Risk assessments for home visits. Is this relevant for doulas?

So the phone rings, or you receive an email with the details of a potential client. The conversation goes back and forth and after a while, she says she would love to meet you. Yay. You make a time to meet her and her partner at their home. Probably one evening after they finish work. So do you know what you are walking into?

Apart from the obvious risks for anyone walking into ANY unknown home with unknown people, as a doula, you are not just entering peoples homes but embarking on conversations that can turn very personal very quickly.

Family dynamics are so unique and often have a private face in addition to their public one. With the old adage “We don’t know what goes on behind closed doors” it is no surprise then that we what we see is not always what we get.

Consider:

  • Victoria, Australia has been averaging anywhere between 6,00 -8,000 Reported cases of family violence per year.
  • We know that these cases are underreported.
  • Pregnancy is often a time violence begins or increases.

So walking into a happy family home may not be so happy. How can we protect ourselves?

And violence is really only one aspect of assessing risk.

What about Alcohol and other drug use? including smoking? Are you happy to step into these environments?

And then there are less nefarious issues of personal safety. Are they renovating? Any environmental hazards that like construction, stairs, or is access in the dark difficult?

You might even think about parking, meters and timing?

These are the sorts of questions some doulas are probably already asking, and others maybe later. I used to ask a few of these questions once I met with clients (particularly the parking question) as a lead up to the birth but later realised that I was regularly venturing out to unknown palaces with unknown people AND often was the only person who knew where I was going and for how long….

Also, consider:

  • If you trip into a ditch on their property and hurt your foot, could this affect your ability to work? Is your income protected?
  • If you get a parking fine after attending a meet and greet have you just taken a big bite out of your profit?
  • What are the additional unforeseen emotional and financial costs to taking this job and is this the right thing for you?

Systems and procedure can be boring and cumbersome. However if doing a simple “risk assessment”, by asking a few questions can prevent any harm to you it might be a good idea to add this to your regular routine. The other benefit routinely conducting a risk assessment is that clients are less likely to feel singled out. Some of the questions might seem really forward however when you are explaining why you ask them most clients are very understanding.

As most doulas are working independently it is important to take the time to protect yourself when no one else can.

 

Words: Jen Hazi

 

 

 

 

10 ways to give birth like an anarchist.

 

  1. Ask questions. About everything. Literally everything. “What are you doing? Why are you doing that? What other options do I have? Are there any risks with doing that? What else can you do instead?” Ask questions about where you birth, when and with whom. Ask what the evidence is and if there is any contradicting it. Learn about levels of evidence and recommendations in pregnancy. Know your hospital’s policies on induction, monitoring, appointments, home visits, breastfeeding and bottle-feeding, support people, bed sharing, everything. Read every one. And learn the difference between policy and evidence.
  2. Birth at home. On your turf. This is probably the closest you will come to completely disrupting the system. When you invite your midwife in, it is in your space, according to your rules.
  3. Say no. Without justification or explanation. (You know, there is no legal requirement for you to give a good enough reason for refusing something?)
  4. Be difficult. Don’t sit down, stand up. Let them sit. You have the power, you take the higher ground. Tell them to wait when they knock on the door, and if they come in unannounced send them out again. Reclaim your space and your privacy. This is your body and you choose who sees it. Be that “bad patient” the one who takes their time, who waits until they are completely sure to make a decision. If your appointment isn’t long enough ask for another one. If that’s not enough ask for another.
  5. Move beyond the binary thinking. It isn’t public v private, midwife v doctor, home v hospital, vaginal v. cesarian. There are a million different possible ways your birth can go. I guarantee there is always a third option. It is possible no one has thought of it yet. It is NOT possible you only have 2 options. This kind of thinking makes people very easy to control. Tailor your care to your needs. Be in the centre of every decision. All of you. Not just your uterus and the life it contains, but your hopes, dreams & identity including spirit and emotions.
  6. Prioritise your needs above your baby. You matter. You matter because you are a person in this world and your experience and decisions matter. You matter just because of you. It is also good to know that no one in this world will love and care for your baby more than you will. So make sure you are ok, because if you are ok you can make sure your baby is too.
  7. Make decisions based on your feelings. The maternity system is obsessed with data. There is a risk for everything, Every choice has a number. And sometimes those numbers are really important. and sometimes they are arbitrary.  It is ok to make a decision or not make a decision based on how you feel. This is just another kind of knowledge.
  8. Never ever ever start a sentence with “Am I allowed to…?”. Try “I want to”. Or even “I am going to”.
  9. Know your power. learn your rights. Get a doula. Collect the people around you that hold you up. Don’t allow anyone in your space that keeps you small. That is your mental space as well as your physical space. You are so powerful. You have not just created but also gestated a baby inside you. Your body is amazing. Don’t let anyone make you feel anything less.
  10. Change your mind. If it feels like things are spiralling out of control or even gently heading in a direction you don’t feel comfortable with and you want to get off the train. Get off. Shut it down. Try something else. You DON’T have to do anything just because you said you would. You have no obligations to anyone but yourself. And I mean only yourself. Not you and your baby (see 6). Change your mind whenever you damn feel about it.

 

Words: Jennifer Hazi

Originally published in Midwif This.

Why having a doula present when there is meconium stained liquor is a good idea!

Blog post by Jacki Barker

It is crazy, but current obstetric practices are actually increasing the chances of causing fetal hypoxia and possible MAS or Meconium Aspiration Syndrome.

On Jan 14, 2015, Rachel Reed posted “The Curse of Meconium Stained Liquor” in Midwife Thinking. Rachel says that it is not meconium alone which is a problem, but meconium plus an asphyxiated baby that can create the possibility of MAS which may result in infection and also death in some babies.

So, is it that obstetric practice is out of date?

We are still:

  1. Inducing labour,
  2. Directing pushing to speed up labour,
  3. Performing artificial membrane rupture (ARM) to see if there is meconium present

It seems that we appear to be fear driven and acting upon the presence of meconium alone without considering the risks of fetal hypoxia which is linked to all of the above as stated by Rachel.

What should we be doing instead? It would seem that monitoring the baby would be essential looking out for signs of distress. Then of course act and make decisions on those babies with thick mec and showing fetal distress.

However, like Rachel suggests, we should be creating a calm environment so the mother is not frightened and we should be avoiding all obstetric interventions associated with fetal distress.

This is yet another highly positive reason to have a doula at birth ensuring the calm relaxed atmosphere that is necessary when meconium is present.

Coming soon… Emergencies in childbearing for doulas and birth workers course. Be the first to know when this course is available by registering your email address here.

 

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The conversations we need to be having more often.

words: Jen Hazi

The problem I find most about being somewhat introverted is that I can’t abide small talk. I am sure this is what suits me well to the world of birthing and women’s spaces. I tend to dive in and talk with people about the more intimate experiences in their life.

So spending a morning with independent midwife Sheryl Sidery and Women’s Mysteries Teacher Jane Hardwicke Collings (in truth these descriptions barely touch the surface of who these mighty women are and all that they do), discussing birth, our maternity system, women’s choices and power struggles was my idea of a perfect day.

Of course, these conversations are important and best shared around. Fortunately, Jacki and I were prepared and managed to film some important and powerful dialogue that we can’t wait to share in our upcoming course: Women, the system and choice the illusion of choice.

If you are not yet on our email list now is the time to add your details and be the first to know when this is course is available.

In the meanwhile, we have put together the sneakiest of peeks for you to get a glance at what we are creating.  drop by HERE

Jen’s story.

My name is Jennifer Hazi, I am a Registered Midwife, Doula and childbirth educator. I work as a midwife in a busy suburban hospital in Sydney, privately with women and their families in their homes and facilitate a monthly space for pregnant women and their female support people which is a unique mix of education, connection and space for women to process the changes and expectations where they are in pregnancy.

I fell in love with birth sometime during my first pregnancy in 2005. Over the course of my pregnancy, the fear I didn’t even know I had was slowly educated away and a fascination with the body’s ability to grow, birth and nurture a baby with very little help from outside.

I began my work as a doula, training with an experienced doula in a mentor/mentee relationship. After a year of working together under the nurturing eye of an experienced doula, and completing the Optimum Birth training for good measure, the launch into private practice was smooth and joyous.

My hunger for all things parturition continued into my direct entry Bachelor of Midwifery at UTS. While studying I juggled childbirth education, working as a doula and my growing family. I am fortunate to have worked with women in continuity not just through one pregnancy but over the course of their childbearing career and being invited into such an intimate and incredibly life-affirming space with new families is a continual privilege.

I now have 5 witty and vivacious girls who keep me busy and work clinically as a midwife in a large tertiary referral hospital in Sydney. I absolutely love working as an educator and working with women and their families as they discover their own fears about birth are dissolved with good information, a space to reflect and time. I work privately with women and families wherever suits them antenatally, and postnatally in their home. Occasionally I attend births as a doula, however, at this stage, I try to “pay it forward” and bring a newly qualified or student doula with me. I have begun to play with photography and filmmaking more to fulfil my creative needs (far from professional!!), and my only regret is I didn’t start sooner.

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So what are my passions? My family is number 1. Having 5 daughters definitely gets me thinking more than ever about women, our empowerment and how to ensure the road is smoother for the next generation. I am fortunate to have found a profession which is also my hobby. I know many of you feel the same way. I truly believe doulas are an underused resource for women and their families in both the birth space and the postnatal period. I know for myself what a pleasure it is to work with compassionate and caring doulas and how much physical and emotional support in the postpartum can have such a positive effect years later.

I really believe we, as midwives, doulas, obstetricians, childbirth educators, birth photographers, postnatal support people, birth workers and all of us in the perinatal space have a massive responsibility to protect the future by providing care in the most respectful and uplifting way possible.

Words: Jen Hazi

7 copy.jpg(It’s pretty difficult finding a non-pregnant pic of me but I did it.)

 

The one guaranteed way to be the best doula you can be.

(Not that I’m prone to hyperbole)

In all seriousness, there is a fundamental skill which separates the passionate, well meaning doula from the insightful, effective and professional one. That skill is reflective practice.

What reflective practice isn’t:

  • Rehashing bad scenarios.
  • Relying on your own knowledge and experience to help you make sense of every situation.
  • Unfocused and undirected remembering and daydreaming.
  • Journaling (although that is a good start).

 

Ok, so what is it?

  • A framework for thinking.
  • A tool to help structure your learning needs 
  • The ability to turn every experience into a growth opportunity.
  • Really rewarding. Once you see what a difference it makes it is hard to stop!
  • Vital for doulas who are working independently or in isolation.

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access to our online course below.

We Birth are making a film and we want you!

UPDATE: We have received a few requests to extend the time for submissions so if you are still keen to be a part of this project please be in contact with us. we are hoping to have them in by the beginning of August. If you are feeling a bit overwhelmed by the thought of filming flick us an email and we can chat with you and help you through it.

 

Hi, Beautiful community of doulas and birth workers.

To all the amazing, heartfelt, caring and passionate people working in the space with women and families as they welcome a new life into the world.

Are you keen to share your passion and experience with a wide community of women and families?

Do you seek connection and community with fellow doulas, where you can share your enthusiasm and goals and business dreams and be supported and support each other?

If so, please keep reading.

We are putting the call out to Doulas in the We Birth community to submit a short video introducing yourself and sharing your top tips or information for women and families.

We will edit the films into 2 different films.

  1. A film about doulas FOR doulas. Giving you an opportunity to get to know each other and support other doulas with your experience. NEW doulas, please don’t be discouraged. we want to hear from you too! Tell us about your transition, your learning, your passions. We are all coming from unique places with value to share.
  2. A film for women and families. This film will be a compilation of the best advice that Doulas in our community have to offer. You can use this video freely with clients, and be a part of the opportunity to build your own brand awareness and generate growth. This film is free for participants to use, and sell. (Yes, it is your property too!). The only restriction with sales is: A. To sell at a standard RRP and B. 50% of the sales go directly to the charity of our choice (more about this later).

Are you still unsure about the benefits?

  • Your couples and the public, in general, will learn just how valuable you are.
  • Grow your status as a doula!
  • Greater awareness creates greater business for you!
  • Be aligned with a community of passionate, forward-thinking doulas.
  • Support organisations on the front line, caring for birthing women and new families.

Get creative if you want and present yourself in wild and wacky ways!

The film is starring YOU and YOUR top tips, so share it and have some fun.

The film will be your property to share to generate huge business growth potential!

It will be such fun getting to know each other in the making of the movies and once complete We Birth will have an event where we screen the movies and have some fun.

Open to doulas and birth workers anywhere.

What do you need to do to join in?
Sign up to our email list and join our Facebook group then simply follow the next steps, including filming yourself being careful to meet each of the criteria.

  1. (optional) Send us an email letting us know what special skill/ tip for women you will be sharing on film. Obviously, we can’t have 30 doulas all sharing the hip squeeze, so if you have a fantastic idea jump in and reserve your spot!
  2. Record your responses to each of the following topics. It is important you leave a 10-second gap between responses to help us with editing. Be mindful of time limits. We may have to trim clips and if over the time limit, they may not be eligible.
  3. Send your film to us at webithdoulas@gmail.com. Large files can be sent via drop box, or as a google file. Contact us if you have any concerns. Also send us your name, business name, contact details and logo etc for us to display in the film.
  4. Tell your doula friends to join in too. Feel free to team up and submit together if you wish.
  5. Submissions close mid August. First come first serve. We will post a list of topics on our blog as they are submitted, so if you are keen to share a particular skill, technique or idea get in and submit your idea. You can check in and see what other doulas are sharing before you commit to filming. We reserve the right to close submissions early if the response is overwhelming.

 

Topics.

  1. Introduce yourself and if appropriate your business name. Try to keep this succinct, however, include the information about yourself/your business that women and families will need to find you. (max 30 seconds)
  2. Tell us about your passions. Professional and private. We want to know YOU (max 2 minutes).
  3. Things you are NOT about. (max 2 minutes)
  4. Your hopes and dreams for your business. Try to sum this up in 2 or three sentences. (max 1 minute)
  5. Your top tips for women and families. These are to be presented in 3 categories: Antenatal, labour & birth and Postpartum. You can be as creative as you like in this area, try and keep it relevant to your business. We are looking for up to about 5 minutes of content for each person. You might use this time to demonstrate one skill, discuss a remedy or read a hypnobirthing script! Perhaps you might offer tips and tricks for 2 or even 3 different categories. Get creative! If submitting clips to be categorised, please leave a gap of at least 10 seconds to help with editing. (4-6 minutes max)

We are really looking forward to receiving your entries.

 

Emergency training for Doulas

Why does a doula need to learn about obstetric emergencies?

 Doulas are NOT medical professionals. Clinical care of the woman and baby is directly outside of our scope of practice. Clearly defining ourselves as non-clinicians is vital to safe practice.

However, we are there on the frontline. We are with women in the dark of night as they labour at home. Women are told to stay home as long as possible so they turn to us and ask for our support and help before they present to their care provider. We know labour is predictably unpredictable and although we do everything we can to direct women to their care provider there are a few, random situations where timely intervention can save lives.

Many professions have first aid requirements, and no doubt many qualified doulas have undergone some kind of first aid training.  An understanding of emergencies for doulas is important.

It is not appropriate for a doula to attend the kind of emergency training midwives, obstetric nurses and doctors attend. Their role in most emergencies is very different. Understanding a few scenarios that doulas may see might give them the insight to recognise when to call for emergency assistance.

Consider the following scenarios:

If a pregnant woman was to collapse at home in early labour what would you do? After calling for an ambulance, you may be asked to assist the ambulance officer on the phone. If you have an understanding of emergencies then you will feel more prepared to assist.

Supporting a woman in the home quickly turns into a precipitous labour and there is no time to get to the hospital. You have called for an ambulance but the baby is born stunned and not breathing. What do you do while you wait for help?

Moments after the birth of a baby the woman in your care begins to haemorrhage. Staff quickly flood the room to help her. How can you help her partner? Is there anything you can do to support the baby?

This is a course about obstetric and neonatal emergencies completely devoted to the unique needs of doulas.

Experienced doulas may have (unfortunately) come across these sorts of scenarios in the past. However, these skills need to be practised, to keep current, particularly when we don’t use them very often. If you are a newly qualified (or qualifying) doula, learning about emergencies and hearing from more experienced doulas can help equip you with ideas and skills if you ever need them in you (hopefully) long and rewarding career.

Words: Jennifer Hazi


We Birth presents a course on emergencies in childbirth for doulas. Thursday 22nd June 2017, at Oxford Falls Peace Park, Oxford Falls, in Sydney’s northern beaches. Reserve your space now.

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