Why I Dropped the Phrase "All Births For All People"

Up until recently, I believed that I was willing and capable of supporting all births for all people. However, a client and I recently ended our relationship and it made me realize that boundaries that I have set in place for the overall health and happiness of myself and my family mean that I cannot support any and every person or birth setting. Oftentimes, I can sense whether a client is a good fit before we even meet (enter a dash of expert level internet research). Other times, it takes the consultation to know whether I want to work with them. During most of the pandemic, I’ve chosen to be a little loose with my boundaries and occasionally ignored my intuition about folks. It hasn’t worked for me or for some clients, so I’m making a change.

One thing that I think a lot of folks, including myself, do not always consider when entering a relationship with a doula is that it is just that, a relationship. Yes, the client pays me to provide a service, but I cannot do that well if boundaries are not well established (on both ends) and one another’s humanity is not respected. While ours is one relationship, we have others that we must attend to with equal or more love and time.

On my end, a couple examples come to mind. I have two children who are the most important people in my life. If they need me, I’m going to be there for them, which is one reason I have backup doulas available. I also value my relationship with self which is why I find that my “built of straw” pandemic boundaries were a terrible idea. Having attended 80-something births is enough to know that I cannot support you without fear or a protective response with any provider or in any birth setting that you choose. And while most people that I work with are different than me and make different choices than I’d make (back to my focus on one another’s humanity), there are some folks that I cannot enter into a business+personal relationship with.

So, I want to apologize to people I’ve unintentionally, but undoubtedly, misled with the phrase “all births for all people.” I also apologize to myself for not seeing how that led to crossed boundaries and near burnout. I’m looking forward to being a better doula for you. Not for everyone, but for you and for me.

Which KY hospitals are allowing doulas?

Updated 04/24/23

Some of you have asked at which hospitals I can support births in person along with a partner, so I will plan to keep the updated list here. Of course, I can attend any Kentucky home birth in person and will happily do so as long as you’re okay with me wearing a mask and you are not COVID positive; I am also unable to attend hospital births if you are COVID positive. I am fully vaccinated and boosted against COVID-19 (Moderna). The following list is not extensive and only includes the hospitals at which I have attended births during the pandemic:

Baptist Health Lexington - “Visitors are limited to 2 per patient and may not rotate. 1 visitor may stay overnight. They are encouraged to remain for the entire stay and wear a mask in the room with mom and baby. Doulas count towards visitor count.” Doulas are not permitted in the OR or in recovery for Cesarean births.

Clark Regional (Winchester) - “No children under the age of 14 are allowed to visit the unit unless they are a sibling of the baby being born. Children under the age of 14 (even siblings) are not allowed to attend the actual delivery. Siblings count as a visitor and need to be accompanied by a responsible adult at all times (other than the birthing person).”

Ephraim McDowell Regional - “One overnight birth support person and two visitors who may not rotate. Total of three visitors during this time. Doulas are considered part of the visitor count. Exceptions may be made on a case-by-case basis with the care delivery team.”

Frankfort Regional Medical Center - “Our women's health department is open from noon to 8:30pm. The mother’s partner or support person may visit at any time. Children under the age of 10 are not allowed, except for the children of the patient.”

Norton Women’s and Children’s (Louisville) - “Two visitors at a time, 24/7. During labor and delivery, a properly credentialed doula also may be present as part of the care team.”

Saint Joseph East Women’s Hospital - three visitors (when in active labor, otherwise one) + a doula

UK HealthCare - three visitors + a doula

Kentucky home birth - partner(s) + a doula

2019 Reviewed

While a 19th baby could sneak in before year’s end, I know that the family would be perfectly fine waiting until 2020 for their newest family member, so I am going to share my stats for this year:

18 births (17 live births, 1 stillbirth)

First set of twins!

17 hospital births, 1 home birth

16 vaginal, 2 Cesarean (1 scheduled for breech, 1 unplanned)

10 unmedicated, 8 epidurals

9 inductions

9 with certified nurse midwives, 9 with OBs or family practice doctors

Smallest baby: 5 lbs, 12 ozs

Biggest baby: 9 lbs, 6 ozs

Shortest labor support time: 3.5 hrs

Longest labor support time: 36 hrs

Average labor support time: 15 hrs

Longest gestation: 41 weeks + 5 days (induction)

First birth: 14

Second birth: 4

Location of births: Baptist Health Lexington 7, UK 6, Clark Memorial 1, Ephraim McDowell Fort Logan 1, Norton Women’s & Children’s 1, St. Joe’s East 1, Home 1

Baby’s sex: 12 females, 6 males

Most common first name initial: M (3)

Most common middle name initial: E (3)

2019 was my busiest and hardest year yet, for some reasons that I will share and others that I choose to keep private. 50% of my clients had their labors induced. I do not know what the average rate for inductions is at most of the practices that were included in this stat, but this felt very high. Some of the inductions were medically indicated and others were elective or for “squishy” reasons as one of my doula friends dubbed them. To me, “squishy” ones are where the provider gives reasons that one might want to induce, but they are sometimes not evidence based and may come with the additional pressure of fear/scare tactics. Again, that is my interpretation and perspective as a doula who has seen 22 different care providers deliver/catch babies. Inductions can be hard for a number of reasons, but one that often surprises people is how long they can take. My record setting labor support of 36 hours was at an induction.

Another reason that the year was hard was that I witnessed coercion and scare tactics from providers. Coercion is crushing to bear witness to and then difficult to untangle the events and emotions that come after it. I am good at helping clients navigate coercive behavior, but it’s not easy.

Was that too heavy? Okay. 2019 had some wonderful highlights. As the backup doula, I supported my first twin birth! For continuing education, I learned how to use a TENS unit in labor, went to the first ever Evidence Based Birth conference, and had a mentorship with Domino Kirke-Badgley, one of the founders of Carriage House Birth. I also became a certified birth doula through Carriage House Birth. One of the highlights in the birth room was seeing a hospital provider be almost completely hands off with a client (like I would see with a home birth midwife) and watch a partner catch his baby girl.

I’m looking forward to next year as I will have my first repeat clients! I am already more than halfway booked for 2020 as I am taking a limited number of clients, so if you’re interested in hiring me as your doula, now’s the time to connect! Thank you to the wonderful families that allowed me to support them in 2019 and to the people who supported me so that I could be at my best for them.

The Ideal Doula Client

As more doulas start practicing in the Lexington, KY, area, it makes my doula heart warm to know that there are going to be more ideal doula + client pairings. In a previous blog post, I talked about finding the right doula, so in this post I want to share what my ideal client looks like. First, here are some of the things that I do not take into consideration when deciding if I want to work with someone. It is incredibly important to me to serve all people, regardless of their race, color, national or ethnic origin, age, religion, disability, sex, sexual orientation, or gender identity and expression. You’re a pregnant human being who wants to explore birth doula services? Let’s talk.

Some people assume that I prefer to work with home birth clients using a midwife. Not true. As long as you’re comfortable in the environment, I am equally content to work at a home or hospital birth, with a midwife, OB, or family practice doctor. Another common misconception is that I’m only helpful as a birth doula if someone wants a “natural” or unmedicated birth. If your preference is to get an epidural (stat!) or you know that you’re going to have a Cesarean birth, I’m as helpful and supportive as I would be to someone wanting to labor and birth without pain medication.

I have had successful doula + client relationships with such a variety of people that I’ve learned to be really open to the type of person or couple that I will work with. One factor that does seem to help my relationship with a client is their relationship with the care provider. A client having trust in their provider typically results in a better birth experience for everyone involved. And as in most relationships, personality compatibility is important, too. I want to know that we’re going to feel comfortable sharing your intimate space and time together.

Are you my ideal client? Am I the right Lexington, KY, doula for you? Read my client testimonials and contact me to set up an in-person conversation so we can find out!

Why wouldn't you hire a doula?

What is holding you back from hiring a doula? I’d claim bias in saying that everyone in Central Kentucky should hire a birth doula, but given the improved outcomes for mom and baby from having continuous labor support, I feel confident in saying that choosing to hire a doula is an evidence based way to better your chances for a positive birth experience. So in all seriousness, I’m asking, why wouldn’t you hire a doula?

One reason I sometimes hear is that a doula is not in the budget. I’d like to tackle that in a few ways. The first would be to suggest that you make changes to your new baby budget to allow it. Is there something on your registry that you might be able to find used from an online mom’s group? I see popular, pricey baby gadgets like DockATots and mamaRoos posted in the Lexington, KY, Buy, Sell, Trade groups pretty often. Sometimes they’re barely used or brand new because not all newborns are hip to the fact that these sleep aids work for other babies. Or perhaps you can add birth doula services to your registry, or ask a few close friends to gift you a birth doula as their shower gift. I know that a lot of wedding registries now include money for experiences/honeymoons instead of the traditional kitchenware, so it’d be a concept familiar to a lot of people.

A second idea would be to contact me to see if we could come up with a payment plan or some other arrangement that would allow a birth doula to work for your family’s budget. There are also circumstances in which I am willing to work at a lower rate for families that cannot afford my services. And if I’m not able to meet your needs, I will gladly refer you to new or training doulas who may be able to offer lower rates than mine.

The third angle I’d like to tackle the money concern from is one of explaining the value of a doula. I think that some people don’t want to pay $300-1000 for a doula because they don’t know the value of birth doula services. If you haven’t already, you should check out the Evidence Based Birth article on doula support. Here’s part of their summary: “Evidence shows that continuous support can significantly decrease the risk of Cesareans, NICU admissions, Pitocin, and medications for pain relief. Labor support also increases satisfaction and the chance of a spontaneous vaginal birth. Although continuous support can also be offered by birth partners, midwives, nurses, or even some physicians, research has shown that with some outcomes, doulas have a stronger effect than other types of support persons. As such, doulas should be viewed by both parents and providers as a valuable, evidence-based member of the birth care team.”

What else might be holding you back from hiring a doula? I offer free in-person consultations if you’re interested in learning more about my services. During this time, I’d be eager to hear what other questions or concerns you (and/or your partner) have about hiring a birth doula. I want families in Lexington, KY, and the surrounding Central Kentucky region to hire doulas! Come at me with your “if, ands, and buts” and let me show you why you should choose About Birth for your Kentucky hospital or home birth.