“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 really know by going through it.  

Nevertheless, a mere 6% of birthing parents 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 with satisfaction, safety, and success when an experienced professional is there to guide, support, and encourage you.

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 2-3 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, balancing muscles in preparation for birth, making birth art, and 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 90 days
• 2 postpartum follow-ups, 1 hour each, 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.

*For families utilizing Medicaid or TRICARE for the payment of doula services, I will do my best to obtain a back-up doula, but may, unfortunately, be unable to guarantee one.  This is due to extra credentialing required by Medicaid and TRICARE for any backup doulas. Likewise, I may be unable to guarantee a back-up doula for families who negotiate a lower price for services with the Need-based Adjusted Payment (detailed on the bottom of my services page), due to the lower fees possibly not amounting to 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:

• Attending a comprehensive childbirth education course spanned over a minimum of 4 weeks.  I am happy to provide recommendations which can fit a range of budgets and schedules.  Generally, a class totaling 12 hours will suffice, if supplemented with cesarean birth education.**  
• Attending less comprehensive childbirth education courses (<12 hours and/or not spanned over time), supplemented with self study that I approve. Books, documentaries, podcasts or other sources of information may be used for self study.
• 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. Pick one of the following for cesarean birth education (optional for clients who are birth professionals):

• a previous experience birthing by cesarean, 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, with my approval of the content you study

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.

Insurance may pay for some or all of your investment in a doula. If you are insured by a Florida Medicaid plan or by TRICARE (military insurance), I will provide an alternative contract to reflect payment from your insurance company. If you have private insurance, check your benefits to see if a doula is a covered expense. I am willing to work with you as you seek reimbursement.

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 — hospital, birth center, or home — in Palm Beach County, Florida. I can be registered at any hospital that has implemented a doula credentialing process (yes, I’m a certified doula plus vaxxed and boosted against covid, though I totally respect you if you’re not).

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

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

I do not attend births in locations where there is an increased risk of my being too late to support you, due to distance, traffic, or your own history of precipitous birthing. I must especially limit which births I attend at West Boca Medical Center and at Lakeside Medical Center. If you have precipitous births in your history, I may be a good candidate to attend your birth at Good Samaritan Medical Center, St. Mary’s Medical Center, the HCA Florida JFK Hospitals, or out of hospital if it is within a ~10 mile distance of my home.

Do you have a preferred care provider?

The best provider for you — and the one I most prefer — is ultimately the doctor or midwife with whom you’ve built solid rapport and who holds your body, spirit, and faith with utmost respect.

Bonus points go to the providers who offer or suggest non-medicinal pain relievers (pools, massage, essential oils, etc), whole food based dietary recommendations, homeopathic and herbal supports, and complementary exercises and therapies (pelvic floor therapy, spinning babies, psychotherapy, hypnotherapy, chiropractic, and energy therapies like acupuncture, reiki, kinseiology, and healing touch).

That said, I generally recommend midwives, unless you have a high risk pregnancy. Midwives seem more adept at preventing cesarean sections than physicians. In our initial consult, I can provide a list of favorite midwives in the Palm Beach area if you would like a referral.

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 low risk 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. Two which succeed at this are:

• Good Samaritan Medical Center in West Palm Beach, and
• Boca Raton Regional Hospital in Boca Raton

Ultimately though, 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 most low-risk parents, and transfer to the hospital is always an option in these cases. Out of hospital providers carry hemorrhage stopping medications, oxygen, stitches, resuscitation equipment to your birth, and usually parents gain more freedom and comfort by staying home or going to a birth center.

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 at the birth?

Friends and relatives can be amazing anchor points to you during labor. On the flip side, they have much to lose if any emergency arises in your birth, and rightfully should be emotional in such an instance.

I complement the support your dear ones provide by bringing expertise and a more neutral perspective. Having obtained substantial education specific to childbirth, and having worked as a doula since 2015 (plus having birthed four times personally), I bring a mature understanding of what language and actions are most helpful to the birthing mother, and am up to date on what evidence based research has to say at each juncture where you may have decisions to make.

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 prior to your expedition?  No.  A climb like Everest requires skilled guidance and the summiting of smaller peaks first.  Birth is much the same.  When you hire me, you have your sherpa.  You still need your training and preparation.  

Trust me on this — knowledge and practice gained from comprehensive childbirth classes are powerful. No matter which childbirth class they signed up for, my clients who have had the most positive experiences in birth tend to be the ones who invested their time prenatally preparing for this. They listened to their Hypnobirthing tracks on repeat, did their Bradley method prescribed exercises, or engaged their partners in practicing various positions and breath work they learned from Lamaze. I share these only as examples — not to limit you to these three childbirth education programs.

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 inconvenience required to be briefed on what to expect in any emergency surgical birth. Cesarean education may be able to prevent PTSD in mothers who are required to have one, and can give you perspective which may empower you to make choices you otherwise may not realize you have. Unfortunately, it is rare for physicians to invite doulas into the operating room (unless the spouse or partner is not present or willing to go in), so before any emergency happens is the only time I have to share relevant information with you. Though some theorize that by thinking about unwanted 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.

What do you think of unassisted childbirth? Would you support me if I want a “free birth”?

Giving birth freely and naturally, guided by your own brilliant instincts, wherever you prefer and with only those you trust — this is a beautiful thing indeed! You can read more of my thoughts on free birth in this book review.

I do attend unassisted births, with some exceptions. When I attend a planned free birth, I expect my clients to have done their homework, prepared back up plans for certain emergencies, and taken good care of themselves throughout pregnancy. I do not attend planned unassisted births for mothers who use unprescribed illicit drugs or who heavily drink alcohol, nor do I attend any home births where there is indoor smoking. In situations where you have received indication that your baby may be on a path to demise or where you have received indication that your own health may be in jeopardy — due to preeclampsia, unmanaged gestational diabetes, growth restriction, prior hemorrhage after birth, or any other potentially life-threatening condition for yourself or your baby — I attend planned free births only under the condition that you also have a contract for a licensed medical provider to be on your premises during the birth, and that the provider is aware of your medical history. Due to circumstances beyond my control, if you are using The Doula Network (TDN) to have medicaid pay for my services, you also must have a midwife or physician present at the birth.

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?

Possibly. Check the details of your policy.

HSAs and FSAs typically allow doula fees to be paid with your HSA/FSA card.

With private insurance, expect to get a “letter of medical necessity” from your care provider, and make multiple attempts to seek reimbursement, which may not cover the entire fee. Unlike doctors and midwives, I do not at this time directly bill your insurance company.

If you have medicaid, you are in luck. Since 2018, Florida has mandated that medicaid cover the expense of a birth doula. To facilitate my participation with and payment from medicaid, I use The Doula Network (TDN). If you have medicaid, go to their website menu and click “Request A Doula,” where you will see an intake form to fill out. Where the form asks for your “Preferred or Primary Doula,” enter my name, Christine Frackelton.

Will you barter or trade?

Bartering can be a win-win alternative to traditional transactions, and under certain conditions (only when I truly want or need your services or products), I am willing to allow bartering to cover a significant portion of the fee. The $400 deposit is not negotiable, however. I also require your services to be completed and/or goods to be completely supplied by 37 weeks gestation, and will modify my contract to reflect the terms of our bartering. The contract must be signed by you and two credible unrelated witness, and notarized. 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, however, I reserve volunteered birth doula services 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.