Belly Up

* bellies * birth * babies * breastfeeding *

Sunday, October 19, 2014

Considering Becoming a Doula? Informed Decision Making - Not Just for Expecting Parents

If you are thinking about becoming a doula, there are lots of options and you deserve to be informed as possible just as I encourage informed decision making for expecting families. I am going to answer for the Birth Boot Camp DOULA program but I encourage you to ask other organizations similar questions so that you can find the program that  offers the best fit for you as you consider becoming a doula.

Can I conveniently find everything about your program on your website?
Yes, of course.  We want you to see how great our program is and we want to make sure that you agree with our scope of practice and professional standards.  Check it out: 

How many hours of my training will be spent in person with an instructor?
Our doulas receive about 30 hours of hands on training with experts who will help you have a successful doula business.  The training is so fun though, that it will feel like it flies by!

What do you cover beyond basic doula skills?
Birth Boot Camp DOULA is unique in many ways, one of them is that our training is actually 3 trainings.  When a doula trains with Birth Boot Camp DOULA, she gets a full lactation course taught by an IBCLC, a full doula class taught by experienced doulas, and a marketing class led by a marketing expert who specializes in promoting birth businesses. 

Does your certification include lactation training?
Yes, it does.  We have an IBCLC come to training who does a complete Lactation Intensive for Professionals. Our doulas are very well prepared and confident to help couples with the initiation of breastfeeding and beyond.

Does your certification include marketing and business skills?
Yes, in fact, this is a large focus of the training.  We prepare our doulas to be wonderful doulas and successful business owners.  We even include a client contracts as part of the training so you can walk out of the training and sign up a client immediately and every doula leaves the training with a professional headshot.

What on-going support do you offer those that train with you?
We offer several things.  One is a formal mentor program, another is that all doulas have access to our marketing coordinator anytime they want to ask questions about how to build their business. Finally, we offer the support of the Birth Boot Camp community.  This includes doulas and childbirth instructors that recommend and refer to each other, that support each other and you will have access to promotional pieces like banners, pamphlets, stock photos and so much more.  Last but certainly not least, you will have access to Supporting Arms.

What is Supporting Arms?
Supporting Arms is a 28 page professionally designed and published booklet that our doulas may give to their clients.  (I suggest our doulas take it to interviews because it will help them get hired on the spot!) It has all the materials needed for two prenatals and a postpartum.  It is not childbirth education but rather a guide for building the relational support that defines doula care.  It covers topics including talking effectively  to their care provider, relaxation and post partum mental health assessments and a lot more.

What is the total cost to be certified?  Are there other fees besides training (ie a membership or packet fee) 
Please refer to the website for the most up to date price, but the cost of everything is included except for the cost of books, study materials and travel costs.  No hidden fees or membership costs. 

If I need to get in touch with someone about my concerns or questions, is there a number or name of someone at the corporate office I can contact?  Is your customer service prompt?

Once again, yes!  I am happy to have you contact me at any time about the program, however there is a very nice lady named Nancy who is at the corporate office that will answer all your questions and help you with the process of registering.  She is also the one to contact at any time after certification about anything (except marketing of course, because once you are certified you can contact our marketing consultant at any time on your own).  Your calls and emails are returned quickly and we love talking to you! Nancy’s contact info can be found on the website.

How does your organization see itself advocating for the doula profession as whole?
This question is a little different but I feel it is important.  Birth Boot Camp is an advocate for our doulas.  We believe doulas are professionals who provide a valuable service to expecting families.  We feel the professionalism of the doula career is represented best when doulas are well trained and have a well-defined scope of practice to operate under.  We also believe that each doula should be equipped to build a sustainable practice based on her goals and needs and that we come along side and help her meet those goals.  When a new doula builds a sustainable practice that can last for the course of a long career, the doula wins, expecting families win and maternity care is improved.

Where will my training be and who will do the training? Does everyone that your organization certifies through receive the same training or does it vary but location and trainer?
Currently all training takes place in the DFW area at a hotel convenient to DFW airport.   Instead of typing out all the reasons we do it this way, here is a great blog post explaining it well. As we grow, this may change, so let us know what you think!  In the meantime this seems to be the best way to get all our experts in front of our doulas while keeping costs down.

Maria Pokluda (me) and Amanda Devereux have written the Birth Boot Camp DOULA program and lead the doula training.  By having the developers of the program teach all of our doulas, we can be sure that every person who comes through training receives the same info and expertise.  We believe there are lots of trainings that can teach a new doula to do a great hip squeeze (and we certainly do that too!) but maybe not how to be a successful doula with a sustainable practice.   Each thing in the program is very specifically in the course and as our program is unique in its approach.  Having Maria and Amanda teach all training helps to insure that Birth Boot Camp DOULAs are the best trained doulas out there!

I hope that is helpful, as always, contact me with questions or if you want to chat about anything related to doulas!  I also admin a Facebook group about doulas for new and experienced doulas and  I would love to have you join the group.

Tuesday, October 7, 2014

Crowd Sourcing - Where to Deliver Your Baby

I was involved in a online conversation this week about choosing the best hospital to deliver a baby.  This group was not a birth group, it was a local group where people crowd source all kinds of questions that pertain to community members so questions about reasonable landscaping services and queries as to the best Mexican restaurant are thrown together with questions like “what is the best hospital to have a baby?”.  This particular question got more replies than most of the threads except those about the best local Mexican restaurant. People have strong opinions about where to have babies and where to eat tacos!
I like Mexican food as much as the next gal, but opinions on food and opinions on hospitals deserve to be answered differently.  Finding the best enchilada is worth an online conversation but going to the wrong hospital might get you unnecessary major abdominal surgery or a baby in the NICU.  In this conversation I saw a lot more comments about delivering at such and such hospital because the food was good and rooms large and pretty than I saw advice on where to have a healthy and evidenced based birth.  One commentator went so far as to recommend her hospital of choice because the room had a large flat screen TV on the wall.  I know priorities are going to be different for everyone, but when having a baby *most* people’s biggest concern is probably not how the TV is mounted in the room.
Choosing a hospital involves a lot of things, including choosing a care provider with privileges there, but a few simple questions to ask no matter what type of birth you are planning can help you dig a little deeper.  If you are planning a natural birth then there are more, but here a few that move past the good food and pretty rooms stage.
* What is the c-section rate at your hospital? (if they don;t know or won’t tell you check out rates at )
* Are babies routinely taken away from mom at any point after delivery?
* Is your hospital designated Baby friendly?
* What routine interventions can I expect?
* Do you offer Family Center Cesareans?
* How many of your deliveries are induced?  Do you do elective inductions prior to 39 weeks?
I think crowd sourcing is an excellent resource for expecting family, however, if you see people recommending their care provider or their hospital, I do encourage you do dig a little deeper.  If you dig deeper and find a hospital that meets your expectations and needs then you can ask about the TV!

Monday, April 14, 2014

VBAC Odds - Lady Luck?

Don't gamble with your VBAC
When thinking about going for a vaginal birth after a cesarean(s) many are skeptical.  What are the odds of actually having a successful VBAC?  I recently heard about a VBAC calculator that attempts to predict the probability of a given woman delivering vaginally after a cesarean.  It takes into account the age of the woman, her height and weight and factors regarding her labor.  That all sounds very scientific,  but this "VBAC calculator" does not take into account possibly the biggest factor that will determine the outcome of a VBAC attempt – the care provider, i.e. the OB or midwife who is supporting (or not supporting) the woman seeking a VBAC. 

In my years as a doula I have worked with a lot of women planning a VBAC.  I dug back into my records and I’ve actually worked with 146 women who were hoping for a VBAC.  My numbers are not large enough to be a statistical sample, but they do show me a trend.  Of those 146 women, 133 had vaginal births.  That's 89% - not bad odds.
So who were the women that had repeat C-sections when they hoped for a different outcome?  It is not women with large babies, those over age 35 or even the ones that have been told they had a small pelvis....most of those women VBAC just fine.  Most of the women that have repeat C-sections are the ones with an unsupportive provider*.  In several cases, an unsupportive provider actually talked the women out of even laboring.  The most egregious example I can think of is that of a couple whose baby was breech at 36 weeks.   A few days later we all got excited because the baby turned, but the OB told the couple he could no longer allow labor because their c-section was already on the hospital's books.  (Obviously I gave them other options, but in the end they chose to show up on surgery day.)  In the cases where the women were with an unsupportive provider, I obviously can’t say how things would have ended up if they had been given a real chance, but based on my statistics, the odds were in their favor.
So why do women stay with non-VBAC supportive providers?  Here are a few common reasons I hear:  

Ask you provider, not a calculator
“I love my OB” – It is good to love your care provider and changing to a VBAC supportive care provider does not have to be framed as a rejection.  A woman may love her General Practitioner who is great when antibiotics are needed for a sinus infection, but not if the woman develops a heart issue requiring a cardiologist.  Choosing to have a VBAC is no different; a woman needs a specialist.  I tell women who want a VBAC to find a care provider that specializes in VBACs, then enjoy well woman exams for the rest of her life with the GYN they love.

“I am uncomfortable with a male OB” – I totally get this one.  Women have babies and it involves some degree of nakedness and our intimate areas.  However, if the best VBAC option in the area is a male, priorities must be decided.  Would you rather have unnecessary surgery from a person with a vagina or have a VBAC with someone who does not?   (I do work with families of various faith backgrounds where a male OB is not an option.  Usually there are some female options that strike a balance between religions convictions and the desire to have a VBAC. )

“It is too far to drive” - I also get this one.  I hate driving.  It is boring, gas is expensive, traffic stinks.  Once again, each couple will have to work through this question.  Is it worth the hassle, time and money to drive an extra 20, 30, 40 (or more) minutes approximately 15 times during the course of pregnancy to increase the odds of avoiding major surgery?

"My OB just really cares about me and my baby’s health" –  Uterine rupture is real but it is rare.  Risks to mom, baby (and future babies) from abdominal surgery are also real.  Choosing how to deliver is not a zero sum game where one choice is completely safe and the other is not.  However, ACOG states that VBAC is  "safe and appropriate" for most women with one or two previous surgical births**.  An OB that does not believe that or does not give his patients that info may not be keeping up as well with the research in his field or he may be putting his liability or scheduling concerns ahead of women and babies’ health.  

There are many other reasons why people don't switch to a supportive care provider, but a whole lot of people don’t switch because they don’t think outcomes are different from provider to provider; that one provider is basically the same as another.   This is very far from the truth.  Even the best provider is not going to have every patient have a successful VBAC; sometimes under the best of circumstances babies are best born via C-section.  However a woman will learn a lot more about her odds of having a successful VBAC not by looking at a generic calculator, but instead asking the provider for his odds based on his experience.  I am not a gambler by nature and so if I am choosing who to support me in my goal of vaginal birth, I am NOT going to lay my money (or my belly) on the provider with long odds.
* What is a VBAC supportive provider?  Stay tuned, writing that next!


Tuesday, December 3, 2013

Best Doula and Birth Stories - vote for me!
I started writing this blog to have a resource to send my clients to after I noticed that I was getting the same questions come up frequently.  I still do this all the time and it is interesting to see that the posts I most often direct clients to are also the ones that receive the most hits from google.  Seems that pregnant ladies everywhere wonder about similar things!  I have to admit with 4 kids of my own and having attended over 45 births a year for the last few years, I have not had the time, or really the energy, to add much to this blog recently.  However, if you love reading about birth, feel free to check out my actual doula website where I blog a bit about every birth I attend.  There are lots and lots of birth stories of all types if you are looking for encouragement or inspiration.

Best Doula, Dallas Child Magazine
If you have enjoyed reading my blog either here on my doula site....I would love to have your vote for Best Doula North Texas from Dallas Child Magazine.  I won this award last year and I admit, it was a pretty cool honor.  So, if you happen to see this before December 15th, 2013 then you can go here to vote for me (or someone else):


Happy Birthing!

Monday, July 8, 2013

It's The Law - Eye Ointment for All Babies

Texas State Rule 97.136 Prophylaxis against Ophthalmia Neonatorum 
(a) A physician, nurse or midwife or other person in attendance at a childbirth shall apply or cause to be applied, to the child's eyes a 0.5% ointment in each eye within two hours after birth.  If this ointment is not available due to the disruption in the distribution or manufacturing, a physician, nurse or midwife or other person subject to this section shall apply or cause to be applied to the child's eyes and alternative treatment included in guidance issued by the Department of State Health Services or the Center for Disease Control and Prevention.
(b) Failure to perform is a Class B misdemeanor under the Texas Health and Safety Code. 

Did you know that every baby in Texas is treated for an STD within hours of their birth?  Ophthalmia neonatorum (ON) is a conjunctivitis (ie type of pink eye) that can be contracted during vaginal birth. The two main causes of ON are chlamydia or gonorrhea. ON is NOT caused by Hep B, Step B or HIV.  If the mother does not have chlamydia or gonorrhea, then the newborn cannot contract it.   While ON can potentially lead to blindness (and that was a common problem before the advent of antibiotics), ON is treatable and blindness would only occur if an infected newborn did not receive antibiotics.  In most states though, antibiotics in the form of eye ointment or drops are administered prophylactically to avoid an initial infection on every single baby that is born regardless of the mother’s chlamydia or gonorrhea status. 

It's the Law
The Texas state law as seen above requires that every baby have the antibiotic erythromycin within 2 hours of birth and the law is written so that it is a misdemeanor for the care provider to not to so (though there are provisions for midwives that I have not listed).  In practice, many hospitals provide a waiver for parents to opt out as patients should always have the right to decline any medical care that they choose.  However, a number of big hospitals do not have any opt out and those hospitals typically call CPS if mom and dad decline and often will administer the ointment against a parent's wishes. 
Why would a parent even want to decline the treatment?  There could be any of a number of reasons.  The ointment is irritating to some babies eyes, most babies are taken to the warmer for the administration of the ointment so baby is taken away from mom during the initial bonding period and the ointment may then also interfere with the baby's sight during that time.  However the most common reason may be that most parents do not want to give unnecessary medication to their children and from a societal perspective the use of unnecessary antibiotics contributes to the growing problem of antibiotic resistance.  Even C-section babies are required to get the medication and, particularly if their amniotic sac was intact prior to surgery, there is almost no likelihood of an infant acquiring an ON infection - even if mom is positive for Chlamydia or Gonorrhea.  Given the numbers of babies being born surgically, that means just by method of birth alone, upwards of 60% of babies are receiving unnecessary antibiotics within moments of their arrival.  That's quite a welcome! 
So where does that leave expecting parents? 

  • Decide if this is an important issue for you.  Ask your care provider when you were last tested for gonorrhea or chlamydia and honestly assess what your risk is of having acquired one since that test.  Find out your hospital's policy on opting out of the eye ointment.

  • If the hospital does not have a waiver,  you may ask to have the ointment administered while you are holding your baby and bring a soft cloth to wipe your baby's eyes.  Even if you want the ointment, it is still wise to ask if the procedure can be done while you are holding baby.  This will keep your bonding time from being interrupted.

  • Decline the ointment with either a waiver or be willing to have CPS give you a call.  (I have had clients where this happened and CPS was totally cool about it, but no promises that will always be the case.)

Monday, June 24, 2013

"Let Me Tell You My Story"

Hey doula!  Let me tell you my story!
When in the course of conversation it comes up that I am a doula I sometimes get the response of  "you do what?" or "what the heck is a doula", but more commonly I get told birth stories...lots of birth stories!  I have heard literally thousands of birth stories from friends, strangers and other women after they hear I support laboring moms.  Some of these moms have fabulous stories, some very scary ones.  Some are recent experiences and some were decades ago.  Women remember their births and most want to share the special tale of how their child arrived.  I listen to them all and hopefully nod and smile in all the appropriate ways. 

I really do love hearing the stories.  When I hear comments like, "my C-section was necessary" or "my labor was really, really, really hard so I had to get an epidural".  I hopefully also nod and smile in the appropriate ways and let these mom's know that I think their story is important.  I wasn't there and they are not asking me anything, really just looking for acknowledgement of their choices, their experience and perhaps my approval, which of course they don't need.

However, I recently had a acquaintance talk to me about her upcoming delivery which was going to be an elective repeat C-section. She told me this was the only option available to her. I try very hard to listen to everyone and support the choices they make and only offer suggestions if asked, but this time I found myself unable to just nod and smile.  I looked right at her and told her (very nicely!) that she knew she had other options.  There are many OBs in our area that would help her have a VBAC and we had even had that conversation previously.  It wasn't that she didn't HAVE options, it was that she had already CHOSEN her option.  And that's OK.  It is OK to choose an option that I would not....however it is not OK to say you have no options to justify your choice. 

Empowered birth and informed decision making is about knowing your options, and deciding what is best for your situation and then owning that choice.  It is even a valid choice to hand over all decisions to someone else - be it an OB or your in-laws or your hubby (all of which I have seen).  It just isn't OK to say you didn't have choices when in most case you do.  From the choice of care provider, to birth location to when and how to deliver, there are lots of options and almost none are irreversible until the baby is out.  (Obviously a mom giving birth to say triplets has many less options than other moms, but even then she has some choices and can feel empowered in making them.)

I often work with moms who are planning a birth that is going to be hard to pull off with their
Informed choices, amazing births
chosen providers.  Now I admit, changing providers late in the game is less fun than starting with a great one, but it isn't that hard either.  One of my most memorable examples of this is a couple who wanted a VBAC.  At 41 weeks her provider scheduled a C-section and said her time was up.  They had a choice.  One choice was to have repeat surgery, the other was not to.  In this case, mom made an appointment with a new OB and didn't show up for her surgery.  The same day her surgery was scheduled she met with that other OB and at 41 weeks and 2 days she had a beautiful all natural VBAC.  That happy ending does not mean though that if she had decided to trust the first OB that she had run out of options.  It would have meant that she had chosen to have her baby via C-section.

When it comes to birth, know your options so you can make informed decisions.  Or maybe even  make a choice to not explore your options (though that is obviously not what I recommend!).  Just know that choosing not to explore your options is in and of itself is a choice.  Empowerment in birth does not come from having a perfect labor, it comes from a couple making the choices that are best for themselves and their baby and being proud of how and why those choices were made.