Finding the perfect support for you and your family is a must during pregnancy, birth and postpartum. When seeking out birth services, including care providers and assistants, you should be confident in that person's abilities, and comfortable with the standards they portray. You don't have to settle for a doctor you don't like, nor do you have to hire the first assistant you interview with. These people can become like a member of your family and you want them to be worthy of that honor.
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What are the costs for doula services?
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It is important to me that all birthing women who desire physical support and the skills of a doula during their pregnancy, birth and postpartum period have access to that support. For this reason, my fee is based on the resources of the birthing client. Depending on financial circumstance, the fee may be a minimal charge to cover basic expenses of support. My full fee, for those who are able to pay it is $500.00. This includes prenatal education and support, consistent one on one support in labor and the postpartum period in the birthing environment of your choice, and immediacy postpartum support. Included at the request of the client is a detailed story of her baby's birth. I require a 50% deposit on agreed fees. In addition, there is the available for the client to contract for additional prenatal and postpartum support as desired for an extra fee. Fees are arranged upon contract signing with the deposit required at that time. Payment options are available.
My husband doesn't see a need for another person in the room, won't the nurses be enough?
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Your husband is right, it is possible for many people to come and go from your hospital room, however those working for the hospital have their own jobs to perform. As a nurse, I understand that the hospital staff has a responsibility to safeguard your medical health, as well as the medical health of others within their care. Never assume that you will be the only patient your nurse is caring for during the birth of your baby. Additionally, hospital protocols often require the nurse to spend time during your labor documenting the labor in detail and monitoring machines, drips, and anesthesia within her duties. Often, offering physical support is extremely difficult for the staff to fit in. The doula is the only person who is a constant presence during your labor and birth, she has no shift change, no paperwork and no other clients to care for. Your doula is the only person aside from your family that is there solely for your benefit. This responsibility is left solely to the support people you choose to bring to your birth. The task of support and comfort can mean long hours of hard work and commitment. Whether you choose professional support or family support, the work of labor is not meant to be handled alone. Plan to bring your mother, a sister or best friend to assist you and your partner in your birth.
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How will my doula support me?
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Doulas offer informational, emotional, physical and advocacy support. In pregnancy, I am available by phone and in person when you need me. I have research and information available to assist you in making an informed choice about your care. I offer massage for physical comfort, help with sleeping positions, show you exercises to decrease pain and muscle aggravation and help to align your baby for an easier birth(Optimal Feotal positioning). A doula provides emotional support through pregnancy, post-date births,issues with anxiety and stress, and many, many more options. During labor and birth I am a constant presence, once called upon, giving physical support through massage, movement and positioning, emotional support with a calm and relaxed presence, and advocacy support through information regarding birth choices as well as encouragement to you and your family. For your postpartum visits; I will supply you with a story of your birth if desired, offer breastfeeding help, help with managing a fussy baby and emotional support for those first few weeks with your new baby.
Q
If I choose an epidural how would a doula help me?
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As part of your support team, I want you to make the decisions that are best for you and your baby. Once you have the information you need to make informed choices for your care then it is my job to fully support those decisions. The facts are, you cannot just walk into the hospital and get an epidural. Once you present in labor, your status will be checked, the nurse will check your dilation and effacement, the strength and timing of your contractions, and your emotional state. If you are in very early labor, your cervix is dilated to less then 4 cm, the baby is still very high, or your labor pattern is erratic you may have to wait for changes to receive an epidural. In addition, in facilities where anesthesia is on-call or limited there may be a delay of several minutes or more for the procedure to begin. Epidurals are most effective when given between 4-8 cms. If you present after 8 cm your doctor will assume your progressing quickly and may want you to avoid an epidural because it can slow progress. Keeping all of this in mind, it is best if you labor comfortably at home until you are sure of your labor pattern, meaning contractions are 3-5 minutes apart and lasting for 60 seconds, your waters release or a time of predetermined agreement between you and your provider. Once at the hospital it takes 45 minutes or more for an epidural to be administered and pain relief to take effect because the fetus must be monitored and additional fluids have to be administered to counter act the side effect of low blood pressure caused by spinal or epidural anesthesia. This means an IV must be started. This all takes time. Even once the spinal or epidural is in place the work is not over, you must be turned from side to side every one to two hours or so, you may have windows of pain, itching, chills, sweats or side effects that are more serious. When pushing starts it can take 1-2 hours longer with an epidural requiring more effort from mom and her support team. Because your doula is a constant support presence, whether at home, or the hospital, you will have other options at hand for pain management should your pain relief be delayed or not work effectively. You and your family will have emotional support and advocacy available to you. Having an epidural for birth does not take the hard work, emotional needs or physical comfort needs away. It does however mean you no longer have the means to manage these on your own and you have to look to outside support.
Q
I'm being attended by a midwife, won't she doula me?
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It depends on where you are birthing. If at home, ask your midwife if she brings assistants with her. Some homebirth midwives bring assistants to help with support. A minimum of 4 people to support you would be appropriate, your partner, the midwife for your care, an assistant for the babies care and an assistant for your support. At home there is also the need for food preparation and cleaning. This needs to be done during the birth and after. If your midwife does not employ assistants, it would be worth your time to look into doula assistance. If your birthing at a birth center a doula would be an important part of your birthing team. Some birth centers employ doulas so check into what your center offers. Even a midwife at a birth center cannot focus on comfort measures. She is responsible for your clinical management and may have to split her time between you and another client. For a hospital birth, a doula is quite necessary for support. You may have hired a midwife for your delivery but your birthing in the hospital. Hospitals are clinical places with rules and procedures. Your midwife will have other clients to tend to and will be working under an obstetrician. It would be beneficial for you to labor at home as long as possible if you want a low intervention birth and are planning on birthing in a hospital as long as this will not endanger your or the baby's well being..
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My provider said a doula would cause tension and would prefer me not to have one, what should I do?
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It is good to remember that you are the birth consumer. Your wishes should be honored, and if you wish to have extra support then you should have extra support. Doulas do not work against your care provider, they do not interfere with medical car,e and they do not ask you to go against your provider's care suggestions. Doulas offer you solid evidence based information so that you can make informed decisions and give informed consent or refusal. A patient who has questions requires more time and a busy provider may see that as a bother. A patient who wants lower interventions takes more time and energy and the provider may be too busy to comply. If you are uncomfortable or unhappy with the care your provider is showing you, you have the choice, at anytime in your pregnancy or birth, to change to another provider. A good provider will welcome the chance to work with an educated patient and enjoy the presence of a doula during birth.
Any time in pregnancy you feel you need extra support, education, information or advocacy. It is generally a good idea to meet with your Assistant a couple times before your birth. This way you can build a relationship, talk about needs and wishes and work out a system that best supports you. I like to meet with my clients starting at 32-34 weeks and then have weekly contact, whether by phone or in person until birth. However, if you are high risk or have concerns you can contract doula support at any point in your pregnancy, even during fertility treatments. It is never too late, or too early for doula support.
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My partner is concerned about being pushed aside. Will a doula replace my partner or be overbearing?
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On the contrary, all of the research has shown having a woman knowledgeable with birth actually helps both client and partner feel calm, relaxed and safe. A doula should compliment the relationship that exists between the partner and client. The doula's job is to ensure the partner participates as much or as little as they want. The doula should never interfere with partner support. I have enjoyed helping several couples in birth, and my greatest joy is witnessing the bond that creates itself in such intimate moments. Women are more satisfied with their partners, and their partners are more comfortable supporting when doula support is available to them.
Can I tell my provider No or refuse interventions and procedures?
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You are the birth consumer and the one in charge of your care decisions. While you have hired your provider for his/her medical opinion, it is just that, an opinion and not a rule or law. You are the one who must decide what choices are right for you and your baby.You are the only one who can allow or consent to interventions and procedures. If your provider disagrees with your choices, you have the option to transfer your care to another provider who is more willing to support your needs and wishes. Of course you can say No and refuse treatment regardless of outcome the decision is solely yours. The most important point in your decision making process is ensuring that you understand the full risks and benefits of the procedure you are being presented with and making a fully informed decision based on those facts. This is why being an informed birth consumer is very important, because the more you know, the better you do.