I’ve had a lot of folks ask me, ‘What does it mean when you’re on-call?’ Usually clients are curious what they’re paying for, or prospective Doulas are curious what it entails. Since I’m finally off call for the summer, I thought it would be a nice time to reflect on the experience!
Whether I’m on-call for a doula or Midwifery client, the call period begins when the client is at 37 weeks gestation and ends at birth.
When I am on-call, I am committing to make sure that I am not without phone service for any unreasonable about of time. In West Virginia this isn’t always easy. I can’t spend too much time at my favorite places in the forest or in Thomas without checking in with WiFi each hour. If I want to go for a hike in the woods this means leaving my cell phone with my husband where he can answer for me if a client calls, and assure them that I’ll be able to leave when I return.
When I am on-call, I am committing not to travel further than a few hours from my clients (typically not much further than I already). I need to stay close enough not to miss their birth. This means no trips to Pittsburgh to go to the zoo with my son (unless my client is in Morgantown) and abstaining from many other small adventures that we enjoy. I’m constantly googling the distance from where I am going to my client’s chosen birth place.
When I am on-call, I am committing to always having a back-up plan. Maybe my family takes two cars to a destination instead of one, maybe I’ve had to call around to make a plan for getting my husband and son home in case I need to leave for a birth, maybe I’ve made plans to get dropped at the hospital and get a taxi to a friend’s house whenever I’m done at the birth. I always tote around my birth bag, and maybe extra (more birth appropriate) shoes. I always have a few babysitters to call if my husband won’t be available, and I try to check in with them so they know the period in which I might need them.
When I’m on-call, I’m committing to check my phone before bed. I make sure it’s charged or plugged in, I make sure the ringer is on and turned up! I am desperately hoping I won’t sleep through a call and hoping that I can relax and sleep despite the worry. I turn it on vibrate during a movie and set it in my lap. I always have it in my pocket or within reach.
Here’s a special one for me: when I’m on-call, I’m committing to say no when my friends ask if I’d like to raft down the Cheat Canyon, or the Narrows, or the Dry Fork. Sometimes if a client’s birth place is close to the river I’m planning to paddle, and the run is short, and I’ve checked in with the client about it, and I take my phone in a waterproof case….then maybe I can go. I love rafting, particularly with my partner and son. It’s one of our favorite activities, but I’m willing to wait until my client has had their baby if necessary.
When I’m on-call, I’m committing to my clients above all other commitments. I tell everyone that I will leave when I am called: my family, my friends, my students, my co-workers. I am asking my family to adapt and change their plans at a moment’s notice.
To a lesser extent, this is even true for my encapsulation clients. I need to get to them within a few hours of birth to pick up the placenta so that it can be processed quickly.
So there it is: working births is amazing, but being on-call can be trying. I’m adapting my plans and habits to work around being available for clients, I’m spending extra money to bring two cars somewhere just in case, and I’m always thinking about how this might affect my plans. Maybe after reading this you’re thinking, ‘wow, this sounds really difficult’. It certainly can be, and that’s why I have a built in fee compensating me for being on-call. I guess the end message here is: appreciate what your doula or midwife is doing for you, even when you aren’t in labor yet!
After two births in a week, its time to re-stock my birth bag! So of course, I thought it was blog worthy.
What is a birth bag, you may ask. This is the bag I have with me at all times when I am on call for a birth (refresher, I am on call from 37 wks gestation until the birth). It goes from car to car, and I’m constantly asking my partner “did you grab my birth bag when you packed the car?”
Some Doulas and birth workers lug around giant tote bags filled with massage rollers, balls, blankets, candles, twinkle lights, heating pads, and all kinds of goodies! Me? I’m more of a minimalist. I have a small shoulder bag which I mostly use to sustain myself during a long labor. Here’s the run down:
Two changes of clothes (typically yoga pants and a birth-y tee shirt): who wants to show up at a birth in a party dress? or get meconium on your favorite pants? This last week I was called out to a birth when I was leading a plant walk in the middle of a rain storm with soaking wet clothes on, thank goodness I had something to change into! I keep two changes in case I am on call for more than one family or in case I get coated in blood, amniotic fluid, or meconium before my work is done.
Toiletries: I keep a travel toothbrush, tiny tube of tooth paste, tiny deodorant, chapstick, and a small bottle of my favorite moisturizer. Sometimes I’m at a labor for a very long time, or need to run right from a labor to somewhere else; my little refresher bag is essential!
Rebozo: technically I carry this traditional Mexican wrap to help mother’s during labor, but more often than not I end up using it to keep myself warm in a chilly hospital or home.
Unscented Oil: I keep a very small bottle of very unscented oil, usually almond oil or jojoba oil, for doing massage during labor.
Hair ties: I have very short hair, so these are for my mom’s! I have a tiny pouch with a bunch of these just in case mom gets a sudden notion to get her hair out of her face or her own hair tie breaks.
Snacks: these are for me! I keep a number of non-perishable bars and fruit chews that are high in calories and pretty healthy. Again, sometimes labors are very long and I need to make sure I keep my energy up!
Double-shot Espresso: do I need to explain this one? More likely for the ride home than during labor.
Watch: when I’m attending births as a midwifery assistant I need to be able to take vitals.
LED candles: I finally used these at a labor for the first time! Laboring mothers typically prefer low-lighting during childbirth, and sometimes they didn’t anticipate that or a hospital will not allow candles. LED candles are cheap and provide remarkably pleasant lighting.
Pen Light: In case I need to search for something and mom doesn’t want to lights on, or if I’m working as a midwifery assistant its good to be able to provide direct light sometimes.
Tea, Cough Drops, and Instant Coffee: Strictly for me, to keep me perky and lubricate my vocal cords. My voice is my most valuable tool during labor!
Lactation Pocket Guide: my small lactation pocket guide is nice to have in the immediate postpartum. I am a CLC and often provide some counseling for parents choosing to breastfeed.
Change and a few bucks: just in case I need to pay a parking meter, or snag something from a vending machine.
Honey pouches: This is for the laboring mama! Its an easy energy-boosting food to ingest during labor, and to be honest honey is easy to sneak at a hospital which has a (non-evidence based) nothing-by-mouth policy during labor.
Cellphone Charger: just in case!
With all this in my bag, I’ll say the things I use most at a birth are my voice and hands. They are my most valuable tools for support and healing; if my birth bag flew out of the bed of my truck while I was driving to a birth, I would likely barely notice once I started supporting the laboring mother. I have things like birth balls, but I don’t bring them unless my client specifically requests it. I sometimes bring the deflated balls and pump in my care just in case it becomes apparent mid-labor that it would be useful. I also tend to keep a sleeping bag in my car, I can easily fold down the back seats and take a comfy snooze if I simply can’t drive any longer on the way home.
I thought I’d write a post about what it’s like to be a Doula in West Virginia, rural WV. Including my work as a student midwife attending homebirths as well, since the experience isn’t all that different.
Today, for example, I’m sitting at my desk. I live on a mountaintop and I have a fantastic view from here. I’m watching rain and clouds and mist roll by in turns with sun; I’m hearing the winds whip around my house and listening to my wind-chimes go a little crazy. I am also obsessively checking my phone, feeling paranoid about the stormy conditions’ potential to knock out my satellite internet which provides me with the ability to use my cell phone in the dead-zone that I call home. I’m on call for a birth with a client who is past her due date; she lives three hours away.
Yup, you read that correctly: three hours.
Two weeks ago I drove two and a half hours for a single prenatal meeting. Then the next week I drove another three and a half for a home visit with a midwife.
Those of you who don’t live in West Virginia, or don’t live rurally, or practice as a doula in a hospital probably think this is insane. Regardless, this is how we live. Doulas, midwives, and birth workers in this mountainous state not only drive what seem unreasonable distances, we also drive them over terribly maintained mountainous roads and bridges that should have been replaced 20 years ago. We drive through floods and snow and hail.
We do all of this because we believe that you deserve the best for your birth.
So back to my desk, where I’m still updating my website and adding facebook posts to my page and catching up on some studying. I’m looking through the window at branches twitching wildly in the wind, and waiting for someone to tell me they’re in labor.
When is the right time to hire a Doula?
Ideally you will know fairly early in your pregnancy that you would like the support of a Doula for your birth. The earlier you decide the more choices you’ll have. Not only do you want to check availability, but you may want to interview several Doulas before deciding. Your Doula should feel right, if they’re not someone you feel comfortable with then maybe you should shop around a bit.
However, we all know this isn’t always the case; circumstances change, as do our visions for our ideal birth. So what do you do if you find yourself in the third trimester looking for a Doula? You’ll be limited by availability, but many Doulas will still take clients this late into a pregnancy. You need time to meet with your Doula at least once before your birth, though most Doulas prefer the consult and two prenatal meetings structure. It is possible for a Doula to walk into a birth never having met the family, but practically unless the Doula works for the hospital and is already on-call, there can’t be any expectation for this to happen.
So to answer the more specific question here: How late do I take a client? I prefer if you contact me before your 36th week, as it gives us ample time to schedule prenatal visits and get to know each other before your labor. I will add, however, that if you find that you are regretting your decision not to hire a Doula later in your third trimester, don’t be afraid to contact me! Pending availability, I am happy to work with you! There is no shame in taking control of your birth experience, no matter when. If I am able, I will do my best to support you!
“The Midwives Model of Care includes: monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle. providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support.” (from the Midwives Alliance of North America)
I believe in this model of care and I’ve decided to begin to pursue my midwifery education and certification through the North American Registry of Midwives Portfolio Evaluation Process. Right now all this means is that I’ve printed out a bunch of forms and made a rather intimidating white board, but soon it will mean that I begin attending births as a student midwife.
I am excited and nervous, but I feel good about this path. I want to help other people have a childbirth experience like mine. Where they can labor and birth in their own homes, where they feel safe and secure. I want to see more photos like this:
I want to see happy families, midwives, and their assistants gathered together to celebrate new life. I want folks to have options for their birth. I want to not only support families physically, educationally, and emotionally during their childbearing year, but also medically.
I will still be working as a Doula during, and likely after, this certification process. It will take a lot of time and many sleepless nights.