I came into doula work shortly after the birth of my first son who was a #borderbaby. I was one of the few Alabama woman who choose to birth across the state line to Tennessee to receive care from a Certified Professional Midwife (CPM) and have an out-of-hospital (OOH) birth. This choice was easy for us to make but an uncommon one at the time.
Prior to 2017, Alabama was the only state where the only option was hospital birth. When I went for my first labor doula training, the majority of it was focused on that setting. From my personal experience, I had a bit more knowledge about attending home births as a doula but really had to help my Alabama peers understand what the job could entail!
However, times are changing in Alabama! The Childbirth Freedom Act of 2017 decriminalized the practice of Certified Professional Midwives and established a state licensing board! We have had several more inquiries regarding home births and are excited about the home birth community to grow in our state. We are eager and excited to have CPMs back in Alabama!
So, what does that look like for an Alabama doula? Or if you have only attended hospital births, what are the major differences? While our support is the same despite the setting, there are some ways of altering your practice to be sure your home birth client has the best birth possible.
Discuss your clients’ intentions – There are many reasons why a woman may choose to have a home birth. She may have had a negative birth experience in the past, may be looking for alternative birthing options such as a water birth or a vaginal birth after cesarean (VBAC), or just wants the benefits of the midwifery model of care. Help her process her intentions and provide resources if needed.
Meet the Midwife – Just as you may typically offer with a client in the obstetric setting, you as her doula may choose to offer to attend a prenatal appointment with your client. This is a great time to encourage your client to discuss and birth wishes and hear the Midwife’s responses to see if they align with what your client desires. If you haven’t worked with this Midwife in the past, be sure your questions are answered as well such as if they have worked with doulas and what are the tools doulas have that they think benefit their clients the most.
Go to her home– Going to her home is very important part in your client’s preparations. In the hospital setting, you may know where to park, where towels are, where to set up a birthing tub, etc. Be sure you know where the items are for her birth. Ask where she would like baby to be born and if she is planning a water birth, check her water hookup to be sure you have the tools you need to take care of that. I also like to know where additional linens are and to take a good look at the kitchen so I don’t have to be opening and closing cabinets while she’s laboring. Figure out the quickest route to her home and know where you need to block where you will not be blocking anyone else’s vehicle.
Always make a Plan B – With any birth, plans can always change. For me, I prefer to make one prenatal to go over to her home and to the preparation for her home birth. During that same visit we then discuss what her options are in case of a transfer or if towards the end of her pregnancy she has to be transferred to other care. This is a difficult conversation at times because woman sometimes don’t want to consider the “what’s ifs” but I personally find it helpful to have those issues discussed and decided on so you can be more available for emotional support if a change is taking place. If a change has to take place you don’t have to play 20 questions to get it resolved but can hold space for her and be present during what can be a difficult time.
Supporting after the birth – Postpartum care can look pretty similar. I find that I typically stay longer after the birth at home versus a hospital birth. There are sometimes a few extra things you can do for your client to help her get settled. Breastfeeding support after birth is what we always do but helping her get the food and drinks she needs, tidying up, taking out trash, getting her bed ready for her to rest, and helping her get cleaned off are some other tasks that may help your client. You can also ask the midwife if you can assist taking items to her car for her or what she needs an extra hand with but remember who you are working for and your scope. We can always help the care provider but we do not step in a do anything medical.
Overall, thinking through your services for a homebirth client is key. Definitely process your options and practice before attending your first home birth as a labor doula. If you have any specific questions or concerns, reach out to your CAPPA Labor Doula Trainer or the CAPPA Connections Facebook group for additional support. Please refer to these additional resources as well as I believe the wisdom from them, especially the late Terri Woods, can help you process if home birth is right for you in your doula practice and the type of skills to implement as you serve your clients.
Resources, links, and other great info:
- Happy Home Birth Helpful Doula Tips, Terri Woods, CLD
- Childbirth Connection, Choosing a Caregiver
- Midwifery Today, The Home Birth Choice
- Midwives’ Model of Care
- Citizens for Midwifery, Doulas and Homebirth
- Waterbirth.org – Website for Waterbirth International
- Evidence on the Safety of Water Birth, from Evidence Based Birth
- Immersion in Water During Labor and Delivery – ACOG Committee Opinion
- Why Pediatricians Fear Waterbirth – Barbara Harper Reviews the Research on Waterbirth Safety, for ScienceandSensibility.com
- Birth, Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth, by Barbara Harper for the Journal of Perinatal Education
- Fetus ejection reflex and the art of midwifery, by Michel Odent
- Incredible moment Lisa Marie Sanchez Oxenham Baby Birth (Video of waterbirth that went viral)
- Gentle Birth Choices, book by Barbara Harper
- ICAN-online.org – International Cesarean Awareness Network
- Vbacfacts.com- information for the risk and benefits of Vaginal Birth After Cesarean
- Won’t Somebody Please Hear Me?: I Am Happy I Have a Healthy Baby, It’s The Rest Of It That Sucked, book by Dr. Pauline Dillard
CLD, CAPPA Faculty
Katie Terry has been a Certified Labor Doula in the north Alabama area since 2013. She became a labor doula after having a “home away from home birth” with a Certified Professional Midwife in Tennessee. She knew if it weren’t for the positive information and resources provided to her by women in her community, including her mother, she would not have had that experience. She then wanted to do the same for mothers and families in the area for whatever birth experience they desire. Katie is Owner of The Shoals Doula Group and has mentored 5 other doulas in becoming Certified Labor Doulas as well. She became faculty with CAPPA in 2017 and plans to start Labor Doula Trainings in early 2018. She is a board member of the Alabama Birth Coalition and is actively involved with the community through La Leche League, ICAN, and Babywearers of the Shoals. Katie and her husband Jeremy live in Florence, AL with their two boys and are expecting a new addition April of 2018. They love cheering on their alma mater (Roar Lions!) and serving the community with their Redeemer Church of the Shoals family.