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 must haves for every doula bag.

How is your Doula bag looking? If it is anything like mine it is a highly cultivated cornucopia of all things birthing, in a convenient package, light and portable enough to be carried from home to clients home, to the hospital and back home again. I have spent a great deal of time balancing the desire to have something for “every possible need” vs being able to actually walk while holding it. The following list shows the most valuable contents that I really can’t live without.

1.  An amazing Bag. Extra points for pockets.

 

 

Ok. Technically this is not in the bag but as someone with a tendency to over-prepare and a love for all things in its own place a great, a hard working bag is a must. I have had my fair share of bags over the years, (some have been better than others) and have found the 3 main needs are size, quality and organisation. To have a handle break or a seam line split mid-birth is more than a little annoying. It needs to fit a pretty wide variety of contents (see below) and what’s more, you usually need to find that one exact item pretty quickly. I have used a large volume Hershel duffel bag (cute, hardworking, pretty indestructible) but there still remains the issue of organising.  On more than one occasion I have had to unpack/repack my bag to get to that all important item at the bottom. You might find organising your belongings into 2 bags serves you well in the beginning, but when you are ready to invest there is a range of perfectly suited bags marketed under “midwives bag” (go ahead, google it) that have pockets for just about everything. In the middle range, you will find a bunch of backpacks/duffle bags/ shoulder bags that have a number of external pockets, and these might be enough for you to organise your supplies without breaking the bank.

2. An old muesli bar.

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Well, that’s what I have but really it can be any snack for you and other support people to share. In a perfect world this would be a fresh salad with some good protein, however more often than not the mad dash out the door means not a great deal of time to plan some meals, sandwiches and snacks for you to eat and restore your energy. For me, the old muesli bar is my go-to because it stores well, is high in protein, doesn’t have a strong odour (garlic breath may not be the birthing woman’s favourite scent), and can be eaten with one hand, a bite at a time, and over several hours if need be.

3. Heat packs.

If you haven’t got heat packs in your bag. well, you should. I personally use sodium acetate reusable heat packs. They have an aluminium disk that you “click” and the sodium acetate crystallises to create instant heat (around 50 degrees celsius) that lasts anywhere from 30 minutes to 2 hours. Theoretically, these can be reused forever, and they last as long as the plastic holds together (usually a few hundred uses). The prices can range a LOT, so think about how many you need to get a good stockpile knowing constant heat on back, abdomen, legs etc. in labour is definitely a bonus. I personally haven’t found a huge variation between the expensive name brands and some cheaper ones (found at the reject shop) but feel free to comment if you have had a different experience.

4. Massage tools

Because birthing women get tired. But so do we. There is a massive range to choose from. Some of the options include small battery operated massagers, wooden reflexology tools and deluxe hand-held percussion/heat/massage tools for head and back. Special mention to the orgasmatron (if you are not familiar with it please try to ignore the name).

5. Spare change

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It feels like most places in the world accept cards, but for some reason, a lot of hospital services aren’t always as accessible. Keeping a few notes and coins around for parking, coffee, vending machine and incidentals will really help. I have been to more than a couple of births that have lasted longer than my battery life (#11 remember your phone charger!!) and needed to check in at home with a payphone.

6. Music player

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In a perfect world, women will have the time, desire and patience to curate their personal playlist/s for birth. But in those moments when they have been forgotten or unfinished, having a few options to play is incredibly helpful. There is nothing worse than arriving at the place of birth and not having anything to drown out the sounds of chatter/ chaos/ other birthing women in the hall and adjacent rooms. Having access to an online music stream is a great option that doesn’t require purchasing a music player, you can find them free or buy a paid subscription. Spending some time making a few different playlists will give you different moods at the press of a button. If you are going to invest in music, I would absolutely recommend a Bluetooth speaker, for your music (or for the music of your client) over a music subscription (if you need to choose) because sound quality and volume can make all the difference.

7. Aromatherapy

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Creating space for women to labour and birth in is essentially flooding their senses with positive sensations. Considering scent, there are a range of uses for essential oils to help create the environment you are aiming for. Consider using them in a massage oil, in a diffuser or a couple of drops on the shower floor or in a bath.

8. Journal

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Keeping a journal of your experiences, what worked, what didn’t, how the woman moved instinctively, or how she was moved into a position (positive or negative) is really beneficial to improving your care and practice. Writing in the quiet moments of labour and postpartum can be a great way of being present (to be called on if needed) without being invasive (respecting that the woman and her family are doing a great job without your intervention and may want your presence to reassure them but not needing direct action). Going back over your notes later on and reflecting on your practice, what worked well, what didn’t, what you know and have learnt and what you still need to know are such a vital component of our work as birth workers. Learning from the women and families we care for never stop,s and keeping a journal is a great way to keep track of that.

9. Knitting

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Firstly, as mentioned (see 8. journal writing) having a quiet, unintrusive activity to do while a woman is labouring, particularly something you can do in a low-lit room can be a fantastic tool if the woman you are caring for wants the reassurance of you being there without needing physical support. It’s a fantastic way to be present without watching her (which can be quite off-putting), but should probably be discussed with the woman before labour so she doesn’t think you are ignoring her. Quite a bit has been written about knitting in the midwifery profession and not all of it applies to work as a doula, though is well worth the read. Bonus points if you are able to craft something so give the parents or baby as a gift. It can be quite special, and think of the energy embedded in something made in the birthing space.

10. Change of clothes

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Because long days and nights can leave you feeling less than fresh, and amniotic fluid has a tendency to splash. No one likes going home with some maternal body fluid on them.