TriCare Doula Coverage at EDBD

As doula support becomes more popular, some insurances have begun to cover doula services. I am thrilled that this means doula care is more accessible to some families, and also it is quite a process as a doula to navigate accepting insurance. So this blog post is an explanation of how I make TriCare coverage work for me and my clients. I hope this information is helpful to you if you are covered by TriCare and exploring doula support, and also helpful if you are doula interested in learning more.

Let’s talk about TriCare. TriCare is a military insurance, and often covers people who are active and in reserve. Since I serve families in the region of the Navy Shipyard in Portsmouth, I encounter families with TriCare often.

For other doulas…

If you want to be covered by TriCare, you need to go through an authorization process. It’s not hard, it’s just a bit cumbersome. You will then be authorized to be covered as an “out of network” service, not “in network.” This is what I did, the webpage for this process is here. 

As the client, there are a couple qualifications you have to hit to have doula support covered. 

• You must be 20 weeks pregnant 

• Have a referral if you need one 

• Be receiving care (and planning to birth at) a facility that accepts TriCare

The type of TriCare plan matters for doula coverage. Prime coverage requires a referral for doula support and Select coverage does not. So check with your plan, and if you require a referral contact your PCP or OB to get one. A note- often PCP’s or OB’s are not aware TriCare will cover doula services, and don’t know how to make the referral. So clients have been connecting with me first, and I give them my name, address, and NPI to give to their provider so they can make the referral. 

TriCare will cover six visits (prenatal and postpartum) and the “birth event.” There are some parameters for this coverage, and they are all detailed in the materials you receive when you get authorized. The rate they cover these services (as of 1/2024) is $46 per prenatal/postpartum visit, and $690 for the birth event. I choose to wait until all services have been completed before I submit a claim that lists all the events on it. 

More on the money, and then I will talk about my experience so far…

My fee is $2000 for my birth support package, so TriCare covers just about half of my full fee. I also have a sliding scale fee system, and I am willing (and have) combined TriCare and the sliding scale, so the lowest amount a client could pay out of pocket is around $500. 

I have two options of how the payments and reimbursement works. The first is my client pays me my complete fee and when I get reimbursed by TriCare, I reimburse my client. This is my preference since I get the money from TriCare months after the birth. For clients where this is not financially feasible, I have them pay $500 as a retainer, and then charge them for any difference after TriCare has paid out. These are the set-ups I have figured out for me and my clients, but there are a lot of possibilities. (A note for doulas- if you are authorized and become an “in network” provider you then aren’t allowed to charge anything on top of what TriCare pays, so that is why I am not “in network”).

My experience so far…

I have supported 5 TriCare clients so far, and my experiences getting reimbursed from TriCare have varied between them. What they have all had in common is that the claim I originally submitted is denied and I have to resubmit it. Somehow early on I got a hold of someone at TriCare and have been able to email them directly for support where they can answer my questions and escalate my claims to get them approved. Even with her support, I have submitted two to four claims per client before they are approved. And I have only completed the process of being fully reimbursed one time. It is a process of patience and persistence for sure. I definitely understand why people choose to not take insurance. 

Doulas- if you choose to go down this path, I will give you my contact’s email address because she is the only reason I have made this work. 

In summary…

If you have TriCare insurance and want doula support, please reach out, and we will make it work. It won’t cover the fee completely, but we will make a plan that works for you. Please message me if you have any questions, I am happy to chat more. 

If you are a doula who is interested in becoming authorized to take TriCare, also please reach out, I have a lot more thoughts and will happily support you in this process. 

Reflections on 2023

Looking back on 2023

Another year has come to a close, and with it comes much reflection. 

The words that come to mind when I think about my business in 2023 are

Settled  Connected  Trustworthy 

Running my own business as my way of life, as the way to pay my bills, and as the foundation of my future is wild. And every year there’s a small sense of “will it keep working? Can I keep going?” but those thoughts vanish quickly because I have work to do! And so I keep doing, and off we go. 

Doula business is not easy, there are ebbs and flows, and it is always always worth all of it. And if I wonder if I can keep going…I just lift my head up and look around me. And around me are all the families I support, doing the hardest work. Managing pregnancy, and navigating birth, and raising children. Is that not the most inspiring and incredible group of people to be surrounded by?

So if you are one of my clients reading this…thank YOU, thank you for trusting me, thank you for letting me into your most precious life moments, thank you for showing me what it looks like to be intentional and persistent, strong and vulnerable, and so so loving. This is the energy I am carrying into 2024. 

A couple business things…

This autumn I supported my 100th birth! Can you even imagine? This year my feeling of being a “new” doula really faded, and I feel so confident in my support. And being able to say “I have support 100 people” really brings that feeling home. So here’s to the next 100 (we are well on our way with how many families have already requested my support in 2024). 

At the beginning of 2023 I changed the way my fees worked. I increased it significantly, and implemented a clear sliding scale fee option as well as accommodating payment plan options. 

This was a big risk, I wasn’t sure if families would still choose me as their doula, but I trusted my gut and what I needed to do to feel comfortably compensated. The results of this change were wonderful! I had a smaller client load, giving me more time to breathe a couple weeks here and there off call, and less “big S stress” that comes with being on call for 3-4 families at a time. Many families utilized my sliding scale fees, and this felt really wonderful because I knew we all felt good with the agreement we came to. So my fees and options are all staying the same in 2024. 

On the theme of a slower year…I took my first time off in 2023. In November I traveled to Italy with my parents and sister, and what a good choice it was! This was the first time I blocked time off on my calendar and said “no” to some folks who reached out. If you know me well (or at all) you know this is not an easy thing for me to do. More vacations in my future for sure! 

One of the most heartwarming developments of 2023 for me was starting a Queer Conception Group here in Dover. In collaboration with the local queer hang group (@lezhang) and Auspicious Brew (the local kombucha cafe), we have been meeting monthly in person. Each meet-up has a loose theme, some highlights have been a long conversation about the cervix, a little workshop on asking for support when trying to conceive, and a lovely night with Jessica from Prenatal RD to learn about food and fertility. The energy of this space and group is overwhelmingly warm, communal, and welcoming. I feel so lucky to be hosting this space where my professional passions and personal community meet. 

So goals for 2024?

Well, just like pregnancy, birth, postpartum, and children…I don’t know how predictable my 2024 will be. But if I can make a “2024 Preferences Plan” (akin to the Birth Preferences Plans my clients make), here are my preferences. 

I am opening the emotional and energetical doors to have a busy full calendar this year (I am already booked for June, so I am well on my way). 

I would love to have a BIG gathering to celebrate 5 years of EDBD…so stay tuned for those details, so you can come celebrate me celebrating you!! 

I will still be running the Queer Conception Group, and I would love for that to grow and develop in ways that best serve the community. 

And I have a preference to make the most of the times I am off call. 

If you have read this far, thank you. Thank you for being here, thank you for your support, thank you for being part of the EDBD community. My life would be wildly different and a whole bunch more predictable without you…I’m teasing, I wouldn’t have it any other way. 

Sending you all a big hug,

Emma

Queer Conception Group

I have been organizing and hosting a Queer Conception Group for several months now, so I think it’s time to write up my thoughts and share them here…I hope you enjoy!

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In March I co-hosted Lezhang Seacoast’s (my local queer meet up group) Sapphic Salon night, the theme was Queer Conception. That night we talked about anatomy, conception options, legal considerations, and then had one of the most engaged, honest, and thoughtful conversations I have ever been part of. 

As the evening wrapped up, the sentiment of “don’t let this night stay in the past, let’s keep meeting” hung in the air. So I decided to take this project under my wing and continue to host gatherings with the goal of finding community, learning, and processing all things queer conception. 

Over the summer I set up a little gathering spot at the picnic table at Henry Law Park in Dover, and we gathered, just a few couples and me, to meet, share, and chat. It was lovely. It is always lovely to be in community, it is always a joy to be with people who want to share and learn. 

After gathering some thoughtful (and deeply appreciated feedback) I now have a list of topics folks are interested in hearing more about. I have been preparing mini-themes for the gatherings, so people can come to learn about that topic, and there is still plenty of space and time to do our usual chatting. 

The first themed gathering was in August, the theme was “my experience as a donor conceived child of lesbian parents.” We had a zoom call with my friend Madeline and she shared her story with us and graciously answered many questions. I can’t wait to have her back again this winter! 

I am preparing for our gathering later this week, the mini-theme of which is “anatomy and such,” so we will look at some diagrams. I know I will go off on too many tangents about the magical cervix, and I am sure we will all learn something new. 

As we head into the late autumn and winter we will be moving from the park to the magical Auspicious Brew, who will be hosting us in their space of delicious kombucha, twinkling lights, and air of queer joy…I cannot wait!! Our first gathering there is October 12th, come join us!

If you want all the updates, please follow my Instagram, it is the most reliable place!

If you want to share this group with others, send them this page on my website (or my instagram).

I feel incredibly lucky to have this space to bring my professional life and my personal community together, and I am so excited to watch this group grow and morph this coming year.

Reflections on 2022

Dear families, loved ones, friends, distant relations, and people who stumble upon my online presence,

I haven’t written a blog post in a while…or a newsletter email…or honestly an instagram post caption, my life has just been so full of the “living it” that I haven’t stopped to write about my reflections. But if I am ever going to slow down and focus long enough to write, it is going to be during the shortest days of the year when time passing is marked by warm meals, cups of tea, and lit candles. 

So here I am with my cup of tea, ready to write out my reflections on the past year to share with you all. 

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The Birth Things

In 2022 I supported 34 families, my busiest year to date, and with that business came an assurance that this is the path I am meant to be on. My doula business felt real this year, I knew the doubt of the ebbs would be rewarded with the surety of the flows, and so I trusted myself to ride those waves. Birth is filled with waves, and with trust…so I just had to walk my talk! In June I hosted a third birthday party for my business, and gathering with my families made it all feel so real.

My first gratitude goes to all the families who welcomed me into their experiences this year. I know I thanked you all when I said good-bye, but I truly mean it, it was an honor to be there with you. Every birth story is different, and none of them are predictable. There was a lot of education, advocating, planning, discussing, and debriefing this year. And there were plenty of challenging experiences this year. Long long labors that ended in cesarean delivery when we were all so exhausted. Many inductions, and cases of hypertension and preeclampsia, which are always hard because we want to make safe and good decisions and also be sure to listen to our guts. I supported people as they learned that cesarean delivery would be the safest way for their baby to enter this world, even when that was the last thing anyone wanted to hear. 

I also witnessed many surprises, fast labors, speedy pushing, babies much bigger or smaller than were guessed. 

In short, I stood next to some of the strongest, bravest, and most caring parents I have ever met. All in all, the birth doula part of my year was as splendid as one would anticipate. 

My next gratitude goes to the providers. I spent hundreds of hours at the hospital, specifically Wentworth-Douglass and all I can say is that I am so incredibly grateful and in awe of all the midwives and nurses who work there. Truly. But that’s not actually all I can say, I can say that I learned from them, and I shared with them, we brainstormed, worried, and rejoiced together. That community is not a given when you are a self employed doula, or a doula working at a hospital, and I don’t take it for granted. 

The last gratitude is for my colleagues, my village, my cup fillers, mentors, friends, and listening ears. You not only paved the way for me, but now we can walk down this road together, and nothing makes my heart more full. I called for back-up 3 times this year when it was needed, and had a doula on standby just in case at least 3-5 more times on top of that. Worrying about back-up can be the most stressful part of doula work, and I am so grateful I have all of you. 

The non-birth things

The beauty of doula work is that it often comes with a lot of time to give to other projects and activities, so there was much more to my year than just attending births. For once you step into the world of reproductive healthcare, you get pretty darn immersed. 

I continued my volunteer work with The Lovering Center in Greenland NH as an abortion doula and aftercare staff. Working in an independent abortion care center was something to behold in the year Roe fell. I watched the most committed providers give the most informed and thoughtful care every day we watched our rights get stripped away across the country. I am truly grateful I was part of the team on the abortion days I was there. 

On the topic of abortion access, in June when Roe was overturned I had the opportunity to speak at a rally in Henry Law Park in Dover, you can watch a video of my speech here. I was also privileged enough to be part of a roundtable discussion with Senator Hassan at Lovering to talk about abortion care in NH, you can read about it here. 

If this topic makes your blood boil as much as it makes mine, feel free to express your rage through donation to either Lovering or the Reproduction Freedom Fund of NH. 

I also continued volunteering as a board member for New Parent Care Package, an organization that creates care packages centered around the pillars of nourish, cope and connect for new parents. We distributed many packages this year, and it was a joy to be part of.

I am still teaching childbirth education classes at Wentworth Douglass Hospital, I thoroughly enjoy enlightening folks on the stages and phases of labor, what to bring to the hospital, and how to ask for support once you are home with a new baby. I love being part of that team. 

And lastly…

Though I sound very busy, I have many days of patiently waiting for babies, and can fit in all the things I enjoy. In 2022 this looked like a lot of time with friends, many outdoor walks and explorations, visiting Wentworth Greenhouse (and when I couldn’t possibly fit another plant in my apartment, I would just go to browse), a good handful of knitting and sewing projects, and of course drinking cups of tea. 

into the new year we go!

2023 lies ahead, so many months, weeks, days, hours, and minutes to fill…what shall I get up to? 

Well for starters I am already booked for the first couple months, and I anticipate my summer being busy as well. More classes, and volunteering, and tea and plants. But what are the dreams? 

The dreams are community, gathering my clients and families (past and present) together to meet and connect and celebrate. In the park, at the beach, I am not sure yet but I want this dream to come true. 

I will also be bringing back my newsletter…which you may know already if you got here via an email from said newsletter. The goal is to make it monthly, with updates, invitations, and celebrations. 

I also want to make an official addition to my services by adding a postpartum doula support package add on. I have been working on my certification and done some support this year, but it’s time to make it official. 

My heart is so full, thank you all for being part of my year, for trusting me, for loving me, for holding me as I trust, love, and hold you. You can’t pour from an empty cup, so thank you for helping me keep mine full. 

Stay in touch (aka text me those baby pics), and I will see you all soon. 

Love,

Emma Dolan

Unsolicited Birth Stories

As a pregnant person (in the holiday season no less), I am sure you are being flooded with birth stories from family, friends, and strangers of all ages and stages. I assume, some of these birth stories are positive and encouraging, but others are scary or maybe traumatic. Hearing these stories might leave you feeling unsure or anxious about your upcoming births.

Here are my thoughts on ways to experience these stories and process them so you don’t feel overwhelmed or worried.

If you can avoid hearing these stories, that is a great first step. Sometimes a simple “I appreciate you want to share with me, but I would rather hear your story after my baby is born” is enough to end that conversation. I understand this isn’t always possible or comfortable, but it is worth a shot.

If you find yourself listening to a story, then let the person tell it, and at the end respond with “thank you for sharing your story with me,” and if it is a traumatic story you could add “that sounds like a hard experience” (or something similar). You don’t have to ask questions or feel apologetic for their story, you can just let it be done once it’s over.

Now that story is in your head, maybe you’re able to disregard it, or maybe the story continues to play in your mind, and you find yourself worrying that their story will be yours too. But their story can’t be yours, because no two birth stories are the same, ever. You can decide what you take away from their story, and here’s what I recommend.

Often people have hard or traumatic births because they were uneducated or uninformed about what was going on (which is not their fault), they felt alone or unsupported, and they didn’t have a way of processing their experiences afterwards to understand what happened retrospectively. This isn’t how people tell their stories, most likely they are telling you about their baby’s heart rate, or a cesarean delivery, or their baby’s size. But maybe you can read between the lines and hear how they were scared and confused.

You can make plans for your birth to reduce the chance of those experiences. You can take childbirth education classes, you can communicate with providers about birth preferences (make a birth plan), you can have doula support, you can talk with a therapist and your provider after your birth to ask questions. These are all tangible and plannable ways to avoid having the hard experience your friend has just got done telling you about.

I am also a big fan of affirmations or mantras that you can tell yourself when things seem big or overwhelming. Here are some for you to use after hearing a story that is stuck in your mind.

• Every birth is different

• I have a strong support system

• I have carefully chosen my birthing place

• I will ask questions if I have them

• I trust my body

• I trust my support people

• If birth is hard, I have the resources I need afterwards to heal

I hope these serve you.

I have three final thoughts on this topic.

One, if there are people in your life who haven’t told you about their experiences, ask them what the best part of their birth was. Often people who have positive birth experiences aren’t as likely to tell their stories because our social script is to tell scary stories. So ask them and see what you can learn, if you want to.

Two, feel free to rant about having stories dumped on you that you didn’t ask for. Rant to a family member, partner, friend, doula, or therapist. Talk about the absurdity of these stories. I think talking about them gives them less power.

Three, share your positive experiences about pregnancy and birth afterwards and in the years to come. Change the narrative in your community and friend group. Offer encouragement and excitement to parents-to-be around you.

I hope you find this helpful, and please feel free to share it with other pregnant folks in your life who are sharing this struggle

Dear Partners- "who don't handle blood well"

 Hello dear partners,

As a doula I hear this concern all the time “I am afraid I might pass out during the birth” or “I don’t really do well with blood” or “I faint easily.” So now you know, if you feel similarly you are not alone!

In this letter I will share some thoughts about birth blood, and then my tips and tricks for staying conscious while you welcome your little one into the world.

Thoughts on birth blood

I am someone who becomes light-headed by the sight of blood very easily, and I support people through labor and delivery as my job. If I can do it, then I believe you can as well.

Birth blood is different than injury blood (for the most part). Birth blood is healthy, it is normal, it is needed, and it makes sense. I equate birth blood to period blood in this way. It can help to know this about birth blood before you see it, because when it is expected you can be prepared.

If you have had traumatic experiences with blood in the past, I encourage you to think about those scenarios and identify how the birth of your baby will be different. Was the blood unexpected? Was someone injured? Did you feel helpless or scared? Was it your blood? Think through those times and notice how birth blood will not be unexpected or due to injury, you will not be helpless, and it won’t be your blood. Reframing your understanding of what blood at birth will be like is really helpful before heading into labor and birth.

Some exceptions

Of course not all blood at a birth is normal and expected. In cases of hemorrhage or cesarean birth, there is more blood than maybe expected. These scenarios are when I have to employ my “staying conscious” tactics, and you may have to as well.

Emma’s proven “stay conscious” tactics for partners at birth

1)    For the sake of all things good in the world…Eat! Eating will give you fuel to make it through the harder parts of birth (yes I am talking to you support people!). And not letting your blood sugar drop is key to staying conscious the whole time. Pack snacks that you can eat easily and quickly. Don’t try to tough it out (more on that later).

2)    Drink fluids and stay hydrated! Nothing like cold water to keep you awake. Staying hydrated throughout the labor will help you when things get bloodier towards delivery.

3)    Have a “fast sugar” option on hand at all times. My go to is a tiny can of ginger ale from the kitchenette (bring your own or ask the nurse for something). Soda, juice, and honey are all great options. Spiking your blood sugar when you feel a little woozy works really well.

4)    Anticipate where and when there will be blood, so you have the option to see blood or not.

• Bloody show can happy as soon as early labor, it is pinkish or reddish and more like a period. Your partner will see it in their underwear or when they wipe in the bathroom.

• More bloody show can present itself during labor, so if your partner isn’t wearing bottoms, some blood may get on the sheet, pillow, towel, or pad that’s between their legs. You may see this blood, but again it is more like dark period blood. Bloody show is caused by the changing cervix. As the cervix softens and opens, blood capillaries can burst and bleed. This is expected and normal and it is a sign of things progressing as they should be.

• When the baby’s head starts to come out or crown is another time you may see blood. If the provider is checking baby’s position, or supporting the perineum during pushing, they might have some blood on their hand.

• As baby’s head is born, there can be more bleeding. This is most likely from any tears that happened in the vagina. Tearing is normal and expected, but this blood can be brighter red and less like period blood. I encourage partners to watch their baby be born (if the birthing partner wants that too of course), so if you plan to watch your baby come into this world, be prepared that there will be some blood.

• Once the baby is here you will probably be focusing on them and be standing closer to your partner’s head admiring your little one. This is when there will be the most bleeding from the vagina especially as the placenta is born. Your provider may be holding some gauze to absorb blood, so this blood can feel the most medical of it all.

• After the placenta is born, the immediate bleeding slows, and any stitches are given, an ice pack and pad are placed between your partner’s legs to absorb postpartum bleeding. You probably won’t see this bleeding, but you may and now you know to expect it.

  (I know this makes it sound like there is a lot of blood all the time in labor, and that isn’t really true, I am just being thorough.)

5)    Expecting blood at a cesarean birth

Cesarean birth has different blood than a vaginal birth, because it is a surgery. If your negative experiences with blood have been in a medical setting, the operating room might pose more of a challenge. Eat and drink before you go in, and have your fast sugar while you wait to be let in. Take some deep breaths and think about meeting your little baby so soon!

• Your partner will be lying on an operating table, and you will be led to sit over their left shoulder. A drape is hung across your partner’s chest, so you will not be able to see the birth as it happens. Because of this, avoiding blood at a cesarean birth is not too challenging.

• I encourage you to keep your eyes on your partner’s eyes, talk to them, and when your baby is born you can admire them. If you don’t look around a lot, you probably won’t see blood.

• When the drape comes down at the end of the delivery, continue to keep your eyes on your partner’s face, if you look around you may see blood on the pads and gauze near your partner’s stomach.

6)    Step away at any point if you need to. Your partner will not be alone (especially if you have a doula), and it’s more important for you to stay vertical in those moments. Take some deep breaths, drink your cold water or eat something. You are not weak if you take a minute for yourself, you are smart.

 I use all these tactics at births, and I encourage you to as well. I haven’t passed out at a birth yet, so I am a believer!

Last thoughts

You are less likely to pass out or faint if you tell people beforehand you are worried that you might. Don’t try to be tough or do it on your own, it’s not worth it. Let your doula know, let the nurses know. They can help you by letting you know when and where blood will be (I do this all the time for partners).

This is part of planning for labor and birth, so thanks for thinking about it.

I know these are a lot of details, and I hope it doesn’t feel overwhelming, just take what works for you and leave the rest.

I will be right there with you staying hydrated, eating fast sugar, and stepping away if need be, it’s part of the process of being a birth support person.

Your teammate in staying vertical,

Emma

Tips on Affording a Doula

• Do you have to pay for a doula out of pocket?

• Will my health insurance cover a doula?

• How much does a doula cost?

These are questions I hear all this time, and here are some answers.

First, if the cost of a doula is deterring you from hiring a doula, don’t stop looking, there are many options.

The cost of a doula

Fees for doula services range anywhere from $0 to $500 to $1500, it all depends are who the doula is and what they offer in their package. Often times doulas who are brand new and working on certification offer reduced rates to their first few clients. More experienced doulas might offer more, and others have additional services in their package (such as prenatal massage, lactation consulting, etc…). In my area (seacoast of NH and ME) most doulas are around $1200.

Insurance

For the majority of people, doulas are an out-of-pocket expense, and in some rare cases private insurance companies will cover the cost or partial cost of a doula. If you have a Health Savings Accounts (HSAs) through your insurance, many times they can reimburse for the cost of a doula.

Affording a doula

If you cannot afford a doula out of pocket, and your insurance doesn’t cover it, don’t despair, you are not out of options! As I mentioned above, certifying doulas often charge less, and are a wonderful resource. It can be difficult to find doulas who are new because they may not have a large online presence yet. I highly recommend reaching out to any doula in your area, and asking them if you know anyone working on certification, they could connect you with. Doulas are a tight knit community, and we all know each other and refer to each other often!

Some doulas offer a sliding scale or payment plans (I offer both of these). Often doulas will also do one birth a year where they waive the fee, so inquire about that as well. At a hospital local to me there is some scholarship money to help people afford doulas, this is unique and not common at most places (but might still be worth asking your provider about).

Bonus tip

Put a doula on your baby shower registry! Instead of having multiple of other items (highchairs, books, clothes, etc…) why not ask your loved ones to pitch in and buy doula support as a gift. You will end up with many hand-me downs and other little gifts regardless, so why not make the most out of your baby shower? And why stop at birth doula? Ask for postpartum doula support, a meal service, etc…

I hope you find this helpful or informative, share it with others who have similar questions, and don’t hesitate to reach out with questions.

Using My Privilege as a White Doula

This blog post is about whiteness in birth work, and how as a white birth worker I am planning on supporting Black doulas and midwives.

Please read this post, please reach out with questions.

If you are another white birth worker, I am happy and willing to talk to you about your privilege and ways you can use it to support Black doulas and midwives. 

Understanding the history of Black birth workers in America is important read about to understand why I am making these decisions.

Please read brief history from personal blog Doulas of Color Boston https://doulasofcolorboston.wordpress.com/page/

Here is a great piece of the legacy of Black midwives in America from National Black Midwives Alliance

 https://blackmidwivesalliance.org/legacy-1/f/what-is-the-legacy-of-black-midwives-in-the-us-and-caribbean

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Now that you understand the history of Black birth workers in America, I want to explain how I as a white birth worker will be using my privilege, and encourage others in similar positions to use theirs.

The first step I will take is monthly donations. Each month I will donate to an organization, movement, or campaign lead by Black birth workers, for Black birth workers, or promoting Black maternal health in our country. I will be donating because it is a way to directly support birth workers who are doing work that I cannot do to promote safety, health, and peace in communities of color. My business is very new, and I do not make a lot of money, so why I am donating? Because I am using knowledge and wisdom that Black birth workers carried through the medicalization of birth. The least I can do is donate a small amount of money monthly to support their work.

I plan on printing out a list of donation recipient options and asking my clients to choose where they would like the money to go. I hope by doing this I can continue to education white families and other white birth workers about the history of violence and racism that we now benefit from.

This leads me to the second way I will be using my privilege. I will share information about specific practices or pieces of knowledge that white women did not invent and give credit to the communities they come from. For example, the use of the Mexican rebozo (separate post to follow). I can work to educate my fellow white birth workers and families of the disparities in reproductive health care and outcomes between white birthing people and birthing people of color. I am not going to inundate my clients with political commentary, but it is vitally important that I work hard to stop the appropriation of birth practices white doulas use daily.

If you are a pregnant person looking for a doula, and that’s how you found this article, welcome! I hope you share similar goals to me or want to learn more. Please reach out!

If you are a fellow white doula, please consider doing something similar to me to create awareness and use your privilege. Call me and let’s talk.

I want to make it clear I am not doing these things just to post about them on social media, or to get “woke” points from friends and colleagues. I am making these choices for my business so I can grow my business with these principles and goals. Working to be anti-racist and undo the harms of colonization and suppression is not easy or fast, it is a lifelong process, and I intend to do this work for years to come.

Black Mamas Matter

“Black Mamas Matter Alliance is a Black women-led cross-sectoral alliance. We center Black mamas to advocate, drive research, build power, and shift culture for Black maternal health, rights, and justice.”

Black Women’s Health Imperative

“We target the most pressing health issues that affect Black women and girls in the U.S. through investments in evidence based strategies, bold programs and advocacy outreach on health policies.”

National Black Doulas Association

“The NBDA connects Black birth families with Black Doulas nationwide. Our overall mission at NBDA is to help fight the Black Maternal Mortality rate in this country and beyond, through educational development and empowerment.”

National Black Midwives Alliance

“We train and organize midwives to serve as advocates to address disparities in maternal health care that impact black birthing people. Our central goal is to have a representative voice at the national level that clearly outlines and supports the various needs and interests of Black midwives.” 

National Association to Advance Black Birth

“A world in which Black women and persons achieve their full birthing potential and thrive during the child bearing years, and have autonomy over their bodies; with optimal birth outcomes for Black women, babies and their communities, and increased options and opportunities for birth; and in which system change has brought about equitable healthcare.”

What to Pack in the Hospital Bag

There are lists upon lists of things to bring with you to the hospital, your clothes, baby clothes, string lights, lotion, toiletries, slippers, blankets, fake candles, oil diffusers…the lists go on and on. If these lists speak to you and make sense and feel like a representation of things that make you feel comfortable and loved, then follow them. If they feel overwhelming and excessive, then read on for my suggestions based on my experiences at hospitals.

Let’s break it down into two categories, for you and for baby.

For you

You can’t bring real candles to the hospital…but these two are so cute!

My strongest suggestion here is to pack things that make sense to you. The point of packing a hospital bag is to make you feel comfortable and safe, to make the hospital room feel a little less foreign. Comfort and security are two huge promotors of oxytocin, the hormone that is crucial to a strong effective labor. Bring things from your day to day life, like a favorite hand cream, and everyday chapstick, a chill playlist. Here are a few things I do think are important to have to feel prepared.

• If you don’t want to wear a hospital gown, pack a long t-shirt or oversized button down (just make sure you don’t mind if it gets a little stained)

• Some slippers or socks with tread on them (hospitals also offer these)

• Your tooth brush/deodorant/hairbrush, whatever will make you feel a little bit more put together postpartum

• Comfy clothes to wear postpartum, you will not suddenly fit back into your pre-pregnancy jeans, so bring yoga/sweat pants that will feel cozy and loose.

• If you have items that you use to relax, such as essential oils, fake candles, or special music, bring these…but don’t feel you have to bring them if you have never used them for relaxation before.

• Your support team bring your partner, your mom, your doula, your best friend…whoever is on that support team, bring them! (This is the most important item!!) 

For Baby

Cozy baby

• A cozy outfit to wear home

• A blanket to wear home

• A car seat

• If you have a breast pump you are planning to use, you can also bring this and the lactation consultant can make sure you are using it properly.

Of course, you can add to this list, or ask your childbirth educator, provider, or doula if they have any further recommendations. Many of the births I have attended end with clothing scattered about, blankets balled up on chairs, slippers left by the door, and the only list item doing its job is the support team. So it’s okay if you forget your toothbrush, or a blanket…but please don’t forget your support team, because you will really need them!

How to Find a Doula

Finding a doula can seem like a daunting task, especially if you live an area where there are many doulas and birth workers to chose from. Maybe your friend had a doula, and she can’t stop telling you how amazing it was. Maybe you heard about doulas in your childbirth education class and wanted to learn more. Maybe you googled “ways to reduce medical interventions in birth” and a doula was suggested. For whatever reason you are looking for a doula, it might feel like a big task. Here are some tips to finding the right doula for you.

First, ask your provider what doulas they usually recommend. Some providers are really supportive of doula work, and have local doulas they regularly refer patients too. If your provider does not have a recommendation, then ask a friend, a childbirth education instructor, or some other provider you have. (As a doula I work hard to make connections to providers who have pregnant clients, so it is worth asking your chiropractor/acupuncturist/message therapist, etc…) I have always found it helpful to hear a direct recommendation from someone than just googling “doulas near me.” That being said…

Second, if no one has any recommendations on local doulas go ahead and google “doulas near me,” or “doulas in Maine,” and see what comes up.

Here are a few websites that list doulas in the area.

DONA International- On their website you can search for birth doulas by entering your zip code and an area radius. The list they provide are all doulas who are DONA certified. This is a good list because you know you are getting a trained and certified doula.  

Doula Match- This website is a resource of hundreds of doulas, you enter your zip code and an area radius, and your due date. The doulas input their availability, so the ones that come up for you are available at your due date! Doula Match is not affiliated with any specific certifying organization, so you will be given a wide variety of doulas with many varying experiences.

Doula Trainings International- this is a certifying organization (similar to DONA), on their website you can enter your zip code and doulas in your area pop up!

These are the three big ones, but different areas have organizations with doulas specific to that location.

Third, look for certification. Doulas listed on DONA’s website are all DONA certified, which is the most common and widely spread certification organization. Doula Match confirms that doulas who say they are certified, are in fact certified, though it can be through any organization. If a doula is certified, it means that they have completed a certain number of births, done a workshop, and participate in continuing education workshops. Some doulas are not certified, and this is not necessarily a bad thing. If a doula is uncertified but has attended hundreds of births, then it is a fairly safe bet that she is a wonderful and talented doula.

Fourth, make your list. Now you have done your research and found all these wonderful doulas in your area. But who to choose? I don’t know of any doulas who charge for a first phone call, we are all happy to hear from prospective clients. Start calling the doulas on your list, ask about their training, their availability, their back-up plan, their values, their fees, and their contract policies. If you don’t click or something seems off, cross her off your list. Chances are that if you don’t get along now, you won’t get along when you’re in labor. This is a good time to go with your gut feeling. Maybe you talk to a doula who has attended hundreds of births but doesn’t have a sense of humor. And then you talk to a newer doula and she is just starting out, but makes you feel comfortable and happy. Follow your gut, birth is a really intuitional experience.

Fifth, I know I just listed things to ask a doula on the phone, but I will lay them out here again for when you meet your doula in your first prenatal meeting.

Ask your doula questions, she will answer them!

o   Her training

o   How many births she’s attended

o   How many clients she takes each month

o   What her fee is

o   Does she support _________ (VBAC, bottle feeding, breast feeding, planned caesarean birth, surrogacy births, clients with traumatic history, whatever is important and relevant to you)

• Most likely your doula will remind you to ask questions multiple times in the interview, and don’t hold back. She is there to answer your questions and to be a knowledgeable resource.

• Your doula will talk with you about her services and her scope of practice, what she can and cannot do as a doula.

• Most doulas (including me) sign a client contract at the end of this first meeting. There is usually a down payment made at this time, as well as an explanation of services. If you have questions about the fees, for example, does she offer sliding scale fees, or payment plans, ask them before you get to signing the contract!

These are my suggestions for choosing the right doula. The big takeaway is to follow your gut instinct, if it feels like a good fit, it probably is. Having a doula at your birth is a wonderful option, and I hope you find someone who is right for you!

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My Journey to Doula Work

I get this question all the time, “why did you become a doula?” or “how did you know you wanted to be a doula?” The question usually follows my explanation of what a doula is, and the person I am talking with realizes I work in a job they never knew existed. Other times I get these questions from other doulas or birth-workers who came into their roles after they had children of their own. I am a doula because I have experienced how empowerment can lead people to accomplish their goals. I want my effort and time to go into work that empowers expecting parents to begin their journey with confidence, love, and a healthy mind and body.

“I don’t remember a time I didn’t know what a doula was. ”

My mom had a doula support her when I was born. I heard about this doula throughout my childhood, she was a pillar of the birth story my mom told. In the stories, the doula was the smart one, the strong one, the encouraging one that helped my mom bring me into the world. My dad says the doula is the reason he made it through the long labor and hard moments. I don’t remember a time I didn’t know what a doula was.

Young me carry for one of my many babies.

Throughout my schooling I was an emotionally intelligent child, always watching out for kids who were picked on or excluded. I took care of all my dolls with the utmost tender love a six-year-old could show. I played “giving birth” with my best friend weekly, one of us was always pregnant, laboring, or breastfeeding, we were very busy seven-year-olds. That soft vulnerable empathy I had as a child didn’t harden over when I became a teenager. I was emotionally tuned into all my classroom dynamics and social happenings. Around the end of my senior year in high school, my mom and I had a conversation and we got to the topic of midwives. She offhandedly mentioned she thought I would be a good midwife, and that idea stuck.

“After that workshop I knew I wanted to be some type of birth worker. ”

In the winter of my first year at Mount Holyoke College, I took a little local doula training class just to see if I was really interested in birth work. I loved the class, I loved learning about birth, I loved talking about it, I loved thinking about it. After that workshop I knew I wanted to be some type of birth worker. 

“The combination of how people work together and solving puzzles of cultural assumptions was just so intriguing, it felt like all of my questions about life and people were answered in the classrooms of my anthropology classes. ”

In the Fall of my sophomore year I decided I wanted to major in Anthropology. I had taken an anthropology class, and I was so interested in conversations on culture, health, structures, and medicine . The combination of how people work together and solving puzzles of cultural assumptions was just so intriguing, it felt like all of my questions about life and people were answered in the classrooms of my anthropology classes. My peers in the Anthropology department were strong, thoughtful, and just as excited as I was for more information and conversations. Some of my favorite classes included Medical Anthropology, Anthropology of Death, Anthropology of Reproduction, Anthropology of Structural Violence, and my senior seminar on theory. Mount Holyoke College is part of the 5-College Consortium, so I had the chance to take classes at other schools as well. I took Anthropology of Food and Nutrition, and HIV/AIDS 35 Years Later (at Hampshire College), and Evolutionary Anthropology (at UMass Amherst). So many interesting classes and professors, I loved learning about all the ways anthropology could be used to understand the world.

During the summer between sophomore year and junior I had the opportunity to shadow and home birth midwife in Portland Oregon. I sat in on some routine check-ups she had, as well as attended some classes she taught at Oregon Health and Sciences University (OSHU). Being immersed in an environment where pregnancy, labor, and birth were widely understood to be natural processes was an incredible experience. Talking to young student midwives, and other doulas was an important step in my own journey because it showed me that being a strong young birth worker was an option for a career path.

The next summer I interned with Health Equity Alliance (HEAL) in Bangor Maine. During my time with HEAL I worked with members of the community living with/ at risk of contracting HIV. While I wasn’t directly working with expecting parents, or birth workers, I was learning about the other pieces of public health work. Anthropology teaches us how to understand structure and how personal experiences are results of structural decisions. In Bangor, I was able to directly witness these experiences and think about the influence decisions being made in the state house. This was an important moment in my journey while I reflected on the bigger picture of public health and thought about how birth and birth support fit in.

My plans for after graduation.

After that summer, I began my senior year with a plan to write a thesis, yikes! The concept of my thesis was using women’s narratives of their caesarean section births to understand the caesarean experience in the US. I interviewed my subjects, did a lot of reading, and wrote my most prized piece of writing, my senior thesis (email me if you want to read it!). After researching and writing about cesarean births, I knew that I wanted to be part of the structural change to reduce cesarean birth rates and empower people giving birth. I had done a lot of thinking and analyzing, my academic side had grown and developed. After graduation I was ready to develop the other part of me, the empathetic, compassionate, strong-willed support person I knew I could be. It was finally time to start my training to become a doula.

“After graduation I was ready to develop the other part of me, the empathetic, compassionate, strong-willed support person I knew I could be. It was finally time to start my training to become a doula.”

I attended a DONA International birth doula workshop in August 2018, and officially began my journey as a birth doula. Over the course of Fall 2018 and Spring 2019 I worked on completing my doula certification requirements. I attended births, read a lot of interesting books, and took some additional classes on breastfeeding support, childbirth education, and running a business. I have found a connection with doula work because it is a place where I can use my emotional skills. I am valued because of my ability to connect with people and give them all my compassion. Being emotional and compassionate is a huge asset as a doula. I love sharing my knowledge with people, I love problem solving and strategizing, and I love empowering my clients. Right now, doula work is a great fit for my strengths in serving my community. In June 2019 I became officially DONA certified! Since then I have been building my business and making sure I have all my bases covered before I take clients. Now I am up and going, ready to take on some clients! Check out my website for specifics about the services I offer, my region, and my fees.  

“I love sharing my knowledge with people, I love problem solving and strategizing, and I love empowering my clients.”