​​Newsflash: You don't have to give birth at a hospital just because "that's what everybody does." I highly encourage you to explore all of the available options and let go of other people's fears and expectations. Ask yourself what you want and which place will get you there.

𝐇𝐎𝐌𝐄
If you and baby are healthy and you wish to go unmedicated and avoid unnecessary interventions, this is the place for you! Labor flows as it's meant to under the care of a midwife who will not push routine procedures or a deadline. Here you will find the most comfort (and patience) and can give birth in a tub or in any room or position you prefer. You will likely also have the same personal care team you had during prenatal appointments. Don't be so quick to dismiss this option if you catch yourself saying, "I really want a home birth, but what if something goes wrong?" This question requires a deeper dive with a professional.
Think a home birth isn't for you? Think again!

𝐇𝐎𝐒𝐏𝐈𝐓𝐀𝐋
If you are anticipating an issue that requires medical intervention/specialized care or you know you want an epidural, the hospital is for you. Here, you can count on the most advanced technology and doctors skilled in labor management. If you're hoping to go unmedicated at a hospital or decline routine interventions, you will need to do some extra work to get your wishes. If the hospital has a tub, you might not be allowed to give birth in it. You will likely labor with many nurses and providers (OB or midwife) you don't know.

𝐁𝐈𝐑𝐓𝐇 𝐂𝐄𝐍𝐓𝐄𝐑
The best of both worlds! This location is NOT at a hospital. It has the creature comforts of home with just a few more pieces of equipment than a home birth. You will labor as if you were home but won't have to deal with the logistics of planning a home birth. Here, you'll give birth with a midwife and the nurses on shift.
𝐇𝐎𝐏𝐒𝐈𝐓𝐀𝐋 𝐁𝐈𝐑𝐓𝐇 𝐂𝐄𝐍𝐓𝐄𝐑
While it's called a birth center, it'll likely still follow hospital policies and give you access to pain meds and an OR. However, the rooms are often more comfortable and you'll probably be cared for by midwives.

Oftentimes, people will put so much work and research into labor. They consider their options and the risks and benefits of the recommendations they are given. They eventually become comfortable leading conversations regarding their care and even become really good at saying "No." However, it seems like all those skills disappear when it comes to deciding what newborn procedures they agree to.

Just like labor/pregnancy interventions, newborn procedures are all YOUR choice, and whether or not something seems mandatory, it's totally up to you. But be prepared for some pushback from your medical team or be asked to sign a waiver if you decline. I've seen many hospitals not give parents any trouble for declining certain newborn procedures. You may also choose to delay any of these procedures. Here are the ones you can expect at the hospital:

I remember that first year as a doula, doing nearly everything to book a client. I recall agreeing to work with people and places that really didn't fill my cup, but I just HAD TO fill my books somehow, no matter the cost. How else was I going to be taken seriously if I didn't actually have any clients? I took on people who weren't as committed to birth as me. People who simply hired me for the sake of having a doula. I worked at places that didn't fully support what my clients envisioned. And I said nothing. I didn't mention the uphill climb they'd have to journey to get even the simplest things like hands-on fetal monitoring. I said nothing when the place, provider, or client felt "off."

How could I possibly land a client if I was brutally honest with them? Who would want to hear me gripe about a hospital or provide I believed wouldn't give them what they wanted? Especially after knowing me for less than ten minutes. How would these potential clients react if I told them I'm not a huge fan of continuous monitoring and that I'm hard to convince when it comes to inductions? What if they knew my biases, my true colors, my non-negotiable values?

After nearly three years I was becoming a living statistic: on my way to burnout within five years of doula work. It hit me like the proverbial ton of bricks. I had to do something BIG if I wanted to keep going! I began following the wise creators of Intentional Birth and made some meaningful changes that have paid off. I became honest with myself and with my potential clients. 

Will this honesty help me land every client I interview? No, but that's ok. 

When I talk to these clients, I'm looking for a connection- for a sign that I will be valued, needed, included, and respected. All of that is kinda hard to gather in a 30-minute conversation, so here's what I do.

• I tell them I'm a straight-shooter and will call them out if they are making decisions that don't align with their goals. When my gut feels something, I allow it to speak.
• I inform them that I will ask them tough and sometimes uncomfortable questions to help them find their true wishes. Sometimes it means going against provider recommendations.
• I tell them I'm quick to point out when I become suspicious of their provider. 
• I let them know what my biases are and I will most definitely not apologize for feeling passionate about them.

If they don't choose me after this initial interaction then I'm sure there's another doula out there who's better suited for them. Me? I'll always stay true to myself and attract clients who believe in me.

​Hear me out just a moment while I step on my soapbox!

I want to talk about Group B Strep (GBS) testing and its management in labor. I'm not here to tell you what to do, but I want to tell you what you 𝒄𝒂𝒏 do.

The typical management in the US is to get tested around 36 weeks and if you test positive you are told to immediately go into the hospital to receive IV antibiotics every four hours until the baby is born. Some providers ask you to come when your water has broken and others, before your water breaks. Why could this be an issue? Well, lean in and learn:

𝟭. Coming into the hospital early could severely alter your plans (the environment can affect the flow of labor and put you at a greater risk of more interventions).
𝟮. Prolonged use of IV fluids could affect breastfeeding.
𝟯. You're killing the bad AND good bacteria in your system which also affects the baby's microbiome.
𝟰. About 30% of pregnant women have GBS and that doesn't inherently mean it's a bad thing. We're all made of bacteria. The issue is whether your baby gets exposed, colonized, and infected. Not all of those three things happen in labor.
𝟱. GBS is a transient bacteria, meaning that if you were positive 4 weeks ago you might not be when you go into labor. In other words, you are possibly treating a problem you might not have. Also, the test isn't 100% accurate, and testing negative could be a false result and you'll labor with an unknown positive diagnosis.

Why are you doing all this? For the 1-2% chance your baby will get infected. Meaning 98% of you will be unnecessarily treated like there will be an issue. The math ain't mathing on this one. But labor care in this country is all about treating a problem before it becomes a problem. I'm not trying to discredit the real effect GBS can have on a baby. I'm just laying out the numbers.

But I do understand if some of you aren't even willing to take that small risk, don't want to defy provider recommendations, or just want to know if you have other options. I'm not here to tell you what's right or wrong, but I want to encourage YOU to call the shots knowing what the risks/benefits and options are.

👉Agree to antibiotics if you get a fever, premature labor, or your water has been broken for 18+ hours.
👉Agree to go to the hospital and get antibiotics only after labor is well-established. Studies have shown that at least one round of antibiotics 2-4 hours before the baby is born can still greatly reduce the chances of infection.
👉Decline vaginal exams that can increase the chances of infection.
👉Decline antibiotics and testing and treat the newborn if there are signs of infection. This is the usual approach in the UK.
👉Ask for a quick screening GBS test in labor instead of the standard one in pregnancy.

Read  more at Evidence Based Birth

Waiting is hard. You probably never expected to still be pregnant or maybe you aren't surprised to be here today, but you weren't prepared to feel the way you do. The days can feel like weeks.

Maybe you've made great physical sacrifices and being pregnant hurts. But you swore you'd choose discomfort over induction. 

You might even be feeling a bit embarrassed because you told your family and friends that baby would be here by a certain date and that date has passed. A great approach when well-meaning people ask when it's finally going to happen say, "Baby gets to pick the day, not me or the provider". Sometimes, it's ok to make your inner circle smaller and be very honest about how those questions make you feel. The people who truly care for you will understand.

You might be feeling pressured to have this baby by a certain day and you probably have an induction scheduled. However, if you feel like you're hoping to miss that induction and aren't looking forward to it, then the truth is, you're not truly comfortable with it and a deeper conversation is needed. Do you want to completely decline it and have you gone over your options, risks, and benefits? Or is there something about the induction that you're worried about? I encourage you to speak to someone you trust and explore ways to get over that hesitation. The point is, no matter your decision, you should feel confident and safe!

You may not know this, but I'm also a spin instructor. I've been spinning for more than 10 years and I'm so passionate about it! Turns out, a lot of what I teach and practice during my classes perfectly applies to unmedicated labor. Think about it. A one-hour spin class is a huge physical feat that can seem daunting, yet other people can achieve it. Some even come back for more! They sweat, let go of inhibitions, push themselves past their known limit, go inward, connect with their breath, and feel euphoric when done. You might wonder what those athletes have that you don't.

Want to know the secret? It's peak performance! When you activate the parasympathetic nervous system, you tap into your peak performance.

One of my most recent births was a toughie. Mom labored for over 50 hours, and I remained by her side for about 30 hours. This particular client was seeking to have a vaginal delivery after a Cesarean, and if you know birth, you know this is tricky territory. Most people face resistance and scare tactics from their provider, but this mama was fully informed and found an OB who truly respected her wishes to go into spontaneous labor. He was all for her having a doula and even had to put a nurse in her place when she attempted to schedule an induction. She knew she did not want an induction due to the cascade of interventions that typically follow. Her hope was also to go unmedicated so she chose to labor at home as long as possible. This woman had done her research!

I thought to myself, "Well, let's see if this OB changes his tune when she's actually in labor."

Inductions are pretty commonplace here in the States (about 25% of labors are induced), but that doesn't mean you are just a number, too. You can definitely come in prepared and make the most of this experience.
​
I'd also like to mention that time can sometimes feel like the enemy during inductions. If you're "stuck" at 3 cm after 6 hours, it might seem like you'll be doing this for-e-ver and the induction might be deemed failed or the hospital might make you feel rushed, but remember that many pregnant people are (sometimes unknowingly) at 3 cm for up to a week and no one even bats an eye at that. The fact that you have to sit and watch the clock between four white walls makes time seem cruel. Trust that if others can take their time at 3 cm, so can you!

The following info applies to labors with no complications to the laboring person or the baby.

If you are (or considering becoming) a Tricare Non-Network Doula and could use some guidance, you're in luck! I've created an excellent guide that can help you learn all about working with Tricare as a Non-Network doula. It's detailed, organized, and easy to read. It has helped multiple new and established doulas understand codes, and billing, and find answers to the most common questions.

Currently, doulas are left to guess or rely on others' advice to piece together what we should be doing to serve our military families. I recall being in literal tears trying to navigate coding, billing, and searching endlessly on the Humana website for answers. I took all of that knowledge and created this guide just for you! This guide is specific for Tricare East doulas, but lots of the info applies to Tricare West.

It's the guide you wish Tricare had provided you with.

If you are interested, please make a $25 PayPal payment to @GuidingGatesDoula and you'll get access to the doc. Please include your email in the note. I also offer consults to answer your Tricare questions. Please book here.

We often don't envision ourselves going past our due date, but it's actually a variation of normal. In fact, most first-time moms give birth closer to 41 weeks. As you get close to 40 weeks, you're likely looking at the calendar and wondering how much longer you'll be pregnant. In this blog post, I want to talk about going past 40 weeks. Why is it that many providers want to induce at 41 weeks and what are the risks of going past 40 weeks? 
 
I will start by saying that when a provider recommends an induction is based on their preference, their schedule, your and your baby's health, and the current and possible risks of remaining pregnant. In other words, there's never really a hard and fast rule to induce as it will vary according to those factors. Ultimately, you have the right to decide whether to induce labor or wait for spontaneous labor with appropriate fetal monitoring.
 
The distinction between elective versus medically indicated induction is not always clear. Some providers consider induction for 40+ weeks of pregnancy alone to be medically indicated because of the increased risks of complications that come with longer pregnancies. Others, look into your specific risk factors and manage your care at 40+ weeks with additional testing (NSTs and ultrasounds) to ensure you and baby are doing well. From my experience, with the clients I have worked with, truly supportive providers give them the option to stay pregnant beyond 41 weeks. They offer additional testing to check on baby's development and placental function and rarely induce unless there is a true need...not a possibility of risk.