I Want To Become A Doula!

When I gave birth to my third child almost 10 years ago I did so with only the support of my partner. We didn't think we needed anyone else with us.  We'd done this before.  Twice.  My partner was great, but the birth was a bit of a farce.  I was induced in the morning and by the afternoon things were progressing quickly.  I did not have an epidural as I had the first two times and my partner needed to stay with me the whole time.  He could not leave my side.  I needed him.  But as a result he was not able to eat, drink, or go to the bathroom.  When it came time to push the deprivation he had endured for eight hours took its toll and he fainted.  The staff were more concerned about him than me and my perfect birth was out the window.  After the birth I experienced lots of Breastfeeding issues that ended with my daughter back in the hospital.  I later suffered from postpartum depression that ultimately took over my life.  If we had support during the birth or the postpartum period I do believe things could have ended differently.

I became intrigued with the aspect of support during birth and the postpartum period and did some research.  By fluke I came across the profession of "Doula".  But how did one become a doula? How did you make this a profession?  I'm often asked this now as a doula trainer so I thought it would be a good idea to lay it out here for everyone to see the steps involved.  

When I first began my research there were really only two organizations that were available to choose from, especially for a Canadian.  I looked at both and sought some advice of other doulas I had met on line in doula chat rooms, remember this was before FaceBook.  One doula in particular suggested I look at each organization's Vision Statement, Position Paper and their Approach to Birth. When I did I found I was drawn to the Vision that CAPPA had toward birth and their doulas. So now I had a path. 

I started with the labour doula workshop.  It was two days and explored a doulas scope of practice, the stages and phases of birth, comfort measures, how to support women and their partners during labour, how to handle unexpected outcomes, how to support a cesarean section or a VBAC, pain medications and the doulas role, supporting Breastfeeding and offering resources to pregnant women and new mums, the business side of your job and finding clients and oh so much more.  It was amazing! 

I walked out of that workshop as a doula in training.  I could now work with women and support them in their births.  During the early years of my doula life I continued to run my Home Daycare.  The families I served were very forgiving if I needed to have my husband watch the kids or my Mum or had to call in sick one day every now and then.  I also spent a number of years working at Shopper's Drug Mart and had a younger teenage cashier agree to take a shift on a moments notice if I had to go to a birth.  I also found like minded doulas who I got along really well with and we worked as back ups for each other.  I was nervous giving up guaranteed income for the risk of being self employed, so in the beginning I took just one a month, and worked slowly to gain experience and immerse myself in the birthing community.  One day I realized I was becoming popular, in demand and I had to make a decision to either do this "doula thing" or quit.  By that time I was also a Childbirth Educator and Postpartum Doula.  So while my income was not Millionaire worthy it was comfortable enough to take away my safety net.  And I'm so glad I did.

During those early years I was also working on the steps to become certified.  Being certified was important to me because I believe if you are going to do anything, you do it right and you do it fully. These days being certified is becoming more important as our profession becomes more popular and clients are now requesting certification.  And, as we creep ever more closely toward regulation, certification will definitely become a requirement.  

The steps to labour doula certification are many but not difficult.  And CAPPA allows 2 years for you to work on these steps.  I also used an extension which was easily granted as CAPPA understands that life happens and family comes first.  

Steps to Certification- Your Road Map To Becoming Certified:

(For the sake of this piece I will discuss the current steps to certification as things have changed slightly in recent years. You should always check the CAPPA website for the most up-to-date list of steps)

The order in which you do these steps is not important except for signing up for CAPPA Academy.  CAPPA is unique in that it has an online certification process.  All your documents, forms, exam and steps are found in CAPPA Academy.  

Once you have signed up then you would be free to tackle the steps as you see fit.  Those steps include: 

- Become a member of CAPPA.  As a member and a trained doula you will appear in CAPPA's referral section so expectant and new parents can find you.  You do not have to be certified before you appear on the website. 

- Complete the preworkshop study that you would get when you register for a workshop.

- Read the manual that you will get and go over extensively in the workshop.

- Read 5 books from the reading list.  You'll probably read more than that as you find books that peak your interest and expand your knowledge. 

- Complete part one of the HUG Your Baby Training program.  This program gives professionals strategies and tools to help prevent or solve problems around newborn sleep, eating, playing and attachment.  Professionals will be able to boost parent confidence, enhance Breastfeeding and promote bonding. 

- Create a resource list that you can use to make referrals to new mums and expectant parents.  That list would include lactation consultants, support groups, midwives and more. 

- Attend a Childbirth Education Class.  

- Attend a Breastfeeding Class

- Pass the multiple choice and essay exam found on CAPPA Academy.  This is an open book exam so no need to worry. 

- Attend three births and have them evaluated by the labouring mum, her primary care provider (Doctor or Midwife) and her secondary care provider (nurse or secondary midwife) for a total of nine evaluations. 

- Sign and agree to CAPPA's Code of Conduct and Social Media Policy, Grievance Policy, Missions Statement, CAPPA Approach / Philosophy Statement, Vision Statement and Scope of Practice. 

And that's it! Once you have completed these steps you gather everything together that needs to be sent in to the office, make copies and send those copies in.  Give the amazing office staff 6 weeks to mark your package and if all is in order you will receive your certification and be able to use the letters CLD next you your name. 

When I received my certification from CAPPA it was one of the proudest moments of my life.  I am so thrilled to be a member of and trainer for CAPPA.  This organization is a true sisterhood of support.  Their motto is "Love Wins!" And they truly mean that! 

So if being a doula is something you have thought of, or you have more questions about how to become a doula you can check out CAPPA's website at www.cappa.net or find workshops on my website at www.torontodoulagroup.com/becomeadoula.htm or you can email me at kim@torontodoulagroup.com. 

Being a doula and childbirth educator is the most rewarding job I've ever had and I can't thank CAPPA enough for being such an amazing, supportive and forward thinking organization.  

Did you know that in most hospitals you are allowed two support people? Presumably one will be your partner and the second can be...your friend, a family member, or a hired professional called a doula.  Having an extra set of hands to assist you and your partner can be very beneficial.  In the case of a doula, The assistance comes without judgement and with an expertise in modern birth and a knowledge of the workings of the hospital.

But what if you were told by your doctor that they didn't allow you to have a doula?  Do you think your doctor has the right to dictate who your support people are? One such incident was highlighted to me earlier this week and it got me thinking. 

Consider this, what are the chances your doctor will actually be at your birth? Having a doula offers you continuity of care.  Your own doctor can't offer you that.  The vast majority only work at their hospital once a week or less.  And as most hospital policies do not dictate the precise "who" you can have, where is it coming from that your doctor can say precisely who will be there to support you?

One reason could be that the doctor has had a past bad experience with a doula and has written off the entire profession.  A situation of one bad apple spoiling the bunch.  But like with all things, there is good and bad.  There are good doulas, and bad doulas.  Just like there are good doctors and bad doctors, good nurses and bad nurses.  But you might agree, that one bad experience shouldn't ruin the experience of all mothers and shouldn't take away a woman's choice for her own birth.  If we did that, then most of us wouldn't be seeing doctors at all, or going to hospitals. 

A second reason might be control.  Some doctors, not all, like to micro manage birth.  They like to control the process and don't like to answer questions.  Some feel the questions you ask are actually you questioning them as a doctor and as a professional.  Some think the doula is whispering in your ear and getting you to make decisions that go against medical advice, or that the doula is bad mouthing them behind their back. 

Nothing could be further from the truth.  A doula is there to support your decisions.  To help you in physical comfort and evidenced based information.  To remind you of your birth plan, that you and your doctor agreed to.  To help you cope when things don't go as planned and to be with you even when everyone's shift has ended.  They are not there to make decisions for you, but to help make sure you have all the information to make an informed consent decision.  And informed consent is your right as a patient. 

So what is a parent to do when confronted with having to choose between the birth team she wants and not upsetting their care provider? The easy answer is nothing.  It shouldn't be a choice.  Your birth should be what you want it to be.  With a care provider you like, who is supportive of your choices, in a place where you feel comfortable, either at home or a hospital or a birth center.  With a team of supporter of your choosing who will care for you, listen to you, and be with you every step of the way. 

But how do you do that? Research.  Interview, yes even doctors.  Go on tours of different facilities, ask questions, ask your friends, family, co-workers, prenatal teacher.  Research on-line, read books beyond What to Expect When Your Expecting.  Pregnancy and birth are all about choice.  Don't have that choice taken away from you because of fear and ignorance. 

My Completely Biased Favourite Places to Give Birth in Toronto

I currently teach prenatal classes at York Central Hospital. Because the program is run by an outside organization I often get couples that are having their babies in other hospitals. I realized the other day that I have an obvious bias toward certain hospitals. So as such, I thought I would try to keep my biases out of the classroom and share them here instead.  

Sunnybrook - Having your baby at Sunnybrook is a definite experience. If I were to have another baby and had to have a hospital birth it would be here. The facilities themselves are practically brand new. Private labour rooms double as your postpartum room and are roomy with most medical equipment actually hidden behind cabinets and stored away. The bathroom holds a wonderful deep tub with jets and room for partner should they choose to join mum in the water. And there is optional dim lighting in there too. And the most practical touch of all, a mini fridge to hold your drinks and food to use during labour and postpartum.

But all that is just window dressing. The staff make your birth experience at Sunnybrook truly fabulous. The nurses, who are your main contact at the hospital, are definitely there for you. Whether you are choosing an unmedicated birth or are looking forward to your epidural, the nurses will be there to assist you in executing your birth plan as best they can. I have rarely seen women pressured in to procedures they don't want to the sake of expediency. They are open and friendly and caring. The doctors as well are a rare breed in the world of maternity care. Several I have seen are open to choice, one was even supportive of a clients desire to have her baby in water. Something we only really see with midwives and homebirths. Whether you are hoping for more then 5mins in your appointment or delaying your cord clamping by 2hrs, there is a doctor at Sunnybrook for you.  

Toronto East General - Until Sunnybrook came on line, Toronto East was my top pick for hospitals in Toronto. Like Sunnybrook the staff is fabulous. The nurses are kind and caring and the pressure to get an epidural is minimal. The facilities themselves while older are still good, with big rooms and tubs in almost every room.

The doctors are also unique in offering breech vaginal delivery and discussing choices with informed consent as opposed to pressuring patients into what will work best for the doctor and their schedule. Toronto East General is also one of only two hospitals in Ontario that have been awarded an official Baby Friendly Hospital by The World Health Organization and Unicef. Not even Sunnybrook has this. As such they also have an amazing breastfeeding clinic to help you in getting the support you need in that critical time after birth when you and your baby are learning to breastfeed.  

Mount Sinai - While many doulas would not even have Mount Sinai on their list at all, I have had too many good experiences not to have them on my list. Mount Sinai is the only hospital where my clients have not ended up in a cesarean section. Almost 30 percent of my clients have birth there and none have had a surgical birth. That's amazing. While the facilities are old and in the process of being updated, the staff are fairly good with staff who are open to natural birth, even if they don't always understand a woman's desire to go natural. I have seen women pressured to accept interventions simply to speed up the process, but if you enter into your labour with a plan in mind, educated on your options and with good support who will advocate for you then you may not fall prey to unnecessary procedures.  

The Others - The rest that round out the list include North York General, of which I have a certain fondness, having been born there myself. Markham-Stouffville, for its recent achievements in reducing their cesarean section rates. And Scarborough Grace where I had my own children with an amazing OB.

So that is my completely biased list of hospitals in Toronto. If your hospital isn't on this list, odds are it isn't one of my favs. But I'm just one doula. Your birth will be what you want it to be and what you allow it to be. But wherever you are having your baby I always recommend a doula to help you get the birth you want.

Pleasant Hospital Experience

It has been just over a year since SunnyBrook opened their doors to their new Women and Babies unit. I had not had the opportunity to attend a birth there until this past weekend. As it was, it was not my client but I was called in to back up my partner. I was extremely impressed.

The facilities were beautiful. Of course it still had that shinny new feeling to it and the paint was probably still wet but it was nice none-the-less. The room had a fabulous deep tub and the room was large and spacious. And to my delight there was a private mini fridge for mum and partner to bring nutritious snacks and drinks, or a small bottle of champagne. And best of all you don't have to keep food in a communal fridge to be stolen by others.

But beyond the cosmetics and bells and whistles of the hospital, one of the best things about this hospital is the staff. The first nurse I met was Aggie. I had met her when this program was done through Women's College and she is still a fabulous, friendly and caring care provider. Then we met Karoline and she was equally wonderful and caring. The doctor who came on shift while I was there, Dr. Nevo and the resident Stephen (I didn't catch his last name), they were both very patient and spoke calmly and slowly about what their recommendations were and what the procedures would entail. This goes along way to making a potentially stressful situation easier for mum and partner.

Unfortunately for our client the end result was a cesarean section but for the comfort and support of both mum and partner, the doula, me, was allowed to attend the section as well. I was very happy for that, as the situation did require more then one set of hands to keep mum calm and comfortable for the hour it took to complete the procedure.

Overall, the entire experience was more then I could have hoped for, for any couple having a baby. The respect for birth and women and their ability to give birth is a rare gem in our world today. While the bells and whistles are great, women have been giving birth without them since the beginning of time, but what they have always needed to give birth is kindness, caring, support and above all respect. And SunnyBrook Health Sciences Women and Babies Program has that in spades.

Can't wait for my next birth there.

The value of a supportive word...

This was not the topic I was intending to write about but sometimes situations arise and you can't help but voice your outrage and concern.

A friend recently came home from a VBAC birth and told me how the doctor basically told her client to stop wasting her time, it was just going to be a ceserean any way, he refused to take responsibility for her and that walking around was a complete waste of time. The client did everything she could and my friend had her doing things we never knew a labouring woman could accomplish while in active labour.

Unfortunately after more then 24 hrs it did end up in a ceserean section.

But why would a doctor come into a hopeful and happy situation and burst every balloon in the room with his words. When a woman is in labour she is so open to the connotations of words. A woman who feels supported and loved and safe will do amazing things during her labour. Her discomfort will be diminished, her labour will go faster, she will not fear the process and listen to her body, and she will preceive the birth in a much better light regardless of the outcome when her basic human needs are met.

Now I'm not saying that in the case of my friend her client would have had a vaginal birth if her doctor hadn't been such a mean guy, but perhaps she would have had a better outcome, a more pleasant experience, a shorter experience, who knows.

Kindness costs nothing, it doesn't infringe on our health care costs but the benefits are huge and it would go a long way if doctors and nurses and friends and family would remember that when talking to a pregnant or labouring woman.

That's my soap box for today, perhaps I'll get to write the next post I was planning on and chat about why you aren't too fat, short or old to have a baby.

Pleasantly surprized!

I spent Valentines at the birth of a wonderful couple in Women's College Hospital. The birth was wonderful, everything went very well. So why was I pleasantly surprised? My only experiences with this hospital was one birth with midwives and several women telling me that their doctor was insisting they not have a doula.

One woman, a single mother with only her elderly mother for support asked her doctor about getting a doula and he told her it wasn't necessary, that he would be there and doulas were not worth it and would ruin their birth. She was a candidate for a volunteer doula and was the one person who really did need a doula. Thankfully she didn't listen to her doctor and had a doula and that took a lot of pressure off her and her mother to be there all on their own. Their doctor was not there for her, he wasn't even there for the birth.

My client this weekend told her doctor that that she was having a doula. He told her that their doula "had better watch her place. I'm not talking to her about you." I was worried that this doctor would ban me from the birth. He had some chip on his shoulder that a doula would encourage a client to go against their doctor. That a doula would give medical advice. That simply isn't the case. Doulas are not medical. Our role is to comfort, physically and emotionally. Our job is to educate and make sure that when a client has a big decision to make they are doing it with all the information.

So when I entered the hospital I was concerned that I would not be able to support my clients to my fullest abilities. Turns out the only problem I had was the incredibly small room. The nurses were awesome and respected my role on the team. The anesthesiologist was fabulous and let me stay for the epidural despite the size of the room. Her doctor went off shift and the new doctor was great and very pleasant.

I was very pleased with how everything went and stayed longer then I usually do. I'm actually looking forward to my next birth there.

Inductions suck! (A Very Tired Rant)

Let me start by saying that for some, inductions are necessary. Those women with high blood pressure or PIH, those with gestational diabetes and those who suffer from other illnesses that may threaten their or their baby's life. For them inductions have saved lives.

Having said that, for women who are "past date" or their water has broken or their doctor is impatient inductions SUCK!

The main reason being that they are designed to fail. Lets consider how it goes:
The pregnant mother comes into the hospital with the belief that her baby is 'overdue', 'very large', 'her water has broken 24 hrs ago', or they had thought they were in labor and the hospital was not busy and even though they were only 1 cms dilated they were kept and given a room. (Hint, go home!!!!)

She is told, for whatever reason, that she will need to be induced. The reasons given sound grave and usually the mother is so sick of being pregnant it is a straw she can't help but grab.

And thus it begins.
She is sent to a room. Forced into a hideous blue gown with her butt exposed. Propped up all comfortable in bed, (The first of the problems). Attached to fetal monitors (The second of the problems) and either her water is broken or she has an iv started and is pumped up with pitocin. (The third of the problems).

If the induction begins with breaking her water, there is usually a shred of hope in that she is able to walk around at least after a little bit of monitoring. This is good and necessary because women need to move in labour.

If she has pitocin then she is doomed. Women in labour can't remain in bed, unless their body is telling them too. Being on pitocin she must stay monitored and thus stuck in bed. Thus begins the interventions.

An epidural follows because the contractions she is getting from the pitocin are unnatural and very painful and being stuck in bed she can't move around to find a comfortable position. You can try sitting in a chair or standing or even on the birth ball, but heaven's forbid she should move because then the monitor won't pick up the baby and the nurse has to reposition it until the baby can be 'found' again and that usually involves the mother being uncomfortable and begging for pain medication.

Thus the epidural now has slowed the labour and mom isn't labouring at the rate she should. According "the text book" you should dilate at a cm per hour once you hit 4cms. Now because of this delay the pitocin is continuing to be increased. After a while the baby may not tolerate the pitocin contractions and the heart rate will dip repeatedly and the pit is stopped but the contractions do too and then the cycle starts. After a while, usually just enough hours to really drain on the mother and her partner the doctor mentions the dreaded "C" word. At this point, the dips on the monitor have scared the parents, they are exhausted and just want to see their baby and be done with it all.

Thus the end of the induction is a c-section. Failure!

So then what are you to do? First off get as much information as possible before you are induced. Ask the following questions:
"Am I or my baby in danger?" If the answer is yes then you have no choice and the induction is necessary.
"What happens if we wait a little longer?" Most of the time it will buy you some time and if the answers you get are satisfying to you then, wait!
"What happens if we do nothing?" Again, more time is bought and you get more information to make a sound decision about the care you are going to be receiving.

Don't blindly jump into an induction without all the facts.

Second, there are lots of great ways to get your body ready for labour:
Massage, accupuncture, chiropractics, sex, and more.

Try everything else first.

Well that is my rant for the day. In case it wasn't obvious I had a failed induction on the weekend and while mom and baby are doing great I'm saddend by the fact that she missed out on the birth she was hoping for.

Therefore: Inductions Suck!