doula

Free doula support? It's coming!

Last week a major announcement reached Canadian doulas. Sun Life, the #1 insurance provider in Canada, approved the use of doulas as a reimbursable service to clients. This is a huge step forward in the red tape to get doulas covered through third party reimbursement.

What does this mean for you?

If you are currently covered through a Health Spending Account with Sun Life, you can apply to have my doula support services covered, either partially or fully. As the process and coverage can vary between employers, this will be dealt with by Sun Life on an individual basis. The only doulas who have been approved for this coverage are DONA-approved, so if you are thinking of going with a doula other than myself, please check to confirm their certification and current membership with DONA by going to dona.org.

What if I'm covered by a different plan or company?

At this point, members of DONA's third party reimbursement committee have been successful with Sun Life. However, they will be working with the other large insurance providers across Canada, and with any luck, other providers will soon provide coverage as well.

Can I apply retroactively for previous doula services?

It's doubtful, but I would recommend sending in any invoices for previously paid doula services in to your insurance company - you never know! The more claims that are processed (or even just sent it) to extended health plans, the more likely these companies are to agree to third party reimbursement in the near future. But do make sure that your doula is a DONA-approved birth or postpartum doula first.

Twenty years ago, midwives became a regulated profession in the province of Ontario, offering women the chance to birth out of hospital, with continuity of care, and informed choices. When we hear that professional doula services are beginning to offer third party reimbursement, it seems like a similar path is taking shape. A doula should be available to every woman and every birth, regardless of income or social status. While we still have a long way to go, this is definitely a step in the right direction!

 

 

Early Labour - What is it? How does a doula help?

Of all the potential benefits to having a doula support you through your labour and baby's birth, one of my favourite reasons can be summed up in two words: early labour. It's an idea that seems easy to understand, but I like unpacking it for my clients, to really give a full idea of how I can help, and why that will become so important for them later on.

Labour and birth are divided into three stages: the first stage, during which your uterus contracts and your cervix dilates, is made up of a few sections (this is where it can get a little bit confusing). Early labour occurs during the first part of the first stage, when the rushes (contractions) are just beginning, and you may or may not feel discomfort or pain. The latter parts of the first stage are active labour, transition, and complete, but they are topics for another day.

What's important to remember, from a doula's support perspective, is that early labour is the only time when you will likely not be offered hands-on support or guidance. Hospitals will admit women when they reach active labour, which is confirmed by a vaginal exam that shows 3-4cm dilation, and midwives will come to a home birth at the same time. While this system is great for offering support at the time that active labour gets into full swing, it means that a labouring woman is on her own for, on average, 6-12 hours before she can benefit from the help of someone who is comfortable and skilled in providing comfort measures and knowledge of labour.

I point this out to clients because I believe that those hours of early labour are an important time: your body is learning how to work with the contractions, and the hormones that will provide relief and progress are beginning to work on your body. It is an excellent time to rest, though the excitement of seeing your baby very soon can make it difficult for some moms. 

As a doula, I arrive to provide hands-on support throughout early labour. In fact, I have yet to attend a birth where I wasn't needed until active labour, which suggests the real need that most labouring moms have for support during this crucial time. I think that when women feel supported, comfortable, and in control during these hours, they manage well as labour progresses to its more intense moments. I can only say this anecdotally, of course, but studies looking into the effects of continuous support by a doula reach similar conclusions. 

I love that I get to be with my clients, often one-on-one, during this time. Whether it's using massage, or watching a funny movie together, it's easy to relax into the labour when you have both physical support, and the knowledge that a doula brings to reassure you that everything is going well. Starting your labour out right means passing through early labour as comfortable and relaxed as you can manage, and it's a wonderful time to feel the effects of a doula's presence. 

 

 

On Midwives, Doulas, and "the System"

Yesterday I linked to an article originally posted to the Positive Birth Movement website, and written by a former NHS midwife. The National Health Service, the UK's universal health care system, has long been considered a model of midwifery care to imitate the world over, because of its approach to childbirth. As you might guess, the UK never lost its connection to women assisting other women during labour, and as the medicalization of childbirth occured, midwives remained an important part of maternity care.

The author of the piece, however, was disenchanted with the system that she had become a part of. I won't paraphase the entire thing, but it certainly gives the impression, as she points out, that midwives are becoming more akin to our own understanding of labour and delivery nurses than autonomous care providers for low risk women. 

This got me thinking about our own midwifery model, so recently revitalized in Ontario. Demand far outpaces the number of available midwives to attend births in the province; at one point there were estimates that one in three women requesting a midwife would not find one. The US has a different system for midwives, that also seems more akin to nursing at times, as many professional midwives train first as nurses. Here, midwifery is a complete university degree, separate from nursing, and even from the standard hospital as teaching centre, which makes it quite unique. 

We can't know how our system might be different if we hadn't lost touch with our midwifery model during the 20th century. But it's interesting to see how rebuilding that level of care from the ground up has led to a standard of care that encompasses all aspects of pregnancy, labour, birth, and the postpartum period for mothers, and a low intervention rate for babies. And with the impending opening of Toronto's first Birth Centre, I think we have a lot to look forward to as we grow into a model of care for birthing women that embraces the normalcy of the childbearing year as a life event.

The author of the original piece ultimately decided to abandon her role as a midwife in favour of becoming a doula and holistic childbirth educator, feeling that these roles were closer to what she had envisioned her job to be. It seems like the track we are on here in Toronto, as well as the province, is a system that respects the hospital standard of care for emergencies, but that is giving women the confidence to birth their children as they choose, whether that is in their homes, a birth centre, or a hospital, under the guidance of midwives who are there to support and guide, rather than to direct the progress of a birth.

What has been your experience with the midwifery model of care? Where and under whose care would you feel most comfortable giving birth? 

And Baby Makes Four? Having a Doula for your Second Birth

I'm often in conversation with moms. On the playground, at the library, or at a music class, and when my status as a doula is mentioned, I get such a varied response on women's experiences with having a doula. Some swear that they couldn't have done without one, and will again for another labour, while others say they had one for the 'unknown' aspects of birth, but feel capable of going at it alone for any subsequent children. I'm impressed by the moms who are confident enough in themselves to fearlessly consider their next birth. Whether it's because they managed to have the birth they envisioned, or that there was no unnecessary intervention to change their opinion, having a strong sense of positivity surrounding your second (or third) birth can have a huge impact on your overall experience.

However, today I feel in the mood to champion the case of having a doula at your birth, even if it's not your first time having a baby. Relatives are found of telling families pregnant with their second child that this next baby will be the antithesis of the first one, that "no two children are ever the same." And we acknowledge the truth of their words most often. Parents whose first child was extra sensitive and often needing to be held find that their second child is strong-willed and independent. Those whose first babies were good natured and easy to soothe find that their second baby is the one that always needs another song, or an specific routine to calm them.

It turns out that, like children, no two births are ever the same. Women find early in their pregnancies that the symptoms of carrying a second child can be very different from their first, and that even the way they carry the baby feels new. And given the fact that a mom planning for a second baby most likely has a busy toddler in tow, it stands to reason that a doula's expertise may help lessen the load that a woman has to shoulder as she becomes a new(again) mother to a newborn.

As a doula, I see births regularly, and have yet to see two that were alike. Even if you feel like a seasoned pro by the time your due date with your second baby rolls around, consider how a doula can enhance your birth experience a second time around.

We can:

- provide prenatal support tailored to your needs, including breastfeeding children of different ages

- offer age-appropriate teaching tools for your toddler or child to welcome their new sibling

- network with other local birth professionals and resources you may need, including postpartum support or childcare

- focus entirely on your needs throughout your labour and birth

- assist your partner in supporting you through a new birth experience

- support early breastfeeding and bonding

- increase postpartum visits, and include childcare within the scope of postnatal support, giving you time to nurture yourself and your new baby

Parents are quick to point out the differences between having one child, and having two. Fewer photos, less one-on-one time, the harried schedule of a newborn and a child - it seems so easy to say that you've been there and done that. But I've also heard many moms say that they wish they had been offered more help the second time around. The excitement of having your first child is shared by your entire family and your circle of friends, neighbours, and coworkers. However, when you find yourself in the thick of new parenthood a second time around, often within three years of the first time, the lack of support can be a frustrating entry into the world of two (or more) children. Of course the excitement is still there; what isn't, sometimes, is the trays of home-cooked meals, and the offers to hold the baby while you shower and take a nap.

It's true - you have been there, and you've got the experience and all the baby gear to prove it. But investing in a doula for the birth of your next child is an easy way to steer this new direction of birth into a positive trend of parenting multiple children. The selfless attitude that has put your first child's needs before your own can sometimes make nurturing yourself seems like an indulgence. The simple truth is that moms who feel nurtured and taken care of themselves are often the best carers of their own children. When you've got a little one running around and another on the way, a doula can be a great way of meeting your unique needs and ensuring that your second birth and early postnatal weeks are calm and nurturing for your entire family.

Trial of Labor - a film about VBAC

I recently came across the film Trial of Labor. The work of Zimbabwean-born director Robert Humphreys, it follows a group of mothers preparing for the birth of the babies who share a common bond: each is attempting a vaginal birth after previously delivering by C-section. 

The film is not yet available for full download, but the lengthy trailer above gives a great sense of the women's struggles, and achievements, as they explore their previous births and plan for their next one. The issue of VBACs (Vaginal Birth after Cesarean) has become a hotbed of conversation in recent years, and the film's title captures that. A "trial of labo(u)r" is the medical definition of the finite time a mother may labour for in a hospital before intervention is deemed necessary. Increasingly, we are hearing about women being allowed these hours as a way of appeasing their desire for a natural birth. In many cases, the "trial" turns into a repeat cesarean. 

Of course, the key to improving VBAC rates is, as the trailer demonstrates, giving women the information and support they need to have a healthy and positive birth. If you are considering a VBAC, there are many great resources, including the International Cesarean Awareness Network (ICAN) , and the Ontario Midwives facts on VBACS.

Doulas, incidentally, can be a great support for you if you are considering a VBAC for your birth.  

For more clips from Trial of Labor, check out the film's Facebook page. They are also providing periodic updates, so stay tuned for a release date!