Birth Companions: Perspectives on Doulas and Nurse Midwives in ASL and English

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The Appointment Jerri and Rania greet each other and Jerri offers to describe what she does. She says she is a birth doula and explains the origins of the word and what’s involved in a doula’s services. She will meet with a mom to find out what kind of birth experience she wants, give her information and explain how she is there to support the mom during the labor, delivery and after the baby is born. Rania asks how long Jerri has been a doula, Jerri replies that she was trained in 2001. She was trained in natural birth by a midwife. She learned how to provide comfort and support during the birth process, how to teach mothers to nurse, and how to provide support for the first 8 weeks after the birth. Her goal is to have the mom get as much rest as possible, so she can go into the home and provide the support necessary to help that happen, whether it be by taking care of the baby, other kids in the house or even cooking. Rania asks if her services are limited to 8 weeks and Jerri explains that she still has contact with some moms three years later and does some babysitting for them (in her home), provides them health and wellness information (although she’s not a doctor) and whatever support they need to help make good decisions. Back to more ASL Appointment

Rania asks if Jerri is certified and Jerri says she has the paperwork completed and ready to send in. Rania goes on to say how she’s been working with a midwife because she prefers the natural approach and likes the female to female connection, but was not clear on the difference between what a midwife and a doula did but understands more now.

Jerri says that although some of what she does is similar to a midwife, she does not actually deliver the baby. Instead, her focus is on providing emotional support and encouragement the mom through the process, keeping her informed about what’s happening during a natural childbirth and sharing what knowledge she has. Rania asks if that includes things like helping her decide about medication or epidurals and Jerri says she mostly is there to provide honest information about the choices the mom has and the mom makes the decision. Also, the doula will have a discussion with the mom before the birth to find out what she want. Some moms want a “natural” childbirth, but Jerri has to make sure to understand exactly what the mother envisions or means.

Rania asks Jerri to clarify if a natural childbirth means the absence of drugs and Jerri adds that it also means no interference in the natural birthing process such as inducing labor or using forceps to deliver the baby. Rania says she is hoping for a natural childbirth but understands that there can be complications and she needs to be a little flexible. She still has a lot of confusion about the possible medications and drugs that might be needed. She does not want an epidural except as a last resort. She wonders if Jerri can help her understand all the medications and possible consequences should she need them and be to overwhelmed to make decisions during labor. Jerri explains that she is there to offer encouragement and support that allows the mom to focus and studies show that that kind of emotional support leads to less use of drugs during labor and delivery. She says that she can help the mom keep from becoming overwhelmed by labor. She can offer back massages, refer to the birth plan if a mom is tempted to use a drug, help the mom shift position as an alternate way to work through pain, and so on. She sometimes rocks the mom through contractions, using the natural rhythm of the body to determine a pace.

Rania says she’d prefer using perineal massage and not have an episiotomy. She wonders about the risks of tearing if she refuses an episiotomy Jerri explains how the vaginal opening naturally stretches to accommodate the child and that position sometimes can make a difference in how easily the tissue stretches. Rania says she’s looked at some of the birthing positions and has some confusion about which ones are best. Jerri says that many women adjust positions naturally by following their bodies instincts. In fact, the typical position with the woman on her back is one makes the delivery harder, although it’s easier for the doctor and that’s why it’s used. She reminds Rania that it’s the mother that delivers, not the doctor, so the mother should guide the birthing process and positions. Rania wonders if some of the alternate positions might she read about might be more difficult to deliver in but realizes that they probably aren’t. Jerri says that some of the squatting positions are better because is allows the tail bone to move out of the way so there’s more room and Rania adds that it also works with gravity to help ease the process as well.

Rania asks what Jerri does when she meets with the moms and what the meeting is about. Jerri gives examples of a mom she met with long before the birth (it was the second time she’d worked with her) and one she met with just two weeks before the birth. She was hard pressed with the latter one because she didn’t have a lot of time to talk about a birth plan. In fact the woman called her just 4 days after they met and said she was ready to deliver, but it worked out okay. So it depends on the mother’s motivation and what kind of support she needs.

Rania explains that she already has two women working as her coaches and she wonders what Jerri’s role would be in that case. Jerri asks about their training and Rania explains they are not trained. One of the women is prepared to give her massage or support but it seems that that is the same thing a doula does and maybe she doesn’t need a coach. Jerri says it depends on the relationship Rania has with the coach. Jerri could serve as support to the coach, offering suggestions, helping her provide support and care to Rania. She can relieve the coach if necessary. In addition, Jerri works to make sure there are no “threats” to the birthing environment. She gives an example of someone ordering pizza and that having a negative effect on the mother. In that case, Jerri would intervene to ask the person to take the food out. Rania says she knows that she’s working with a lot of hearing people who may not know anything about Deaf people and thinks it would be nice to have someone to make sure the experience is positive and help smooth out the process.

Rania asks what Jerri would be doing during the actual delivery and Jerri gives an example of how one woman was feeling a strong urge to push, but was being told not to by the medical staff. Jerri stepped in and told the woman to do what her body said and the baby came out fine. It was good she did because the cord was wrapped around the baby’s neck, but the baby is doing fine. So she feels she is there to minimize any outside interference with the natural progress of the birth. Rania asks if Jerri monitors the dilation and lets the staff know when the mom is ready to give birth and Jerri reiterates that she tries to avoid doing anything that dictates the process to the mom. Instead she tries to encourage the mom to follow her bodies instincts as labor progresses. She can go get help if it’s needed but she really tries not to tell the mom what to do and instead just provide encouragement for the mom’s natural process.

Rania then asks about fees. She knows doula tend not to be covered by insurance, so she was wondering about the cost range for the service. Jerri first notes that due to a recent case, some insurance may cover the services of a doula. Then she explains that she works through an agency that pays her around $400 for each mom she serves. If she works with a mom independently it would be around $500. The overall range for doula services seems to be between $300 to $800. Rania asks if that flat rate covers all services before, during and after the birth. Jerri responds that she tends to get paid after the birth although some doulas want partial payment before to be compensated for any work they do with the mom before the birth in case the mother changes her mind about the service later. Rania asks if Jerri has a contract of some kind that they sign and Jerri says some doulas do have a contract they sign with the moms that outlines the roles of both people, the fees, etc. Rania says she read there are doulas that focus only on prenatal services and those that focus only on post-natal services and wonders if they have different kinds of fees. Jerri says she’s not sure. She knows there are some doulas that only focus on one area but some that do both, including her. Rania confirms that Jerri’s fee would include both pre and post-natal services. Rania asks if she would qualify for the program Jerri works for (and they both struggle to remember the exact name of the program). Jerri asks if Rania lives in St. Paul and Rania says she does. Jerri says that the program will pay for her services.

Rania says she’s a single mom and asks if she has to apply. Jerri explains the process: first Rania signs a release of information so Jerri can let the program know she’s providing service. Then Jerri keeps track of her visits and work with Rania. After the delivery, Rania signs a form verifying that Jerri was present and Jerri collects some data on the outcomes for the program. Rania clarifies if she needs to apply and be approved and Jerri says she does not.

Rania says she’d be interested in working with Jerri, particularly because she doesn’t know of other doulas who can sign or are Deaf. She says she feels comfortable with Jerri and would like to exchange contact information so they can work together. Jerri agrees and they wrap up their meeting.

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