“The Birth Less Traveled” Doula Service

Two roads diverged in a wood, and I —

I took the one less traveled by,

And that has made all the difference. “

from the poem The Road Not Taken, by Robert Frost, 1916

Birth is guaranteed to be one of the most significant rites of passage in your life, and a wilderness you can only know by going through it.  

Nevertheless, a mere 6% of birthing mothers have a doula attend their labor, according to a 2013 Listening to Mothers national survey.  Why do these outliers choose to hire professional birth support?

It is much for the same reason that mountaineers hire sherpas to aid them on their summit to Everest — the expedition is more likely to end safely and successfully when a trained, professional sherpa is involved.

Research has found doulas to significantly reduce the incidence of:

  • cesarean sections and their unintended consequences (including longer recovery and additional risks in subsequent pregnancies)
  • instrumental births — vaccuum and forceps delivery — along with their unintended consequences (such as possible injury to baby)
  • medicinal pain relievers and their unintended consequences (more challenging start to breastfeeding, for instance), and
  • negative feelings about their birth experience.

Birth can be challenging, but you were made to get through this. The endorphin and oxytocin highs will be worth it! Oh, and that baby of course will be worth it!

With my warm heart, soft touch, and devotion to your family, you will have a reliable advocate and supporter, so you can travel through labor with poise.

What’s included

Before labor:

  • 1 hour complimentary consult in West Palm Beach
  • 4 hours of private prenatal meetings (typically 2 meetings). Prenatal meetings are customized to your needs and interests and may be used for any of the following; dialogue about your pregnancy and birth concerns, private breastfeeding and bonding class, drafting a birth and/or postpartum plan, practicing techniques for labor progress and comfort, creating birth art, balancing muscles in preparation for birth, preparing any older siblings for what they may witness and how they may provide age appropriate support
  • Access to a library of physical and digital resources
  • Unlimited support by phone and email

During & immediately after labor:

  • 24/7 phone support for questions, encouragement, and suggestions as soon as you think you may be in labor
  • Continuous* physical presence as soon as you decide you are ready for me to meet you at your location.  During my continuous presence, I will provide physical, emotional, and information support, as well as advocacy, as needed.
  • Guaranteed** back-up doula in the rare event that one is required
  • Photography of your labor and delivery on your own personal camera (I will first prioritize physically supporting you during labor, but often am physically free to take photographs)
  • Note-taking of memories and quotes from your labor
  • Exclusive 50% discount on rental fees for the AquaDoula birth pool and the BirthRite birth seat, with complimentary delivery, set up, and break down.
  • Postpartum and breastfeeding support for up to two hours immediately after the birth

Postpartum:

  • Unlimited support via phone, text, video calls, and email for the first 40 days
  • Optional 1.5 hour postpartum meeting in your home. This time can be used to debrief the birth experience, to receive breastfeeding support, to offer feedback on my service, and — time permitting — to take a shower or rest for a while as I take care of some basic household or baby care tasks.

*In rare circumstances when I am at a birth for an extended period of time, a back-up doula may be called in to trade places with me and bring fresh energy to your birth space.  This is a decision we will make together and only when necessary.  I have not yet exercised this option, but do want you aware that it is a possibility.

**For families utilizing the Need-based Adjusted Payment (NAP) scale (detailed on the bottom of my services page), I may, unfortunately, be unable to guarantee back-up doula coverage.  This is due to the lower cost paid for services, which may not be enough to cover a back-up doula’s fees.

What I expect from you

Commitment to Being Informed and Prepared

As of April 2019, I require all of my clients to obtain a comprehensive education in childbirth, as detailed below. Any of the following are acceptable fulfillments of this requirement:

  • Previous experience giving birth vaginally with no pain medications, supplemented with cesarean birth education (see note*** below for more details).
  • Attending a comprehensive childbirth education course.  My recommendations are here.  Generally, a class lasting 12+ hours and spanned over 4 or more weeks will suffice, if supplemented with cesarean birth education.***  Comprehensive childbirth classes completed during a previous pregnancy may be used to fulfill this requirement.
  • Attending less comprehensive childbirth education courses (<12 hours and/or not spanned over time), and supplementing with self study by books, documentaries, podcasts or other sources of information that I approve as adequate to fill in gaps from your childbirth education course.
  • Recent experience working as either a labor & delivery nurse or a doula
  • Being credentialed as a certified doula, childbirth educator, midwife, or OB/GYN

***No matter how low your individual risk is, birth by cesarean is always in the realm of possibility, especially in south Florida where the rate is higher than average. Therefore, please pick one of the following for cesarean birth education (optional for clients who are birth professionals):

  • a previous experience birthing by cesarean section, along with commitment to seeking appropriate therapy for any related trauma if relevant
  • a cesarean birth workshop, led by me
  • reading 3 chapters from Ancient Map for Modern Birth, by Pam England.  The subjects of these chapters are: (1) long and difficult labors, (2) informed consent, and (3) cesarean birth.
  • self study, per your request and on a case-by-case basis

Investment

$1850 is the total investment for “The Birth Less Traveled” Doula Service.

Repeat birth doula clients enjoy a 10% discount.

A minimum $400 deposit is required to reserve the service for your due date. Payment schedules will be customized to the client’s preferences and needs, but the final balance is expected by 37 weeks.

A sample payment schedule could look something like this: $400 paid at 20 weeks. $400 at 24 weeks. $400 at 28 weeks. $400 at 32 weeks. $250 at 36 weeks. Total paid = $1850.

Special rates are available in certain circumstances. Families with income under 215% Federal Poverty Level may apply for my Need-based Adjusted Payment (NAP). Expecting mothers who lack familial supporters due to death, incarceration, or health and disability issues can request volunteer services. Scroll to the payment & affordability questions at the bottom of the Q&A section on this page for more information.

Questions & Answers

I think you’re the doula I want!  What is next? Yay!  Get in touch with me by phone (561-827-3263) or email (tremendoulas@gmail.com) so I can check my availability and put your estimated date of delivery on my calendar!  I’ll send a copy of my contract to you, and we will plan our first get together to become better acquainted and prepared for your upcoming birth.

Where do you attend births? I attend births at almost any location in Palm Beach County, Florida.

Covid vaccination records and doula certification records are available for any location that requires these documents for me to attend your birth.

I only attend home births if there is no cigarette smoking indoors.

Outside of Palm Beach County, I accept clients on a case by case basis and charge an additional travel fee.

If I believe there is a strong probability that I will be unable to make it to your birth in a timely manner, I will not be able to accept you as a client. This may be due to a history of precipitous births, or due to a longer distance from my location (whether you’re within or outside of Palm Beach County). For this reason, I must especially limit which births I attend at West Boca Medical Center and at Lakeside Medical Center.

Do you have a preferred care provider? This will vary from one family to another. Unless you have a high risk pregnancy, I generally recommend midwives, who are much more adept at preventing cesarean sections than physicians (this matters since local c-section rates are way higher than national and global health targets). In our initial consult, I can provide a list of favorite midwives in the Palm Beach area if you would like a referral. Ultimately though, the best provider for you — and the one I most prefer — is the doctor or midwife with whom you’ve built solid rapport and who holds your body, spirit, and faith with utmost respect.

Undecided on your provider or location? I suggest reading these short articles for guidance — (1) Normal, Healthy Childbirth… What You Need to Know, and (2) 10 Questions to Ask.

Do you have a preferred hospital? For most mothers, a hospital with a lower cesarean rate and one that allows birth pools (if you want to consider hydrotherapy in labor) is my first choice. Good Samaritan Medical Center in West Palm Beach and Boca Raton Regional Hospital are two which have historically had lower cesarean rates compared to other local hospitals, and both allow laboring in water. That said, there are never guarantees; positive as well as negative birth experiences occur at all birth locations. Ultimately, your own gut feelings and sense of emotional safety are of utmost importance as you choose where to birth.

If you’re undecided on your birth location, these two articles are a helpful guide: (1) Normal, Healthy Childbirth… What You Need to Know, and (2) 10 Questions to Ask.

Keep in mind that birth centers and homes are safe alternatives to hospitals for many parents, and transfer to the hospital is always an option if the rare unanticipated needs for a blood bank or anesthesia arise. Hemorrhage stopping medications, oxygen, stitches, resuscitation equipment, and highly skilled hands are available in birth centers and homes just as they are in hospitals. If you would like to find out if you are a good candidate for an out-of-hospital birth, I can refer you to a provider who will be able to assess your risks.

What exactly do you do during a birth? Because every birth is different, my work is quite varied.  Here’s a sampling of how I may be working in a birth:

  • demonstrating a massage trick for your spouse or partner to try with you
  • wrapping a rebozo around your hips to try to shimmy your baby into a more favorable position.
  • performing the “hip squeeze” to release pressure
  • adding counter pressure at your back to relieve pressure
  • suggesting different positions that may aid with labor progress and comfort
  • obtaining beverages and nourishment for you and your partner
  • catching your losses if you become queasy (it happens)
  • offering some soothing peppermint essential oil to allay nausea
  • coaching you through resetting your breathing pattern when it would be helpful
  • sharing encouragement when times are tough
  • remaining by your side, if as a couple you decide a nap for your partner would make him or her more helpful to you
  • reminding you and your team of your birth plan when circumstances arise that seem to contradict your preferences
  • advocating — helping you and your partner have a strong voice and get the information you need to make any pertinent decisions
  • in a surgical birth during which your provider prohibits doulas in the operating room, I am praying for the safety of all on the other side
  • when privacy is desired, I may be found down the hall, chatting with extended family members and keeping them out of your personal space until you’re ready for them

How is having a doula different than having my mom, sister, or best friend present for the birth? Having obtained substantial and continuing education specific to childbirth and having worked as a doula since 2015 (plus having the experiences of birthing three children personally), I bring a mature understanding of what language and actions are most helpful to the birthing mother, and I am up to date on what evidence based research has to say at each juncture where you may have decisions to make. Because your friends and relatives have watched you grow up and have much to lose in the rare event of any emergency, they may not be at ease emotionally during your labor in the same way that I am.

Can’t my labor & delivery nurse or midwife act as my doula? Research suggests that the benefits of continuous physical support during labor are greatest when they come from a person who is not on the medical team.  Your medical professionals are responsible for medical record keeping and the needs of other patients who are laboring at the same time as you, and also have obligations to hospital administrators, state licensing boards, and insurance companies, all of which must be balanced with their responsibilities to you. As a doula, I have far fewer competing responsibilities and generally only accept 1 birth doula client per month, which helps me keep my focus on you.

Do I really have to take childbirth classes? Can’t you just teach me what I need to know? Do you think it is acceptable to merely hire a sherpa for your ascent up Mount Everest, and skip the experience of physical conditioning and summiting smaller peaks first?  No.  A climb like Everest requires skilled guidance and training.  Birth is much the same.  When you hire me, you have your sherpa.  You still need your training.  Trust me on this — knowledge and practice gained from comprehensive childbirth classes are powerful. My clients who have the most positive experiences in birth are the ones who invested their time prenatally preparing for this.  I refer out to other childbirth educators because I think very highly of some of the existing classes, and it would require much more time than the approximate 4 hours we have in our prenatal meetings if I were to teach you everything myself. However, you are always welcome to schedule additional prenatal meetings for $35 hour if you would like to spend extra time together preparing. 

I plan to have a natural birth, so why do I need cesarean education?  The potential benefits of cesarean education far outweigh the minimal time it can take to be briefed on what to expect in a surgical birth. I have observed women experiencing PTSD many years after their surprise cesarean births, and while I make no guarantees that prenatal cesarean education will prevent such a disorder, cesarean education is at least unlikely to be harmful.  Though some theorize that by thinking about negative outcomes you may predispose yourself to those outcomes, I prefer the stance that entertaining all possibilities helps you smartly conquer fears ahead of time so you can more freely surrender to the natural process of labor.

Would you support an unassisted birth (or “free birth”)? Generally, yes. Giving birth freely and naturally, guided by your own brilliant instincts, in your preferred location, with only your dearest supporters nearby — this is a beautiful thing indeed! I do have a few exceptions. These are: (1) I do not attend planned unassisted births for parents who have not prepared for the experience with adequate self study, self care, and childbirth education classes, and/or who do not have backup plans for risky situations (this we can discuss in more detail in person), (2) I do not attend planned unassisted births for parents who smoke inside their home, and/or who use illegal drugs, and/or who heavily drink alcohol; (3) if you have received any indication that your baby may be on a path to fetal demise, I will not attend a planned “free birth” unless you have a contract for a licensed medical provider to be on call and present; and (4) if you have received any indication that your own health may be in jeopardy — due to possible preeclampsia, gestational diabetes, history of hemorrhage after birth or any other potentially life-threatening condition — I will only attend a planned free birth if you also have a medical provider present.

Do you have a birth philosophy? Absolutely!  Feel free to read my convictions about birth here.

Will my insurance or HSA / FSA / HRA pay for this? Check the details of your policy. You may need to get a “letter of medical necessity” from your care provider, and likely will need to make multiple attempts to seek reimbursement. Unlike a medical provider, I do not at this time directly bill your insurance company, nor do I have preexisting relationships with health insurance providers at this time. Florida Medicaid is required to pay for doulas, and I am currently exploring the opportunity to become a Sunshine Health (FL Medicaid) provider to facilitate payment for clients with Medicaid. With an HSA/FSA, doula fees are generally covered, and the process may be as simple as swiping your HSA/FSA card.

Will you barter or trade? Maybe.  Assuming I am in a position to accept bartering opportunities and I truly want or need your services or products anyway, bartering can be an option to cover a significant portion of the fee. In bartering arrangements, I require your services to be completed and/or goods to be completely supplied by 37 weeks gestation, and also require an additional contract which must be signed and notarized in the presence of witnesses. Please expect me to ask for references and other evidence of your workmanship, professionalism, and quality if I am willing to entertain such an offer. 

What if the fees are out of my price range? Every now and then, I have the availability to volunteer for a pregnant person who wants a doula, however, I reserve volunteered birth doula service exclusively for those who lack familial supporters. Please feel welcome to ask me about my volunteer doula services if one or more of the following applies: you aged out of foster care, have become orphaned as an adult, are widowed, or have a spouse/partner, mother (grandmother-to-be), sister, or other very close female relative who is in residential/inpatient therapy, in hospice, incarcerated, or is otherwise unavailable. For those who do have close supporters, I am still sensitive to financial needs, and offer payment plans, gift certificates your friends can buy as baby shower gifts, as well as a Need-based Adjusted Payment (NAP) scale. In the NAP scale, my services are essentially partially volunteered and portions of the contract are modified to reflect different expectations. If in spite of these options you’re unable to make a financial commitment, you can ask me about the possibility of private prenatal meetings, during which I can help you and your birth partner prepare for the birth.

Tell me more about the Need-based Adjusted Pricing (NAP) scale. How do I qualify and apply? After our initial consult, pregnant families with low resources and income less than 250% federal poverty level are welcome to request a NAP application for birth doula services.  I do not currently offer NAP for other services.  I will require evidence of your income and any assets you hold, and will keep all financial information in confidence.  

The following are rough guidelines of what you may expect to pay for the birth doula service if you apply for NAP, based on your income as a percentage of the Federal Poverty Level (FPL) and evidence of low financial resources:

  • Income between 150%-250% FPL: $1200-1800
  • Income between 100-150% FPL: $900-$1200
  • Income at or below 100% FPL: $750-$900

If you are applying for NAP, please be aware of these important notes:

  • In the possible event that I am unable to attend your birth, I will make every attempt to obtain a backup doula for you, however, I can not make guarantees as I do for my full-price clients. Because backup doulas require fees from me, and because I am receiving a smaller fee from you, there may be insufficient funds to cover the cost of a back-up doula. Your contract will be modified to reflect this.
  • I have limited availability to accept NAP applicants as a clients. Please do not take offense or lose heart if you are not accepted as a client.  In such an instance, I will make referrals to any other doulas who may be able to meet your needs.

I have questions that aren’t answered here.  How do we get in touch? Email me at tremendoulas@gmail.com or call/text 561-827-3263 during daylight hours, Monday through Saturday.  When calling, please leave a message.

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