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.

How do I choose my care provider? Statistics, Opinions, or Intuition?

Recently, my doula friend, Mother Well Doula Services, held an amazing webinar on birth options in Central KY. It was so wonderful, in fact, that I am offering the replay to any client who wants more information before they choose their birth location/provider. If you’re in the process of making these choices, hospital statistics and “amenities” can be very helpful in informing your decision. There’s also a really good chance that your friends, or even complete strangers, have told you which providers they’d recommend (and maybe you’ve gotten their full birth stories ((unsolicited?)) as well). Maybe the stats and recs lead you to meet with a provider, or even consider them your chosen provider. You go to your first appointment and your gut is raising red flags, or maybe it’s saying that you are safe and heard. So, what do you do with all of this information? What do you listen to- statistics, opinions, or your intuition?

Honestly, it’s a question that I cannot answer without knowing A LOT more about you. In general, I’d say that all of them matter, but the one that deserves the most weight will depend on your individual needs and plans. As a doula mainly serving folks birthing in Lexington, KY, I have worked with a lot of professors from local universities and colleges, including UK, Centre College, Transylvania University, and Lindsey Wilson College. Some of these clients are very data-driven and pay close attention to the statistics. For these folks, it’s important to know a hospital’s numbers, and likely more important to know the numbers specific to their provider’s practice. Many of us are also influenced by our peers’ opinions. Spend 20 minutes in a parents’ group on Facebook, and you can probably gather as many provider recommendations. Then, there’s also the feeling you get when meeting with or looking into a certain practice or birth location. It’s a lot to process, especially if this is your first baby.

As of Monday, I have watched 30 different providers catch/deliver babies. I’ve been to all of the hospitals in Lexington, most in Central KY, and a couple in the Louisville area. I’ve also been to home births with three different professional midwives. So, I’ve seen what the statistics look like in person/action. I know the offerings of most local hospitals. I have a really solid sense of how the different practices operate and which providers are most in line with your desired birth experience. Maybe your friend says Dr. X is amazing or that Midwife Z is such a good listener, but to who are they comparing these providers? I cannot emphasize enough how valuable my experience with so many different hospitals, OBs, midwives, doctors, and nurses is to you when you choose me as your doula. While protecting specific client details, I promise to be transparent about what I have witnessed as a doula.

You’re likely to hear a lot of noise in terms of opinions when you’re pregnant. It’s rarely helpful and often causes you to question your own intuition. While there are certain professionals who are incredibly knowledgeable about the medical side of birth, or the statistics and evidence around birth, as a doula I have a broad perspective on birth experiences in Central KY. I also do my best as a professional to remain unbiased and provide information that is specific to you and your needs. I also feel best aligned with clients who are able to tune into their intuition about providers. You know better than anyone what is best for you, your baby, and your body. Did you feel rushed and ignored? Listen to that. Were you surprised that your blood pressure stayed normal and that you didn’t feel embarrassed asking all of the questions you put in your phone notes before you left home? Wow- that’s meaningful. I’m here to listen to you and provide unbiased informational support.

Every birth I’ve supported has been different in so many ways. Yours will be different from those. I hope to help you quiet outside noise (and even noise in your own brain) and help you focus on what is important to you. I don’t have a list of recommended birth locations or providers and would never blast a recommendation to the general public because everyone’s needs are different. Your situation is unique and I’m ready to support your decision making with unbiased informational support and active listening. I will never doubt that you know better than anyone what is best for you.

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.

Condescension and Dismissal in Pregnancy and Birth

Being a doula and someone who cares about the emotional, informational, and physical support a birthing person receives, so many of the Lexington, KY, moms’ group Facebook posts about pregnancy and birth light me up! Like right now, I’ve got that temples-about-to-burst feeling from reading through a post about how to manage discomfort in labor without an epidural. A couple commenters wrote that their providers reminded them that they wouldn’t receive a medal for unmedicated labor and that they should do what’s “easiest” and not try to be a superhero. The condescension in those remarks is repulsive.

The overused comment about a medal for forgoing pain medication does not even make sense and is demeaning to all birthing people. One choice doesn’t get some sort of reward that the other does not. Both are valid and can be the best option for any individual or situation.

Anyone who dismisses your preferences or belittles you for the decisions you make is not providing respectful care. In labor, as in every other moment of your life, it is your body. When you are pregnant or laboring, you don’t suddenly lose control over making informed decisions about yourself and your baby. 

A respectful provider should listen to and answer your questions. Yes, they know more about pregnancy and birth than you do. They study and train and practice their work for years. They can understand your medical history and determine your and your baby’s health. But what they are not is YOU. You are a unique human being with experience, values, and thoughts that they may not ask about or may not understand (or that you choose, for one reason or another, not to share). Expecting this level of care is not unreasonable and there are midwives, OBs, and family practice doctors in our area who provide it.

If your provider is demeaning or doesn’t take time to answer your questions, that’s likely the type of care you’ll receive during your labor and birth. And if a friend, family member, or stranger is going to make judgments about you based on your choice to receive pain medication, they’re probably not the ones to go to for advice or pregnancy support. I have seen firsthand how much the birth experience affects the emotional well-being of the birthing person and their family immediately postpartum and months/years afterwards. Please take time to create a birth team that will meet your needs and provide respectful, evidence based care. You are absolutely worth it.

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!