth Mag and is now being made available online to improve accessibility.

What is the #1 reason people hire Doulas and Midwives?  Satisfaction with the birth experience. Or, in other words: trauma prevention. 

My goal here is to critically look at the role continuity and continuous support play in outcomes for the people we serve, and hopefully avoid pitfalls in the way we structure services that can negatively impact clients. How we can take care of ourselves physically, emotionally and financially, while simultaneously give our clients the care they deserve? 

Continuity of care and continuous labor support are intertwined as one of the most difficult aspects of birth work.  They can lead to severe burnout and limit our income when we don’t have partnerships or backups available. We can easily justify taking more clients in a month than we know we should, making these exceptions because we tell ourselves “they need us” and saying no breaks our hearts. Most of us have broken our own number of clients per month rule, maybe more than once. Maybe it turned out OK, possibly not. Maybe the stars aligned and mercy was showered, everyone was cared for and you made it out the other side with happy, healthy families. But at what cost?  Burnout comes in many forms, and we might not even recognize it happening. If you are on the verge of burnout, you won’t be your best for your clients, and they deserve stellar care. Your clients deserve to have you, the Midwife/s or Doula/s they hired at their side for their labor and birth. You deserve to be happy, healthy and thrive. 

What does continuity of care mean to you? 

“The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on before, during, and after birth. Midwives specialize in pregnancy and childbirth, developing a trusting relationship with their clients, resulting in confident, supported labor and birth.” https://mana.org/about-midwives/midwifery-model

The universally defined role of a Doula includes ‘continuous labor support’. Benefits of this continuous support are well documented.  https://evidencebasedbirth.com/the-evidence-for-doulas/

I practiced as a home birth midwife with my Midwifery partner Deborah Simone, in the SF Bay Area, CA for 15 years until moving to Portland, OR in 2017.  I’ve been training doulas since 2006, and have been a preceptor for a number of aspiring Midwives. 

Early in my career, I learned the most important aspect of my work was the relationship between myself and my clients. My clients were depending on me and my practice partner to be there for their birth. This was the most important consumer decision they’d ever made: Hiring the team that would bear witness to and be safekeepers of their personal metamorphosis and ushering in of their beloved baby.  They were putting their hearts in our hands. 

This overarching truth about the responsibility I had to my clients was highlighted when people would come to me in second pregnancies with stories of abandonment and trauma from their first birth. And this happened often.

These abandonment stories all had a common theme. The hired Doula or Midwife, with whom they’d cultivated relationship and trust, was at some point not available when they were needed most. This could be in the days or hours before labor, or during labor and birth. 

Common Stories

The contracted doula or midwife had a strict call period, usually 37-42 weeks, and was not available before or after those dates. Often, a vacation had been scheduled at 42 completed weeks for the client. Once a Midwife called me to request I take over her practice while she was on vacation, as she had 3 clients within dates while planning to be out of town! A home birth client hired a doula who planned a vacation when the client was in her 41st week, but felt confident it would be fine because the first baby came at 40 weeks. The client had talked themself into believing there would be no emotional affect, because they wanted this Doula so much. This was a very risky scenario. It ended with the Doula attending the birth, but not without some stress involved. 

The Doula or Midwife has two people in labor simultaneously. They call their backup, with whom the client has had a prenatal visit and feels comfortable with, but that backup isn’t available. Instead, a Doula or Midwife from the community that is a stranger to the family comes to be with them. 

Homebirth client transfers to hospital. The Midwife accompanies them to admissions and helps get them comfortable. The Midwife, in private practice with other clients due does not stay at the hospital. They may go home to rest or keep scheduled appointments so they don’t get behind. The midwife instructs the parent/s to call when they are close to pushing, or if anything urgent happens.  

Doula leaves the labor at some point to get rest, often after the client gets an epidural. 

All of these scenarios create stress for clients. Worrying they won’t have their baby before the Midwife or Doula goes on vacation often delays the onset of labor. Discovering that they’ll be attended by a stranger alters the hormonal cascade, affecting the birthing experience. Being left at the hospital exhausted with no advocate, wondering if and when to call the Midwife or Doula in time for the birth often leads to clients making snap decisions that would have been made differently had their support system been present. 

In the last scenario, there also is a good possibility that no support person will get back to the hospital in time for the birth. From personal experience, you never want to live with the feeling that if you’d have just stayed, there wouldn’t have been a cesarean or…

What can be done to minimize these scenarios: 

Work in partnerships. My practice found that 3 was our sweet spot. We had a rotation of 2 people on call and one off call at all times. A partnership of 2 as can work as well, with scheduled blocks of time off for the practice.  Money is shared, but clients get to know each provider and are guaranteed to have someone they know at their birth.

Have backup backups and childcare backups. 

Doulas: Meet with your clients at least 4 times prenatally (instead of the standard 2). Have your backup/s attend at least one prenatal visit. If you’re in a partnership, split prenatal visits equally.

Be realistic with how many clients you take and how many backup gigs you have. If you’re in private practice, 3 births per month will be a good bet that you can attend every birth. In a 2-3 person partnership with solid back ups, 4-5 clients will ensure that your clients are covered. Another benefit in limiting clients numbers is sustainability for you and your family. Your clients get the well rested (not burned out) Midwife or Doula care they deserve.

Be on-call for clients from the time they hire you, until they have their baby. Be in town on ‘hard call’ from 36-43 weeks. Be available by phone or have a backup if you are out of town before 36 weeks. This gives your clients coverage in most situations.

Work on shifts with your partner or backup. Take turns relieving each other every 8-12 hours. 

If you are a lone provider in a rural area with little to no backup, there may not be a choice but to be up for 2-3 days. Take care of yourself by not taking on too many clients at once. Practice radical self care between births. Midwives: Work with Doulas! You can rest assured that your clients are cared for, so you can be well rested when you’re called.

If you have no backup, bring a sleeping bag to the hospital so you can rest, yet be in the room with your client, in order not to miss anything. 

Always have what you need to be nourished during a hospital shift. Carry a cooler with food and plenty of beverages.

When your client gets an epidural: 

When the birthing person gets an epidural, it is usually after everyone in the birth team is tired from long hours or days of continuous support. This is often seen as an opportunity to get a ‘break’. After the epidural is placed, team and family go to the waiting room or leave the hospital to get some sleep. The birthing person may even say with a smile, “I want you to go get some rest now, I’m ok”

What’s being said and the emotional impact are two different things. The laboring parent most likely doesn’t understand the short or long term emotional impact or dangers of being left alone with no support person. The birthing person is still in labor, and the importance of staying connected to the work and connected with their baby cannot be overstated. 

The epidural cuts off sensation, which in turn cuts off the cocktail of hormones that drive the primal experience of birthing and bonding. It’s hard to stay connected when lines of communication have been blocked. 

There are also risk factors that come with the epidural. Even if the birthing person and  baby are considered stable, the risk factors do not go away. There are physical, emotional and iatrogenic (hospital caused illness or injury) risks. Institutional risks include protocols, time limits, lack of trauma informed care, shift changes. The often seen opportunistic behaviors of the hospital team, when there’s no support person or advocate in the room must not be understated. 

It is well documented that the security of the continuous presence of a doula helps birthing people feel safe enough to allow the process to unfold, in other words to ‘open’. Epidurals and pitocin are not miracle workers, they cannot force a pelvic birth if other essential elements with birther and baby are not in alignment. 

The Doula needs to keep a hawks eye on everything while the birthing person rests, hopefully being undisturbed for as long as possible. Realistically, there isn’t much uninterrupted sleep. We want to believe providers when they say ” get some rest,  we’ll be back in a couple hours” as the lights are turned off. However, the nurse is in and out, on the computer, evaluating the monitor, adjusting belts if baby moves or heartbeat aren’t being recorded, emptying the catheter bag or a number of other tasks. Also, things can change quickly, as in a rapid birth. A laboring person can quickly dilate to complete once they’re able to relax internally with an epidural.  In some cases, the decision for a surgical birth is made when a baby shows signs of not tolerating the labor, and there’s no time to call support people back to the hospital. 

Tips for the Doula when there is an epidural: 

  • Help the laboring person get blocks of rest by making a plan. This can be simply that they’ll sleep for an hour while you ensure nothing is done to them without their consent. The laboring person is more likely to sleep if they know their doula is watching over them and the baby. 
  • Ensure the laboring person is turned every hour.
  • Massage, rock, visualize, sing with, read to, engage the client with the baby, and bring on the unique magic that each particular Doula has to offer.
  • Keep an eye on the catheter bag and alert the nurse when full.
  • Advocate that the laboring person is taking in food and/or liquids. 

It is our duty as birth workers to care for ourselves, so that we can be fully present in body, mind and spirit for our clients. It can be challenging to find like-minded colleagues to be 100% responsible, solid backup. Pay backups generously for taking call. Be a stellar backup for others. Doulas and Midwives: Learn how to run successful, sustainable partnerships. The promises we make are not only to our clients, but also to ourselves, our families and communities.

Juli Tilsner is a California Licensed Midwife, CPM, Author, Educator, Consultant, Parent to a human and a fur baby, Grandparent, Co-Founder and Co-Executive Director of Cornerstone Doula Trainings. In service of reproductive rights for all people & birth justice, working towards a world where birth trauma does not exist. Insta: @cornerstone.doula.trainings https://www.cornerstonedoulatrainings.com/

*Header photo by Natalie Broders: Portland Birth Photographer https://www.nataliebroders.com

Filed Under: Birth Community, Birth Support, Birthworker Life

Share

Facebook Google+ Twitter Pinterest Email

thebirthmag

Happy new year! 2020 was rough on the Birth Mag cr Happy new year! 2020 was rough on the Birth Mag crew, and we know it was for many of you as well. This turned out to be a terrible year to launch a new magazine project, but it's over, and we're moving forward.

What's next then? First and foremost, the next print issue is coming! Look for a sneak peek of the upcoming cover next week. We are also settling in to a more consistent release of digital content going forward. 

We are so thankful for everyone who has hung in there with us through the tumultuous ride that was 2020, and look forward to bringing you so much more in 2021!

#thebirthmag #birthwork #birthworkers #midwifery #doulalife
New on the website this week, from Dr. Ali Davis, New on the website this week, from Dr. Ali Davis, DC (@dr_ali_thechiro ): 

"Someone you know is LGBTQIA+, possibly even someone you love.
If you’ve been in practice for any length of time, chances are you have LGBTQIA+ clients.
Even if you don’t know which ones they are.
Even if you practice in a small rural town.
Even if you think your practice serves a 'different' niche of clientele."

Read the full article at www.thebirthmag.com 

#inclusivecare #inclusionmatters #lgbtqia #lgbtqbirthmatters #queerparents #thebirthmag #birthworkforall
Repost of a snippet of a live from @maytethewombdo Repost of a snippet of a live from @maytethewombdoula and @mujer_dela_tierra discussing violence in American midwifery. You can find the full length video over on Mayte's page, and I strongly encourage everyone, especially white midwives, to go watch it. There's some excellent explanation of differences between traditional midwifery (specifically parteras) and modern midwifery as typical in the USA, and the ways bias impacts care. Warning: this is a hard conversation and does include talk about loss of a baby.
New this week on the website, some thoughts from @ New this week on the website, some thoughts from @doula_barb of @birth_fort_worth on sustainable birthwork practices, because we all know that burnout is real.

"Sustainability.

These days, it almost seems like a buzz word in the birth world. A free download. A hashtag. A commodity, even.

In reality, though, sustainability in birthwork, particularly in the doula-world, means getting to do the work that sets your soul on fire for longer than a few years.

Sustainability means creating a business from which you don’t need to regularly take self-care, or 'burnout breaks'. It’s so much more than warm baths, massages, mantras and aromatherapy.

It’s understanding that you have value. It’s understanding that it’s ok to charge whatever it takes to make you feel GOOD about walking out the door and leaving your life behind for an unknown amount of time. It’s about business models and contracts. It’s about boundaries."

Read the entire article on www.thebirthmag.com (link in bio).

#birthwork #birthworkers #doulalife #midwifery #birthsupport #thebirthmag
New on TheBirthMag.com this week from Juli Tilsner New on TheBirthMag.com this week from Juli Tilsner (@midwifejuli.cornerstone ): 
"Continuity of care and continuous labor support are intertwined as one of the most difficult aspects of birth work.  They can lead to severe burnout and limit our income when we don’t have partnerships or backups available. We can easily justify taking more clients in a month than we know we should, making these exceptions because we tell ourselves 'they need us' and saying no breaks our hearts. Most of us have broken our own number of clients per month rule, maybe more than once. Maybe it turned out OK, possibly not."

Read the full article on the website. Link in bio!

Photo by @natbro.photo

#doula #doulalife #doulaservices #midwife #midwifery #midwifelife #birthwork #birthworkers #birthsupport
New on the website this week: Raichal Reed (@mcdon New on the website this week: Raichal Reed (@mcdonald_herbalist ) shares some information about waterbirth and Covid-19. 

"According to the CDC, 'There is no evidence that COVID-19 can be spread to humans through the use of pools and hot tubs. Proper operation, maintenance, and disinfection of pools and hot tubs should remove or inactive the virus that causes COVID-19'. All rules that currently stand for a birthing person to be able to be in the pool (no fever, respiratory issues, etc.) should stay the same so that those who are sick in general are not in the water. Infections and how they spread vary and because there is no current documentation as to every way a person can contract the COVID-19 it is important to have proper personal protective equipment with each birthing person. Currently the CDC has not found any traces of COVID-19 in any municipal water systems, but they have not properly studied well water so their research is to be determined."

You can read more on TheBirthMag.com! Link in bio.

#waterbirth #birthduringcovid19
#midwifery #birthsupport
#birthwork #bornin2020
The lactation issue is out! We had an abundance of The lactation issue is out! We had an abundance of delays, but they have now all been mailed. If you've been waiting on this issue, keep an eye on your mailbox, because it is on the way!
Community led, community based. The Birth Mag is l Community led, community based. The Birth Mag is looking for new submissions! Are you a birth worker? Are you interested in helping your fellow birth workers learn and grow to be more inclusive and educated on the issues birthing people are facing today? We want to hear from you! Compensation starts at $35 for any article that is used. Please e-mail us at thebirthmag@gmail.com for more information or to submit an article.
#Repost @thevaginachronicles
• • • • • •
There is so much to learn from this week. So much to give and receive. .
.
This list is not an extensive and in no particular order but it is some of the HARD and persistent work that we must do. .
.
Black people breastfeed. Even when we tell you no after you’ve asked 15 times if we want formula. Even when we are afraid of what it looks like and how we can continue It. Even when we see how you look at our breasts not understanding how different they can be. Even when we must figure out breastfeeding complexities by ourself. Even when we had to do it for you, before we could do it for our own children. .
.
WE BREASTFEED!
#Repost @blkbfingweek • • • • • • HAPP #Repost @blkbfingweek
• • • • • •
HAPPY BLACK BREASTFEEDING WEEK! 🤩

By our histories and by the truths we know from living, our possibilities are greater than any imagination. 

For all the days that have felt hopeless, we invite you to enter a period of nourishment to revive.

Where there has been loss, grief and uncertainty, our restoration is key to being present and imagining healthy futures. 

And all through #BBW20, we reclaim our time, lives and families. 

Let’s gooooooo! 

#ReviveRestoreReclaim #blackbreastfeedingweek

Artist: Andrea Pippins @andreapippins
#Repost @storkandcradleclasses • • • • • #Repost @storkandcradleclasses
• • • • • •
New York, New York

Today starts Native Breastfeeding Week. Here are some native breastfeeding facts you should know.

-“The mission of the Native Breastfeeding Week community is to reflect the diversity of native breast-feeding experiences and to encourage and uplift visibility of native breast-feeding experiences”
-“this community also helps to address the inequality and injustice of indigenous mothers and their abilities to practice their roles in accordance to the tribal communities they dissent from”
-American Indian and American Native rates of breastfeeding initiation is 73% versus the national average of 83%.
-Formula supplementation is high (97%) for mothers who didn’t initiate.
-many native mother’s insurance doesn’t cover donor milk which could greatly benefit infants.
-many native women lack breastfeeding support because of social and cultural norms.

Facts are from @ja_lyonhawk article posted at illusa.org 2019

Please visit Native Breastfeeding Week’s Facebook Page for info about the virtual events you can support this week. ❤️

#indigenousbreastfeeding #indigenouswomen #americanindian 
#nativebreastfeedingweek #blackibclc #ibclc #doulasupport #doulas #blackmidwives #midwives #breastfeedingsupport #storkandcradle
#Repost @taprootdoula • • • • • • Blac #Repost @taprootdoula
• • • • • •
Black Maternal Health Week is EVERY week •
•
Art @designedbydg •
•
The best way I’ve improved my ability to care for black parents is to listen to them. But before I could learn to listen, I had to commit to the LIFELONG task of confronting my biases against them. I must also commit over and over to the a promise that I would confront bias and racism I witness in my colleagues, providers, leadership and institution. This involves being brave, frank and unapologetic, and well-versed in the mechanisms for reporting abusive and problematic  behavior, even in situations with an imbalance of power (nurse v. physician, etc.) Anti-blackness is the default in our culture. As healthcare workers if we don’t intentionally, diligently, and sustainably work to confront and destroy our biases, these biases WILL lead to black birthing people and babies’ harm and death.
•
Every birth worker - doctor, nurse, doula, midwife - needs to invest in an anti-racism training - @rebirthequity ~ @theblackdoula ~ @shishi.rose ~ @abide_women are some leaders who receive compensation to help you confront your biases against black birthing people. Anti-racism training is not CULTURAL COMPETENCY TRAINING. Cultural competency training is required by most employers, it’s been around for a while, and it doesn’t change s#%^.
•
Follow 
@blackmamasmatter @4kira4moms to keep up to date on ways you can learn more and legislation that is working towards the goal of protecting black parents and babies from medical racism that causes harm.

#blackmamasmatter #maternalmortality #blackmaternalhealthweek
Load More... Follow on Instagram

Search

  • Facebook
  • Instagram
  • Twitter

Copyright 2021 The Birth Mag | Site design handcrafted by Station Seven