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.

2020 Reviewed

21 births

15 hospital births, 6 home births

20 vaginal, 1 Cesarean

1 VBAC (vaginal birth after Cesarean)

14 unmedicated, 7 epidurals

9 inductions

15 with midwives, 6 with OBs

Smallest baby: 5 lbs, 9 ozs

Biggest baby: 9 lbs, 1 ozs

Shortest labor support time: 3.5 hrs

Longest labor support time: 34 hrs

Average labor support time: 13 hrs

Longest gestation: 41 weeks

First birth: 10

Second birth: 9 (6 repeat clients!)

Third birth: 1

Fourth birth: 1

Location of births: Baptist Health Lexington 1, UK 9, Ephraim McDowell Regional Medical Center 1, Frankfort Regional Medical Center 2, Norton Women’s & Children’s 1, St. Joe’s East 1, Home 6

Individual provider who caught the most of my clients’ babies: Sarah Hood, Home Sweet Home Midwifery Services (4 babies)

Practice whose providers caught the most of my clients’ babies: UK Midwife Clinic (7 babies)

Professional development: Became an NRP Provider (Neonatal Resuscitation Program) and started childbirth educator training with Birthing Advocacy Doula Trainings

2020 ended up being my busiest year yet. It started off beautifully, with my first repeat client giving birth at home (her first baby was born at a hospital) under the care of a midwife. Three more babies came before the pandemic, with one being born the week before everything started shutting down in KY. I had planned off call time in April due to a spring break trip (that got cancelled), so thankfully I was not dealing with the initial insanity caused by frequently changing hospital policies and had time to prepare for the possibility of supporting clients virtually. Thankfully, I was able to support ALL of my 21 clients in person. I had one client switch from hospital to home birth because of the pandemic, but others considered it.

My clients’ induction rate went down to 43% (9 of 21) after last year’s 50%. Not surprisingly, my longest continuous support time of 34 hours was at an induction. Even though I tell clients to expect inductions to last days, it’s hard to wrap your head and body around what that feels like until you’re in it; exhaustion is typically a huge factor in the process. Out of the nine inductions, there were only two that I would consider elective (although I don’t know that that is how they were labeled by the providers).

Some other stats that I want to highlight are that one of my clients had a VBAC (100%) and that six were born preterm (2) or early term (4). Both of the preterm births were originally planned home births, but transferred to hospital care- one for hypertension/preeclampsia and the other for imminent preterm birth at 35wks 1day. Not surprisingly, I had a COVID exposure at one birth (that I know of). The hospitals stopped rapid testing at some point and unfortunately, we found out that a client was positive two hours after baby was born. Thankfully, I did not get infected and the mom and her baby are healthy! Also, I had a Leap Day doula baby this year! He was born at 12:48am on February 29, 2020.

The year was hard for lots of reasons, but I feel that it was the one in which I’ve grown the most as a doula. It no longer feels difficult to share confidently about my value when talking to potential clients; I’m really good at doula work. Thank you to the providers and nurses who provided over-the-top excellent care to my clients during some seriously stressful times. Thank you to the six families that allowed me back into their birthing spaces this year and to the fifteen others who welcomed me for the first time. You all have provided some of the brightest moments of 2020!

Attracting doula clients that are unlike me

I’m not the doula for everyone, but I am the doula for a lot of you. I was looking back at birth data for my clients and thought, “I wonder how many of these people have ever or will ever cross paths? How many of these people would I have ever met or supported had it not been for doula work?” Not many was the answer to both, but especially the second question. I am not a social butterfly, so that’s a factor for sure, but also the majority of my clients have been so much different than me.

The reason that I attract such a varied population is because I know that your birth experience is not about me and everything that I do is in accordance to this belief. This is not to say that I have no beliefs, preferences, or personality of my own. I seek to be myself always.

Thank you to all of my previous (and future doula clients) who’ve shared pieces of themselves with me and trusted me with their stories and care. Our relationships have been examples of health and growth, where we both give and both take and both end up better because of them.

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.

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. 1 visitor may stay overnight.” A certified doula does not count as a visitor. Doulas are not permitted in the OR for a c-section and it is up to nurse if doula is allowed 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