When seeking a professional doula, several different models of care are available to families. Some areas of the country have hospital based doula programs, both as paid and volunteer positions. Other doulas have joined forces to form collectives, and share their resources and sometimes on-call coverage. In recent years doula agencies have become an option in some cities. I've even heard of a 24-hour call line where you can hire a last minute doula during labor. But the way many of us began, and continue to practice, is the independent doula model.
Let me first say that I truly value and support all doula support models of care. A diversity of options is the best way to serve families seeking professional labor support. Multiple choices allow families to choose the support options they prefer, a price point that works for their budget, and a model of care they align with. For doulas, an on-call program can provide a predictable schedule, which allows for another job or secure childcare coverage. A doula agency can provide a pathway for new doulas to begin working without the stress of building their business and advertising their services. Variety is the spice of life - but it's also the key to long term success for the doula industry.
I began my career with a DONA International doula training in 2007. Back then the only avenue open to doulas, at least in my area, was to go into business for ourselves. My husband and I already owned a small business, so launching my own doula business wasn't a daunting prospect. Being an independent business owner takes effort and drive, but it can also be extremely rewarding. I work for myself, and as such I have the freedom to direct the course of my business and future.
2015 has been a year of significant change in the Central Ohio doula community. A local hospital launched a grant funded hospital based doula program, with a focus of providing a low cost option for families who would otherwise not be able to afford doula support. This is a doula model of care I am very excited to welcome into our community. I have supported the program by providing photography for their advertising campaign, as well as referring families seeking low cost support services. A doula agency has opened it's doors, as well as a doula collective, here in Central Ohio. Through it all, being an independent doula has continued to remain the right choice for me. When I sit down to reflect upon my reasons for following this path, the following items step front and center.
PRENATAL SUPPORT: I provide clients with two in-home prenatal visits, and we normally talk for 2-3 hours at each meeting. We also speak on the phone, email, and I even join them at a provider visit when requested. Many families tell me that these prenatal discussions helped them bring all their education and research together into a cohesive understanding of labor and deliver. It is my belief that a large part of how a doula can affect positive change is through preventative action. Encouraging clients prenatally to ask detailed questions helps families understand their care provider's approach to labor management. Don't wait until your water breaks, or you're scheduled for an induction. Speak with your provider early in your pregnancy to find out their protocol for watering breaking before labor, reasons and methods for inductions, going past your due date, and other birth options. Having these conversations prenatally gives families time to understand their provider's plans, work on compromises if needed, and even make a change in provider or hospital if necessary. I want my clients to walk into their births with a full understanding of their provider and hospital's labor management plans. I find this often reduces anxieties, and builds a family's confidence heading into birth. Many clients hire me thinking that they want a doula primarily to help provide comfort measures during labor, give their partner a break, or even to help them achieve a particular birth goal. But after birth they often remark on how impactful our prenatal discussions were on their experience.
THE RIGHT FIT: Working with an independent doula allows each family to assemble their personal best birth team. A woman and her partner should choose the care provider, birth location, and doula who are right for them. I may have many years of experience and happily support a wide variety of birthing plans, but I am not the right doula for every family. Interviewing a few doulas and finding the one who is right for you is vital to the success of your doula experience. As a doula, I also value the freedom to choose families who are a good fit for me. We spend a lot of time together, and share an intimate experience, so being a member of a cohesive birth team is essential. Having someone else assign doulas to families, or using an on-call doula program, doesn't allow the woman, her partner, and the doula to choose each other.
CONNECTION: In my mind there is no match for the personalized connection one doula and one family can create together. In a world of large care provider practices, shared provider on-call coverage, and nurse shift changes, the independent doula is one constant for the woman and her partner. I take time to get to know my clients. I know their preferences, their hopes, their fears, and their personal relationship. They get to know me. They know what to expect of me, they know how I communicate, and they have time to develop a comfortable trusting relationship with me.
UNIQUE SERVICES: The independent doula often brings additional services to the table. In additional to being a certified birth doula, I am also a licensed massage therapist and professional photographer. A doula might also be a Certified Lactation Counselor, IBCLC, Childbirth Educator, Nurse, Postpartum Doula, Bodywork Therapist, and have attended Advanced Doula trainings. Additional services can help families find the type of support needed for a positive birth experience.
NO TIME LIMITS: I have recently begun seeing some doulas and agencies offer a time limit for their labor support. They might provide 12 or 18 hours of labor support coverage as part of their doula service, but charge per hour for additional support. As both a woman who has given birth, and as an experienced doula, I find this tactic at odds with the humanity which doulas strive to bring to birth. During my first labor, which lasted 45 hours, I remember asking at a point relatively early in labor (not that I knew it at the time) to have my doula come to my home for support. As it turned out, I wasn't as far along as I had hoped. But that didn't change the fact that I needed her physical presence then, not just in the last 12 hours of my long and confusing labor. For me, knowing I risked an additional charge for labor support hours would certainly have affected my decision as to when I requested my doula's presence. I will never put a client in the position of deciding between requesting me when they need me, or waiting, despite needing me, in order to avoid additional fees. I always provide plenty of phone and text support before I physically arrive at a client's home. But I tell every client that I will join them in labor when they need me, no matter when that time arrives. Does that mean I am occasionally at a birth for 36 hours (or more)? Yes, it does. I also have some clients birth their babies quickly, and I am only with them for 4 hours. For inductions I typically go at the beginning to help ease the family through the process of hospital check-in, facilitate induction plan conversations, and assist them in getting comfortable. If they are able to rest then I often go home for a few hours, but if not I stay with them throughout the entire process. When you hire me, you have my support - no time limits.
HOME LABOR SUPPORT: I'm often hired by families who wish to labor at home for a period of time. This can allow them to enjoy the comforts of their home, while working through a portion of their labor. I do not provide any clinical services (cervical exams or health assessments), but can offer guidance as to where they might be in their labor progress, as well as positions and options to manage their labor. Hospital based doula programs begin their support once the family has arrived at the hospital. When the woman is admitted to the hospital, the on-call doula is called to come to the hospital for labor support. An independent doula provides early labor phone and text support, home labor support, hospital labor support, as well as support in the first 1-2 hours postpartum.
NO MIDDLE (WO)MAN: You don't go through anyone else to reach me. If you call, email, or text you will always get me. We have a personal relationship together, from the moment you inquire about my services until we hug goodbye at our postpartum visit. Doula work is about personalized support, and that's what you get when you hire an independent doula. You can also know exactly where your fee goes - to the doula herself. No part of your fee will go to a management agency or other organization. Independent doulas are small business owners, and as such a portion of their income goes to self employment taxes, business and professional licenses/permits, mileage, office supplies, website, advertising, and other expenses. I typically net about 60% of my fee after expenses. That is a much larger share than doulas who choose to work for an agency, and other models of service. Those doulas only receive a portion of their fee. Unless they are an employee, they are also subject to many of expenses previously listed. Supporting women in small business is important, and you can help the effort by hiring an independent doula.
AUTONOMY: I value the freedom I have to change and grow in my career. I've chosen to offer professional photography services in the last several years, and I continue to offer licensed massage therapy services to my clients. When I see the need to provide updated information to my client handouts and prenatal conversations, I have the option to refresh my approach. If I'd like to provide services to a family not in my regular coverage area, I am free to do so. If a client requests an additional service that's not part of my regular doula package, I have the autonomy to meet her needs however I so choose. This alone is a MAJOR reason why I continue to be an independent doula.
POSTPARTUM SUPPORT: In the days and weeks after birth, a new family can greatly benefit from doula support. We are already a trusted member of their birth team, and able to assist them in finding necessary resources during their postpartum recovery. An in-home postpartum visit is typical for most independent doulas. That visit offers the family a chance to not only review their birth with someone present for the experience, but also allows for discussion of any breastfeeding, sleeping, and recovery questions and concerns. One limit of many hospital based doula programs is the lack of postpartum support. Birth can be many things - joyous, challenging, confusing, and even traumatic. Having doula support to help them process their birth experience can be of great benefit to a family.
COMMUNITY RESOURCE: There is much to be said for an independent doula's role in helping a couple get the services and support they need outside the birthing year. I am often in contact with families who are not yet pregnant, some of whom I have previously worked for, and others who plan to hire a doula when they become pregnant. They are seeking referrals for care providers who share their philosophy, hospitals with specific options, childbirth education, counseling support to process past experiences, and much more. An independent doula can help guide families to services and support best suited to their personal needs, even before they become pregnant and decide to hire a doula.
I want to encourage all independent doulas to find support within their local (and national) birth professional communities. Having peer support and encouragement is vital to growing into our best selves as professional doulas. Here in Central Ohio I have the privilege to be a member of Central Ohio Doulas, a professional doula organization which works to support each other and build positive relationships with the medical community.
Independent doulas provide family centered, full spectrum professional labor support. We are passionate about the unique personalized support we provide. Long live the #independentdoula!
(photo credit Happy Ely After)