How Much is Your Doula Worth?

How Much is Your Doula Worth?

I've been giving a lot of thought to my doula pricing lately and I have come to the conclusion that I am very comfortable with my current pricing.  I feel it fairly reflects my training, level of experience, continuing education, and skill set.  When establishing what she will charge her clients a doula takes a number of things into account.  Her considerations might include the number of years she has been a doula, the number of births she has attended, the cost of her initial Birth Doula training, training material costs, her travel time, her locality's cost of living, the cost to maintain her professional accrediting, childcare expenses, business expenses, her ability to make a living wage, and her continuing education work (this might include childbirth education, lactation support, comfort measures, massage therapy, herbal support, acupressure, postpartum training, postpartum depression support, optimal fetal positioning, VBAC support, aromatherapy, business training, etc.).  Clearly, keeping relevant in the field of birth work must be planned for in terms of the commitment of time and finances.  If your doula is worth her weight in salt she will be well trained, have a vast amount of knowledge and experience, and be well versed in a broad spectrum of areass as it pertains to pregnancy, childbirth, postpartum, and beyond.  That being said I also realize the cost of hiring a doula might be a stretch for some but always keep in mind how much time and finances she has invested in getting her to where she's currently at.

NOW, let's consider what you are getting when you hire a doula.  When you sign a contract to work with a doula, you're getting the support of a woman who is highly trained to deal with all things pertaining to pregnancy, labor, delivery, postpartum, and beyond, not to mention someone familiar with multiple hospitals (and their policies and protocols applicable to their labor and delivery units).  Also, you're gaining someone with firsthand or professionally shared knowledge of local OB/GYNs and their personal delivery stats regarding epidurals, C-sections, inductions, episiotomies, VBACs, forceps, vacuum extractors, and their use of other interventions, along with details about how those doctors operate under various circumstances that relate to childbirth.  She can tell you which hospitals/doctors are VBAC friendly, which ones have evidenced based practices, or which ones are all too reliant on their "toys," otherwise known as interventions.  She can tell you which nurses are familiar with supporting a non-medicated birth and which nurses you want to stay away from.  In a nutshell she can tell you, with a great degree of accuracy, which facilities are conducive to the type of birth you are in the market for.   The doula you contract with will support you in all of your both choices with a judgement free posture regardless of her own personal preferences.  That same doula will provide you with resources so that, as you are making these same decisions, you're doing so with all the information needed to be well informed and comfortable with these decisions.  This same doula that supported you in the decision making process will then faithfully support you as your delivery draws near and you have questions, concerns, problems, or false alarms.  Once labor has begun she will be by your side in less than 2 hours, and in most cases, less than an hour of your call ready to do all in her power to ensure you have a satisfying birth experience.  Her level of expertise will allow her to detect if your baby might be in a funky position and need help getting in an optimal position and she will advise you accordingly with positioning tips.  As you labor her hands will be a constant source of comfort as she massages different parts of your body, mops your face with a cool cloth, applies counter pressure to your back, works those sacral points with her thumbs, keeps those compresses warm for your back, and does those double hip squeezes that help you bear the pain of  contractions.  She will stand by your side during labor as you moan, whine, fret, cuss, cry, and complain that you can't do this anymore all the while reminding you to keep an empty bladder, relax, stay hydrated, breath deeply, and stay calm.  She will support you through contracting, barfing, showering, vacillating between hot and cold, panicking, all manner of intimate bodily functions, and, finally, rejoicing with you as your reward is realized.  She will also look out for your husband making sure he is eating, drinking, and resting, as well as providing suggestions to how he can best support you and alleviate your discomfort.  And, need I mention the fact that she is doing all of this day or night for any length of time.  She, by virtue of the nature of this profession, will drop whatever she is doing, whoever she is with, whatever day of the week, where ever she is, to be by your side, and she does so fully expecting that to be the case.

So, as you consider your choices in doulas and what you are comfortably able to manage regarding pricing, keep in mind ALL that you are getting in exchange for your payment.  Also, keep in mind that saying, "You Can't Put a Price on Peace of Mind," which is what you are in the market for.  You're looking for someone who can work with you to achieve the best possible birth experience and who will do all within her power to ensure that your delivery is free of all that you're trying to avoid and surrounded by all that you are looking for.  When looking back on your birth experience you want memories that are filled with satisfaction and not regrets.  And you can't put a price on that.

Our Special Adventure with Benjamin

Our "Special Birth" Adventure

My season of childbearing began just like any other woman's, except that somewhere along the way, we decided to embrace as many babies as we were blessed with, and baby number 13 was proving himself to be special in so many ways.  First of all, Benjamin was our 13th child and he was being welcomed into this world by 12 adoring siblings, and one smitten sister-in-law, who recently revealed that she, herself, was expecting, which made Benajmin an uncle when he was born.  How's that for a birthday gift for him.  

Secondly, Benjamin's labor was like no other that I had ever had!  My typical labor, starting with baby # 1, would begin with piddly, erratic, annoying contractions that kept me up all night and then fizzled out by morning.  This would go on for 3-4 nights till my body finally decided to get down to business, except business wasn't business as usual.  Business to my body meant laboring that final night into the early morning, all through the following day, and, finally, delivery late the next night.  EXHAUSTION was my state of mind, not to mention my body.  This was how all 12 of my babies had been delivered.  However, Benjamin's labor and delivery was turbo charged from start to finish, to say the least.  My water broke a few minutes after 3 in the morning and he was born at 4:06 AM.  My husband had to firmly demand that I get out of bed and get dressed so we could head to the hospital, because, after encouraging me to get moving, I procrastinated and lounged in bed for another 20 minutes after my membranes ruptured.  He knew that once my water broke the baby would usually come soon thereafter.  OK, so I finally decide to dress and I could barely make any progress because I was in transition and things were already hot and heavy.  So, after dressing, I grabbed my jacket (a maroon fuzzy one, which we'll discuss in greater detail later), headed to the car, stopping every minute to work through my contractions.  I get to the car and am about to step in and realize I'm ready to push.  My husband grabs the towel I have between my legs to catch the amniotic fluid, since he sure doesn't want that stuff on his BMW's white leather seats, and throws it on the ground and spreads it out with his feet.  He stands behind me while I push and out comes Benjamin in a couple of pushes.  How's that for a precipitous labor?  

We decide to continue on to the hospital and, of course we had to get gas, which was my only pet peeve of the night, but we make the one hour trek to show the midwives our newest blessing.  On the way in I start rubbing Benjamin off with the only item of clothing  available, my jacket.  Not only is it somewhat scratchy but it has the feel of wool. not the fluffy, downy soft, flannel you envision greeting a newborn with.  But, hey, it'll have to do, right?  So a little while later, with the help of Denny's obnoxious flash glaring repeatedly as he snaps pics of his comatose wife holding their newborn, I realize Benjamin's skin looks weird.  Upon closer inspection I begin rubbing stuff off his face and body that looks like burgundy hair. Yep, the jacket is shedding and it's clinging to his entire body thanks to the fluid, vernix, and blood.  The hospital folks (midwife and her entourage of nurses) met us at the parking lot, which, by the way, is where I delivered the placenta, and came well prepared for greeting a new baby.  They had towels, sheets, blankets, baby hat, scissors, cord clamp, bulb syringe, wheelchair, and anything you could ever possibly need in that type of situation, even a basin for the placenta.  Not only were they well prepared for us but one of the nurses even cleaned up the mess I left in the passenger seat.  How's that for service?

 The third reason Benjamin was so very special was that, after getting to our room and settling us in for Benjamin's newborn exam, one of the nurses told us it appeared Benjamin had some of the markers of having Down Syndrome.  They never officially tell you "your child has Down Syndrome," since they must wait for the genetic testing result before making if official, but they prepare you with the "marker" buzzword.  Anyway, after getting over that bit of news they tell us they think he has a problem with his heart, which is typical for DS babies.  So we snuggle him for a bit and off he goes to the NICU.  He is put in an isolette and hooked up to oxygen with a nasal canula.  We meet the pediatric cardiologist, who was wonderful, and is still Benjamin's doctor, and he tells us Benjamin has 2 holes in his heart which is causing him to have pulmonary hypertension.  He was given multiple meds to dilate his blood vessels but, after a few days, it becomes obvious Benjamin needs more than they can give him there, so he is transported to a different hospital.  There he is hooked up to multiple meds, at least 7 from what I can tell, and he is sedated to keep his heart rate normal.  After 4 days there, he is, again, transported by helicopter to the University of Virginia Hospital, which they tell us has the last possible thing that can help Benjamin... the ECMO machine, which is a type of heart and lung bypass machine.  There they tell us that, if the ECMO machine doesn't give Benjamin's heart and lungs a chance to relax and slow down, there is nothing else they can do for him.  They prepare us for the worst and we begin to prepare ourselves for the devastating possibility of losing our little man. 

This whole time we were somewhat in a daze.  For me it was not necessarily due to the Down Syndrome diagnosis, although, in a small part, that was a bit of a shocker, but, primarily, because of the medical crisis our little man was in the midst of.  He was so little and hooked up to so many wires and tubes and meds and machines, and he was so swollen from being given so much fluid to try to dilate his blood vessels, and his little chest was bouncing up and down so fast and hard from the oscillating ventilator he was attached to, that you just ached with pain for him.   Seeing your child not being able to breathe and struggling to cling to life was SO VERY HARD.  He was suffering so much and yet there was nothing in our power we could do for him.

Well, with all thanks to our Heavenly Father, Benjamin pulled through after just 3 days on ECMO, to the delight of his docs, and of course, his family.  The docs said that it was unusual for a baby to improve and get off of ECMO so quickly.  We had soooo many folks around the world lifting him in prayer.  It was an amazing time.  After his stint on ECMO, it was discovered that Benjamin had an intestinal obstruction that would need to be surgically repaired.   Once he stabilized from the heart and lung issue he was prepped for intestinal surgery, which was successful and, after a few days, they let him begin to receive milk.  And then, finally, after 5 weeks of pumping, which, by the way, was WORSE than the pits, I was able to nurse Benjamin.  He did great.  At that point, after 6 tumultuous weeks in the hospital, we were able to bring Benjamin home to his eagerly awaiting siblings.  What JOY!!!  I wept for joy in the overpass that connected you to the parking lot.  I felt like a prisoner whose death sentence had been commuted to life, no pun intended.  

During Benjamin's hospital stay at UVA we were blessed by the kindness of so many folks.  From our stay at the Charlottesville Ronald McDonald House, where every need we could possible have was met by their supportive staff, to the many meals that were sent to our children while we were away 6 weeks, to the hospital visitors who came just to pray for our little man, to the cards, gifts, prayers, and words of encouragement from so many.  And we can never forget the 2 week visit to stay with our children made by our daughter-in-law's mom, Kristi, which blessed this mama's heart to no end.  We were amazed by how our emotions were so close to the surface for weeks on end.  Whenever someone would share a kind word, a much needed hug, an offer of help, or just an understanding gesture, we were immediately on the verge of tears and had to explain why, for example, someone's gesture to put gas in our car brought us to the point of tears.  

After Benjamin's discharge we had multiple visits to the pediatrician to monitor his not so great weight gain and, also, cardiologist.  We also made the long treks back to UVA to see a pediatric endocrinologist to treat his hypothyroid condition.  I thought it would be interesting to list all the different health professionals (medical and otherwise) that have shared in our special adventure with Benjamin.  Here goes... the aforementioned pediatric cardiologist, pediatrician, and endocrinologist, a general surgeon (intestinal repair), radiologists, anesthesiologists, pediatric cardiac surgeon (cardiac repair), a newborn physical therapist and infant teacher (who were assigned to him during his NICU stay), social worker, respiratory therapists (who constantly monitored the various respirators he was hooked up to), the ECMO folks (2 highly trained nurses who were required to maintain a 24 hour presence while he was hooked up to ECMO), an in-home speech and physical therapist (who have become a regularly part of our lives), a special services coordinator, a private speech and language pathologist (that we have hired to work with us in implementing our preferred method of speech and language acquisition), a chranial-sacral therapist (for complimentary treatment), a developmental pediatrician, a gastroenterologist, and the various ER and hospital staff along the way that have treated him at his multiple visits and hospital stays for his bouts of croup, asthma, and RSV.  

 These are just a few ways our little Benjamin Zebediah Green has set our feet on a special adventure that just gets sweeter everyday.  We look forward to our days with Benjamin, unfolding each one as an adventurous gift from above.  Thanks for reading my tribute to Benjamin.


 

A Beautiful Birth

Yesterday I had the opportunity to serve a lovely couple attempting a VBAC at an area hospital known for their great midwives.  This couple were repeat clients and I really looked forward to working with them.  They came into their labor well researched, prayed up, and anxious to meet their little girl.  Mom's labor began around 2 AM with contractions coming every 3 - 4 minutes and lasting a minute to a minute and a half and this had been going on for a couple of hours.  I fully expected this labor to be over soon but I was quite mistaken.  After laboring all day and late into the night the baby's heart rate dropped significantly and failed to rise back to normal rates.  After attempting to get the baby's heart rate back into an acceptable range the midwife decided the baby was in distress and she rallied the OB/GYN team for an emergency C-section.  Mom accepted the decision quickly with her only concern being that for her baby girl.  It literally took less than a minute get Mom into the OR.  While waiting for Mom and Dad to return from the OR I had a lovely conversation with Mom's dad where we recounted her last labor, two years prior, when we supported Mom and Dad as they labored and, ultimately, awaited their return from the OR.

You may wonder why I entitled this post, "A Beautiful Birth."  There were quite a few, the first one being the wonderful midwives that served, encouraged, supported, and lifted this sweet couple.  Even though the labor was rather long with very little visible progress, since Mom only dilated to 4 cm., both midwives were genuinely concerned that this mom get a legitimate and exhaustive attempt at a VBAC.  I was so impressed with both midwives, but, particularly with the latter one as she propped Mom up through moments of despair, tears, discouragement, and, ultimately, the decision to move quickly towards the section.  Another thing that made this birth beautiful was the wonderful spirit of worship that we all experienced as Mom's dad led us in singing, praying, worshiping, and praising through the ups and downs of this labor.   He was an anchoring presence to both Dad and Mom and even the staff was touched by his ministering presence.  As the C-section was approaching he helped to steady Mom and Dad and led them to a place of thankfulness and acknowledgement of our Heavenly Father's sovereignty.  The final thing that bears mentioning is a sweet bonus to a long day.  As Mom was returning to her room her bed was wheeled into the room and, curled up in her mother's embrace, was this sweet little girl that we had been waiting for all day.  She was alert, calm, and so full of peace.  What a healing presence she was to her Mama.  I was amazed with it all.  

So, as I made my way home, exhausted to the max, I pondered the unfolding of the day and I, again, realized how I truly enjoyed birth work and serving my clients in gaining the birth they are looking for.  What a pleasure to get to know my clients as the explore their needs and options as they await the birth of blessing.  Looking forward to many more days of serving expectant couples as they meet their newest loved ones.