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Doula Programs: The Latest Evidence
Doula program managers and grant writers are always in need of the latest statistics to bolster their claims of benefits to clients served by the doula program. Now we have some exciting news! In February 2011, Childbirth Connection published online Systematic Reviews: Continuous Support for Women During Childbirth. This updated systematic review of the effects of continuous labor support was published in The Cochrane Library in 2011, issue 2. The review summarizes results of 21 randomized controlled trials that involved 15,061 women.
According to Childbirth Connection, this review is descended from the first systematic review of controlled trial research of effects of labor support, which appeared in Effective Care in Pregnancy and Childbirth (1989). It has contributed to the development of policy statements and guidelines, legislation, and programs promoting continuous labor support in many countries throughout the world.
The most recent update incorporates six new randomized controlled trials, expands outcomes included in subgroup analyses, discriminates among three types of labor support companions in a subgroup analysis, and has been updated to reflect current methodologic guidelines
Overall, women who received continuous support were less likely than women who did not to:
- have regional analgesia
- have any analgesia/anesthesia
- give birth with vacuum extraction or forceps
- give birth by cesarean
- have a baby with a low 5-minute Apgar score
- report dissatisfaction or a negative rating of their experience
Women receiving continuous support were more likely than those who did not to:
- give birth spontaneously (that is, with neither cesarean nor vacuum extraction nor forceps)
have a shorter labor
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Birth & Parenting News: Cord Clamping Controversy
On Dr. Mercola’s website, there is an interesting summary of the umbilical cord clamping controversy. For many years, the World Health Organization and the International Federation of Gynecology and Obstetrics have advised against early umbilical cord clamping. But U.S. obstetricians have been reluctant to change their habits. Although no clamping occurs in nature, cord clamping has become such an accepted norm that delayed clamping is generally considered a new or unproved intervention.
Meanwhile, a separate review in the Journal of Cellular and Molecular Medicine also highlights the importance of delayed cord clamping, stating: “Many clinical studies have revealed that the delayed cord clamping elevates blood volume and hemoglobin and prevents anemia in infants…. Moreover, since it was known that umbilical cord blood contains various valuable stem cells, … the merit of delayed cord clamping has been magnified.” Read the full article.
Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them.
Doula Business Advisor: How to Set Your Rates
For doulas opening a birth or postpartum doula business, an important early decision in setting up the business is “how much should I charge?” The answer is based on the composite answer to the following questions.
1. What are your expenses? (see last week’s blog)
2. What are similar businesses charging?
The answer to this question will vary somewhat, depending on where you live. Even within the state of Michigan, for example, rates are fairly divergent in metropolitan areas such as the greater Detroit–Ann Arbor area compared to some of the more severely depressed areas of the state. Make a few calls to your sister doulas, introduce yourself, and ask openly what they are charging. Connect with other doulas. See if there is a local support group you can join.
Not all doulas are comparable. Someone with ten years of experience and a strong local reputation is likely to place herself at the higher end of the pay scale, while someone just starting out and still seeking to fulfill certification requirements may offer her services for free or seek only to get her out-of-pocket expenses covered. Determine what the range is and then see where you fit in. In the end, it’s your call, and if the market will bear your price, then good for you!
To be continued …
The Doula Business Advisor blog is designed to support the establishment and long-term sustainability of private doula businesses. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Do new doulas need mentoring?
Doulas are brave. After completing training prerequisites and attending the doula training weekend workshop, would-be volunteer Doulas Care doulas simply needed to sign up for the volunteer orientation to be ushered into the program. On occasion, the volunteer coordinator made doula–client matches by the end of the first orientation session.
The sink-or-swim approach worked surprisingly well, for the most part. Some doulas, feeling a bit timid, asked to shadow a more experienced
doula or be mentored in some way for the first birth or two, while others
just forged ahead and jumped in the deep end. We were reluctant to take on the administrative burden of establishing a formal mentoring process for the doulas. This was primarily because I felt that the clients’ needs must always come first and that two doulas might be overwhelming to some women. I suppose if it had been a persistent need, we would have found a way to do it. Most doulas simply rose to the challenge and overcame their reservations, and I have come to believe that the need for mentoring is more perception than reality. I am forever encouraging new doulas to focus on their strengths (exactly the same thing we tell the laboring mother) rather than their insufficiencies. When you are with a
mother who needs support, you will find a way to support her, from your heart and from your existing knowledge base. Your goal is to serve her, to be an asset. Surely, we can all find a way to do that. After all, it’s not about you. (Say it to yourself ten times: “It’s not about me, it’s not about me . . .”)
Still, it can be really helpful to have someone to debrief with after a particularly challenging birth. Our partners, after all, have a limited capacity for listening to birth stories. My very indulgent husband claims to know WAY more about birth than he needs to—“TMI” as they say. So a support group for doulas is a great solution, serving as a means to do some group problem solving, learn from each other’s mistakes, and identify common themes for future The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other.
Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Business Advisor: How to Set Your Rates
For doulas opening a business, an important early decision in setting up the business is “how much should I charge?” The answer is based on the composite answer to the following questions.
What are your expenses? Typically, expenses are minimal for service-oriented businesses. Rarely is it necessary to rent office space, invest in inventory, or buy expensive supplies. But that is not to say that there are no expenses. At a minimum, there is the cost of professional affiliations, continuing education expenses, mileage, marketing, some supplies, and, for some, child care.
Think of the ratio of expenses-to-income for self-employment in the same way that you might perform a calculation for choosing to work outside of the home. In order to work outside the home, one needs to factor in the cost of a suitable wardrobe, transportation to and from work, increased cost of eating more meals out and grabbing food on the go, and, last but not least, child care. Tax implications for the additional family income also need to be taken into consideration. If, after doing these calculations, you discover that the job will net $3 per hour for your efforts, you might just decide that the benefits of the income versus the downside of paying others to raise your children is not a ratio you can live with. Those of us who are self-employed also have a cost of doing business and must make similar calculations when setting our fees. Start by making a list of your anticipated expenses.
To be continued …
The Doula Business Advisor blog is designed to support the establishment and long-term sustainability of private doula businesses. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Enhanced Doula Training
With our volunteer community-based doula program, Doulas Care, early program evaluation results, including published data gleaned from focus groups with the volunteer doulas, revealed that many volunteers felt unprepared to meet the unique needs of the population served by the program.
The doulas were more or less “birth junkies” whose training had prepared them to discuss the development of a birth plan with the expectant mother, and provide hands-on support at the birth. In some instances, however, the doulas were matched with homeless women whose primary concern was whether or not Children’s Protective Services would take their baby away if they were unable to find affordable housing before the birth. Clearly, birth plans take a back seat when survival issues are on the table.
Furthermore, helping doulas to establish good boundaries with their clients emerged as THE primary issue with which the doulas needed help. As awareness of the need for training beyond the core doula training curricula emerged, a two-part orientation program was developed as an essential component of volunteer training and preparation. Part I was designed to enroll qualified doulas as volunteers in the program, addressing scope of practice, policies, and procedures. Part II expands the role of the doula as a community outreach worker and provides training on perinatal risk factors and related topics.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Birth & Parenting News: Induction of Labor
Childbirth Connection has launched an excellent and comprehensive educational resource on induction of labor. See also Amy Romano’s accompanying January 28 post on Science & Sensibility, “Except When Medically Necessary: Making informed choices about induction of labor.”
Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them.
Doula Business Advisor: Money Matters!
If you are charging a fee for doula services, then you are, by definition, a professional doula. Indeed, money does matter. Just because you love the work does not mean that you should not get paid for it. Just because you would do it for free does not mean that you can do it for free.
If you begin to think of yourself as a professional doula, then you will begin to present yourself as one to potential clients. When you present yourself as a professional, you have every expectation of being paid your fee. That is simply how it works. It doesn’t work well when we have doubts about ourselves, our worth, our qualifications, our clients’ ability to pay, or the value of the work itself. If we harbor a belief that true work must be boring and painful, then we will not feel comfortable accepting money for work we simply love to do. And we will find a way to undermine ourselves, to give a mixed message to clients, to present our expectation of being paid as flexible, negotiable, and so on. We may even undermine the prospective client’s confidence in our capacity and professionalism—because they will read between the lines. They will hear every “but,” explicit or implied. (“I charge $20 per hour for postpartum doula services, but . . .”) And then, like water running through cracks, the customer finds the opening—and the doula finds herself negotiating her fee down to $12 per hour.
My question is—Does this work for you? Are you okay with negotiating your fee? How low will you go? Do you not believe that you are worthy of the fee that you set in the first place? I cannot overemphasize the importance of examining your own beliefs about your value and worth as you set up your business. Every single time you sell yourself short, you absolutely must observe yourself consciously and admit that you just did it again. Then, I encourage you to consider the reasons for that behavior and change it. Otherwise, you will not be in business long, because I promise that you will keep attracting people to you who are going to be difficult about money.
The Doula Business Advisor blog is designed to support the establishment and long-term sustainability of private doula businesses. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Scholarships for Doula Training
It is essential that community-based doula programs, seeking to recruit women to serve their low-income sisters as doulas, establish a scholarship program to underwrite the costs of doula training. Otherwise, your program will end up with a doula pool consisting primarily of middle class white women. Please don’t expect the doula trainers to eat this cost. We do what we can do, but we cannot make a living, giving something for nothing, over and over and over again.
When writing grant proposals to fund your doula program, include doula training scholarships for low-income women to become doulas as a line item in your grant budget. See my book, The Doula Business Guide to learn more about how we managed to fund hundreds of women to complete doula training, including pre-requisite classes and, in some cases, even covered certification fees.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Birth & Parenting News: Cesarean Data & More
A special article in the January 2011 edition of the journal “Pediatrics” provides a summary of the most current vital statistics data for the U.S. This year, the “Annual Summary of Vital Statistics: 2008″ also includes a special feature on differences in cesarean delivery rates according to race and Hispanic origin.
According to the report, cesarean deliveries continued their twelve-year rise in 2008, making up almost one-third of the births in the U.S. A range of reasons for the increase are cited, including mother preferences to doctors’ fear of lawsuits. Cesarean deliveries have increased 56 percent since 1996.
Other key findings in the report include a decline in the overall birth rate, with births to teens aged 15 to 17 declining two percent from 2007 to 2008. Births to unwed mothers represented 40.6 percent of all births in 2008, an increase of almost one percent, and the proportion of babies born early went down three percent from 2007 to 12.3 percent of all births.
Rates of multiple births were the same as in 2007, and infant mortality declined from 6.75 per 1,000 live births in 2007 to 6.59 in 2008. The report is compiled by the National Center for Health Statistics and the Johns Hopkins Bloomberg School of Public Health.
Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them.