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Jenn Johnson shares her personal pregnancy stories and discusses how even as a nurse she had to advocate for herself during pregnancy.  Jenn also shared info on her book, A Nurse’s Happy Place.

Hello, hello!  This is Kristin with Ask the Doulas, and I am thrilled to chat with Jenn Johnson today.  Jenn is the owner of Rx for Growth, and our topic today is all about trusting your intuition with your pregnancy and your health, not only in pregnancy, but also in the postnatal phase.

Jenn Johnson is a wife, mother of two, and a registered nurse in Ontario, Canada.  She’s spent the last 14 years of her career in the emergency room of big and small hospitals all over northern and southern Ontario.  She’s personally been a part of all the heartbreak, drama, life and death moments, and also trying to cope in the ER journey and ongoing pandemic.

Her books are her battle cry to all other nurses struggling through this pandemic who are losing their love of nursing.  They are burned out, depressed, and feeling hopeless.  The love, caring, and camaraderie of nursing has changed for all of us, and the expectation that nurses continue to show up to a job that puts their lives on the line is new to them.  And obviously, coping has been hard, not only in the pandemic, but just for health care workers in general.

So now more than ever, Jenn is focused on supporting nurses and helping raise each.

Welcome, Jenn!

Thank you!

I have such a respect for nurses, working with labor and delivery nurses closely as a birth doula, and also in my experience in the postpartum units and the antepartum units with the nursing staff there.

That’s a job where – it’s one of the floors where it’s like, I’ve got some education and background in labor and delivery.  I’ve never actually physically been hired on labor and delivery and worked it, so much kudos to those nurses, because am I ever triggered by loud noises?  And that whole department is nonstop screaming and yelling.  Kudos to those people who can sit there and take moms through it because having had two kids, you know, your body takes over, and you are absolutely out of control.  Your body is doing it for you, and the nurse – I thought I could rely on the nurse background, but man, she flew away real quick.  And you’re at square one with everybody else.  You’re just another scared mom trying to get through it, and the pain is new.  The fear is new.  Everything is new, and you’re not sure what to expect and how things go and how the day goes, so it’s – yeah, kudos to those guys, because every specialty is their own special people, but I’ve got a lot of labor and delivery friends, and man, they are the most special people.

Well, I feel that way about the ER department.  You never know what you’re going to get.

That’s the fun part!

You like adventure; okay!

There’s an ongoing meme that circulates the ER and labor and delivery.  Somebody comes in, and the ER nurse – she’s pregnant.  Oh, I hope it’s not a baby.  I hope it’s a snake.  And here’s labor and delivery – oh, my God, I hope it’s a baby, not a snake!  We’re very comfortable with chaos and weird, but for some reason, the responsibility of helping bring in another life, and all the legalities and risks associated with birth and pregnancy scares the living daylights out of us.  So we’re very happy when you’re over 20 weeks and we get to say, you know what, you’re get to go right up to L&D.  Have a great day!

Right!  I know when I had my daughter, there wasn’t yet a separate entrance for our women’s center, and so I went through the emergency room and triaged there.  People had head injuries and so many different things going on, and I was just in labor having a baby, so…

Right.  This is the normal thing.  The rest of these are accidents.

People were coughing and sick.  It was interesting.  But now we have a whole separate entrance and triage, which is very nice.

That’s so epic!

Yes!  Well, I would love to hear about your personal journey and how that really led you to want to not only advocate for nurses but also speak for mothers.

So I started out with a biology degree, just kind of barely getting through.  I failed organic chemistry and was just like, okay, this is clearly – I’ve never failed anything.  What is happening?  And thankfully, I had a girlfriend in residence who was already in nursing, so we’d pour over her textbooks and kind of go like, okay, this is cool.  This is what I want to learn.  So I swapped into nursing and graduated in three years out of four because we had a fast track program and I already had some university credits.  I ended up meeting my husband and starting my first job.  My first job was in a very, very small hospital where there was only one nurse for emergency, one nurse for the floor – one RN for the floor with two RPNs, and maybe 14 beds, but the town size was maybe 5000 people.  So we were doing it all.  We were doing, theoretically, labor and delivery and med surge and emergency and all this, and you’d just kind of rotate back and forth based on the day.

Fortunately or unfortunately, they did end up closing the L&D portion down fairly soon after I started, which kind of sucked, because I was like, oh, I’m doing my perinatal certificate.  I could help.  I’ve got my fetal monitoring certificate and I’m all ready.  But here we are; on to the next thing.  I ended up moving down south to southern Ontario, getting married, and having my babies.  It wasn’t until getting pregnant and having trouble getting pregnant that it was like, oh, man, there is so much more to this other world that I had no idea about.  Thankfully, after about a year or so, we ended up getting pregnant with my first.  Pregnancy was going like, okay, puking my brains out.  I’m thinking, okay, this is all normal and this is what’s happening.  And it’s like, okay, well, it’s kind of continuing, but I’m not hungry; I’m nauseous; I’m losing weight.  Something wasn’t quite right, but I wasn’t clueing into it.  Thankfully, we had midwives, and the midwife appointments up in Ontario – you’ve got 30 minutes to 45 minutes with your midwife, so you chit chat and you hit all the marks, versus kind of the OB route where a lot of people I knew were kind of in and out very quickly, and it was like, okay, let’s check your weight, let’s check your pee, and out the door you go.  So I was so thankful that we were able to get in with a midwife and a phenomenal team in the area.

It wasn’t until I was 38 weeks and literally walking out of one of these appointments going like – and one of my midwives and I were just chatting, and I was like, hey, my feet are so itchy.  Like, I’m over it.  Every night, itching my feet.  Is there any kind of salve or a medication I can take or something?  It’s just driving me nuts.  And she looks at me, and she goes, oh, crap, you were so textbook.  I’m like, what do you mean, was?

So she kind of explains to me, okay, it could be cholestasis in pregnancy, and we’re just going to send you from the office down to our sister hospital and we’re going to just get you checked out.  I was like, all right, not a big deal.  I was not thinking in the moment that it was anything too much to worry about.  But genius me, I started googling, like a moron, like any good scared mother.  And of course, all that keeps coming up is cholestasis in pregnancy – the risk is late term stillbirth.  So at 38 weeks, I am losing my marbles, going like, it’s a 25, 30 minute drive down the highway, and I’m going, what is happening?  Oh, my God, everything has changed.

So we go up to OB.  We get checked out.  They draw bile salts, which is a very specific test that is used to diagnose cholestasis.  So I’m sitting there; I’m being triaged up in OB.  They’ve got me all hooked up; they’ve got Wyatt all hooked up while he’s still in me.  And the OB comes back and goes, okay, so your bile salts are really elevated.  You’re not getting up off the stretcher.  We’re going to induce you right away.

I’m like, look, we left our car in one place; our house is in another; I don’t have anything with me.  We’re just going to go.  We’ll get all the stuff.  We’ll come back.  And the OB was like, absolutely not.  You’re not getting up off this stretcher.  We’re inducing you this instant.  I’m like, holy crap.  Okay.

So everything changed very, very quickly.  It was already probably 5:00 or 6:00 at night.  And again, the Googling, and you’re just going like, well, what is this?  I’ve never heard of this.  I’ve even got a perinatal certificate, and I’ve never heard of this.  And they’re like, oh, it’s so rare and it’s very nonspecific.

And so you go through the beginning induction process with the one they stick up there.

Cervidil?

Cervidil, thank you.  Started with that and then they moved me to a room and they put in the IV and we got Pitocin started.  I had some experience with Pitocin, being the one to adjust it.  To all my previous labor and delivery moms, I am so sorry!

It can be intense!  I’ve not personally experienced it, but my clients certainly have.

I am so sorry to my moms who I kept increasing the Pitocin!  And I’m like, I had no idea that the pit pains were so bad.  A nice, regular, average birth, you’re just very slowly working up to the pain, whereas the pit pains, you go from zero to 60 in an instant without having time to kind of cope or adjust or anything.  And you’re just going.  And so tried to get an epidural.  The epidural failed three different times.  And by the third time – I think they’d actually gotten it in the third time, but as they were taping it up my back, I was like, oh, my God, I’ve got to push.  My girlfriend, who actually was my OB nurse, thank God – she was there.  She goes, okay, well, we’re just going to check you, but you were only 3 or 4 centimeters an hour ago.  And I was like, no I’ve got to push.

And so she checks me.  She’s like, well, so you’re 10 centimeters and he’s right there.  I’m like, no, bolus me the epidural.  I want the pain meds.  She’s like, no, we’re way past that.  I’m very sorry.  I’m like, no, don’t tell me!  Please give me the meds!

So Wyatt was out.  He was deemed a precipitous delivery because he was out in an hour 45 from time of water break, and it was just this whirlwind of everything happened so very fast.  So then you’re in new mom mode, and when everything starts to kind of settle – the dust starts to settle just a little bit.  You’re finally feeling like yourself again.  I get my liver enzymes checked again.  They have come back down to normal.  We’re all good that way.

Doing my research – because now I’m super curious about cholestasis, now that I know about it.  Like, let’s see what’s going on.  So the time that I read things, they didn’t know whether it was the physical weight of the pregnancy, the chemical weight of the pregnancy, the hormonal weight of the pregnancy – what caused, for some reason, your body not to process your bile salt anymore.  So what they would do is they would actually kind of accumulate in your body but settle to your feet as little crystals within your system.  That was what was causing the itchiness.  So I’m like, okay, let’s do all this research and let’s get going.  I’m so curious about this now.  So, reading, if you’ve got the same baby daddy, you’ve got a 70 to 90% chance of getting cholestasis again.  Oh, great.  So the miracle is not getting cholestasis again.

So yes, I was worried and whatever else, but because everything happened so fast with Wyatt, not super concerned.  Normally, I think they find it roughly 34 to 36 weeks.  Something happens where you’re having symptoms and they detect an elevation in your blood.  At 28 weeks, I sat there and I’m going, okay, I’m not sick.  I don’t feel unwell.  But something is telling me that there’s something wrong.  So at 28 weeks – I had OB coverage but was still with my midwives.  With the cholestasis, I did go back to my midwives and say, hey, I’m just feeling off.  Is there any way we can do to the bile salts just to see if they’re elevated?  And sure enough, at 28 weeks, they were already starting to climb.

So I’m like, oh, here we go.  So I actually ended up with the same OB who delivered Wyatt.  It’s like, okay, so you’re getting weekly blood work that was not covered by OHIP, which is the Canadian healthcare system, so I had to pay out of pocket – fun.  That was $70 a week for bloodwork that I had to fast for.  Then it was biweekly ultrasounds.  So all of a sudden, this pregnancy turned into a full time job.  And I kind of found that the bile salts were just slightly elevated at 28 weeks.  I found that for me personally, I couldn’t eat anything that was super refined sugar or anything deep fried.  So for those of us who were of age, the Simpsons, where Homer robs the burger because he’s trying to gain 150 pounds – he robs the burger on the wall, and if it’s clear, that’s your window to gaining all this weight.  So I was like, okay, anything beige and anything deep fried, I’m going to have to see.  For some reason, I just got super nauseous with it and it didn’t sit well with me.

So cutting those out without realizing it, my bile salts ended up coming down and coming back down into normal range.  So I was like, oh, so this is just diet.  My OB was like, oh, we want you to take these pills.  They’re usually used for gallstones.  You need to take these, blah, blah, blah.  So me being the great nurse that I am, I went through all of the research and trying to find a lot of really good evidence-based studies and trials to back this up.  I’m worried about my kid, so what are the long term effects?  And trying to do what I could to find any information.  Well, because it was not necessarily an off-label use for this medication to use it in pregnancy but it was kind of not advised.  And when I went to go fill it, the pharmacist called me three different times.  Do you know what this medication is for?  You’re pregnant?  Does your doctor know you’re pregnant?  What’s your weight?  Are you sure?  He really kind of freaked me out.  The pharmacist never calls anybody at home.  Why is the pharmacist calling me three different times, no less, about this medication?  So I was super hesitant to take the medication.  I ended up not taking it because by the time I got that prescription and everything was filled and we’d been doing the weekly bloodwork, my bile salts were already coming down.

So I said, you know what, my bile salts are already coming down without the medication.  I can’t find a lot of evidence on this and long term use and XYZ.  Trying to explain to my OB that I wasn’t comfortable with this, and that was the first time I really got a lot of pushback from the OB to be like, oh, my God, we use this in England all the time.  I don’t understand why you’re not just taking the medication, and kind of gave me a what-for.  And I’m like, wow.  I’ve never been on this end before.

Right, as the nurse.

I’ve never been the patient getting the what-for, and do I kind of – the number of times myself I’ve kind of gone like, oh, why is this patient not taking their medication?  It’s the best thing for you.  The doctor’s prescribed it.  We wouldn’t be just throwing it at you.  So to be on the other end and be kind of refusing and having to advocate for myself and say, look, I don’t understand why the pharmacist was so upset, why there’s not a lot of evidence and data to back up the use of this medication in cholestasis in pregnancy.  I’m just a little leery.  And even just saying I was a little leery, that really aggravated the docs.  I was like, oh, I’ve never been here.  I can’t remember if he knew I was a nurse or not, but I was just like, man, this is weird.  Okay, note to self.  I’m going to have to really keep this in mind for when I come up on the other side of this later in life and so when people are telling me that they’re not taking their medications, maybe to dig a little bit deeper as to why they’re not taking their medications.  So that was just a little takeaway.

And so I went through the pregnancy.  Bile salts were fine.  Everything was great.  Halloween rolled around, and Elise was due, actually, at Christmas.  Halloween rolls around.  This is my favorite holiday.  We’ve got Wyatt out and trick-or-treating.  We’ve got all the candy lying around the house because we’re in a busy area.  And I kind of binge hard on all the candy, and suddenly my bile salts shot up.  So by November, the middle of November, my bile salts were all of a sudden elevating, and the OB is looking at me: I’m not going to sleep until I induce you.  What are you doing Thursday – and this is Tuesday?  I’m like, absolutely nothing!  And he goes, okay, we’re going to induce you.  And I’m like, okay, that would make Elise 36+6, which is technically preemie, so I’m like, okay, we’re just kind of walking that line.

I got induced, and this one at least was a scheduled induction, so I kind of knew what I was walking into.  He was like, call the floor; make sure they’ve got a bed for you.  Make sure they’ve got a nurse for you.  I said, I’ve got midwives, and he was like, I understand, but we still also pair you with an OB nurse.  I was like, great, I know most of the girls on the floor.  So at 6:30 or 7:00 in the morning, I call.  Yeah, we’ve got a bed.  Fantastic.

I am raring to go.  I’m like, let’s get this kid out of me.  I’m done stressing about what’s going to happen.  I just want my body back, the whole bit.  So we go.  We get induced.  And thankfully, Elise comes out just fine.  And going back and looking at test results, with Wyatt, by the time we found the cholestasis with him, my bile salts were in the 200s, when the range is 0 to 10.  With Elise, by the time we induced with Elise, I think we were only at 15 or 20.  So I was really glad that I didn’t know this when we were having Wyatt.  I’m really glad, because I think I just would have hit the roof.  But it was one of those things where you can trace it back to that feeling of, I’m not sick.  Like, I don’t feel unwell, but just something in my being is telling me that something is off.

With Elise, we made it to the hospital about noon and had the repeat of the pit pains.  I definitely wanted the epidural, and it was successful, thank God, so a little bit of a different experience than my son where there was no time for the epidural.  The midwives had been telling me the whole pregnancy that when I do start having contractions, please make it to the hospital ASAP.  Your son was precipitous; we expect you to go within 45 minutes once your water breaks.  So I was on high alert.

When I got to the hospital, we started the Pitocin and nothing really happened.  It took what felt like forever and a day for the doc to come in and break my water.  I was like, okay, 45 minutes; let’s go!  And nothing happens.  I was like, what’s going on?  So we waited enough time, and clearly, this isn’t moving fast enough.  I think it was that time that I decided to get the epidural.  It was 45 minutes after the epidural was given that Elise decided to show her adorable little face.

She was technically preemie, so we had decided to stay a couple of days.  Her sugars were a little on the rough side, so the nurses and the midwives were like, well, we can either admit her to NICU, put in an IV, and get some dextrose and we can be exclusively breastfed, or we can supplement with formula and kind of keep you in the OB side and Elise can stay with you and we’ll just check her sugars really, really regularly just to make sure that she’s going.  I said, look.  I’ve already played the blame and the grief game with breastfeeding with Wyatt.  That did not go nearly as planned.  And to the point of crying in Walmart, looking at the formula.  It says on the box that breastfed is best.  I’m like, I know breastfed is best, but it’s just not working!

It doesn’t for everyone; right.

It’s so hard.  And again, thinking I was a nurse and I had a little bit of experience with OB; oh, I can just wing it.  No, stupid.  Don’t do that.  I should have gone to a breastfeeding class.  I should have really given it some effort and some planning ahead because you hear about all these wonderful breastfeeding stories and you’re like, oh, it’s going to work perfectly and everything is going to be fine and it definitely did not.  So when it came to Elise and they’re like, oh, are you going to exclusively breastfeed?  I was like, forget that.  I’ve already played that game.  I’ve already cried those tears.  Give me the formula.  There’s no point in an invasive procedure if we can just get away with formula for a little while.  Not a big deal.

We stayed in the hospital for a few days because not only were her sugars a little irregular, my husband, my son, and my mother-in-law who was visiting all got gastro at the same time in the house.  I was like, okay, I’m clearly not taking a brand new, fresh, preemie baby to a gastro household.  This is not happening.  I ended up going to my parents and spending a week there.  It actually was lovely to have that experience with my mom and my dad and Elise and just kind of relax that way.  But the whole process is just so crazy, and then to have somebody say, oh, cholestasis is so rare, and you’re like, what do you want to bet it’s not actually so rare, it’s just that the symptoms are just so ridiculous.  It’s itchy feet!  You would chalk it up to another weird pregnancy symptom, blah, blah, blah.

Right, like the itchy, dry belly.

Yeah.  It’s nothing.  It’s itchiness.  It’s not a big deal, except when you’re up itching for an hour and you just can’t satisfy the itch.  It’s rough.  Your feet start bleeding and they’re sore and you don’t want to get up and it’s a whole thing.  But I’m like, okay, if more people knew about this very real complication with very serious results or potential outcomes – we need to start educating, especially when people come into the ER.  I’m very quick to say, okay, have you had any itchiness in your feet?  How far along are you?  What are we dealing with today?  Because usually it’s nausea, vomiting, cramping, bleeding, pain, that kind of thing and the whole spectrum of the pregnancy.  But I’m always the one to be like, do your feet itch?  And everybody thinks I’m so weird.  I’m like, you think it’s weird, but here’s my story, and then they go, oh, and I’m like, yes.  So now another nurse has been educated on this complication.  Let’s go talk to the patient.

But then it’s also educating my doctors, too.  We had a patient not even too long ago who I think was 38 weeks and was coming in with nausea and vomiting and couldn’t keep anything down.  I was like, okay, well, do you have any itchiness in your feet?  She was like, yeah, a little bit.  Pardon me?  Okay.  And then my doc, because she was having abdominal pain as well, ordered liver function tests, and they were kind of elevated already.  So I’m like, oh, this could be a thing.  So talking to my doc, I’m like, hey, I don’t know if you want to pass this on to OB.  Bile salts isn’t a test we would normally order in the ER because normally results take a good 24 hours to come back.  It’s not something we look into unless we had somebody to follow up that test result, heaven forbid it’s positive.

So in talking to my doc, he was like, what?  What is cholestasis in pregnancy?  I’m like, yes, here we go again!  So educating my doc, and again, having that personal story to really hammer that message home, to be like, no, this is actually something that can happen.  And it really makes me wonder personally how many late term stillbirths were related to cholestasis and nobody caught it.  And how many of these poor women and poor families are then repeating the process with the same spouse and wondering where that’s going to take us.  So yeah, being able to advocate for that, to have that conversation with my doc, to bring awareness on his end.  How many more people are going to benefit just from me talking about it?  It’s one of those things when there’s somebody pregnant coming into the ER, I’m kind of all over them like white on rice, not only just to be like, I’m going to check your fetal heartrate, A, because I love that sound, and then B, because I need the practice.  I’m sorry.  But we also need a fetal heartrate.  It’s all the things.  It’s one of those things where you don’t think it could happen to you or if you’re even aware of it.  So to all the mamas, if you’ve got really itchy feet and you’re up for an hour every night itching, please talk to your provider because it’s something that is absolutely manageable, and you just need a little bit more monitoring.  We’ve just got to start talking about it.

Thank you for sharing your story!  I’ve been to some maternal health conferences where that’s been one of the primary topics.  It was interesting.  I’ve not yet had a birth client with it.  Maybe some signs went unnoticed, but I’ve never had one who was diagnosed with cholestasis.  Very interesting stories, and I’m glad that everything turned out well and you advocated for yourself, which is the whole point of knowing your body, even how you were cutting back foods that weren’t agreeing with you and how that made a big difference.

I can remember, because I’m a huge sweets person, and working shift work, my whole diet is deep fried and sugar.  So then having to go through, like, what else can I eat?  What am I going to be able to tolerate while working shifts and not pass out?

Yeah, and the cafeteria, there’s a lot of fried food and temptations, and then people bring nurses gifts.

We appreciate the donuts and the coffee more than you know.  Especially the ER, we run on spite and caffeine pretty much alone, with a little shot of adrenaline here, there, and everywhere.  You want to win your nurse over in 3.2 seconds?  Bring them coffee, or even just ask, or just say thank you.  That’s something that we don’t often get to hear.  I’m thankful that most people who work OB – you get to have that really great connection with the patient, and you grow over potentially a couple of days, maybe even longer if somebody is staying there for a longer period of time.

Absolutely.

But most people know their L&D nurse’s name, or at least one of them.  It’s a lovely little world.  Every now and again, I’m like, could I?  Yeah, I could, but would I?  I think I’ll stay in the emergency with the air of an OB background, ish, and then be able to teach in the ER and have that access to that education within the ER.  I think that’s where I’ll land, and I think that’s where I will stick for now.

I love it.  So tell us more about Rx for Growth.  You have books and other projects?

So many things going on.  Clearly, I’m undiagnosed ADHD, because I can’t stop moving, which also fits with the ER.  Rx for Growth is my love child.  It started out with the book I wrote, Nursing Intuition, which helps nurses to really hone in on that trust your gut feeling.  Most women know that feeling very, very well, but in the context of the creep factor.  Now I’m kind of taking it over to nursing where you’re caring for someone, and there’s just something that says, something’s not right.  I don’t know what’s going on, but something is off.  And pairing that with evidence based science.  So not only have they proven intuition with peer reviewed evidence, but they’ve also specifically done it with intuition in nursing, which is huge for the nursing community.  If that’s the case, if it’s backed up by science, now we need to take it out of the “woo woo” closet and the 3:00 a.m. conversations and take it into education and talking about it openly and sharing our experiences with one another about the times that we did trust our gut and the times we were right.  Solidify that it’s 100% a thing.  Everybody’s got intuition.  It’s just a matter of whether or not you actually notice it when it’s happening, and then if you actually do anything with it.  So are you getting that kind of thick feeling in your gut that’s like, I don’t know, and what are you doing with it?  That’s kind of Nursing Intuition.  That started the journey of helping new nurses grow and heal.

I’ve come out with a couple of journals for nurses.  I’ve got a grief journal so that you can chart and journal.  There are prompts about grief and how you’re grieving.  There are spots to journal about up to 5 patient deaths.  How you’re doing, how you’re coping, what you’ve learned, how you’re changing your practice at all, how it’s affecting you at home, and are you carrying that person still with you?  Many nurses who probably have more than five or six years’ experience already have a death of somebody who sticks with them.  So it’s time we kind of start unpacking that just a little bit and normalizing talking about grief and death and grieving over a stranger.

There is also the nursing wellness journal, which is more of the day to day.  How are you doing?  Did you sleep?  Did you eat?  What did you eat?  How many steps did you do?  That kind of thing, and trying to very, very gently realize that I know that you’re tired of caring for everybody else and you feel like you don’t have time of you, but we need to kind of switch that paradigm where it is not selfish to put you first.  So let’s kind of take a step back and reassess some stereotypes and kind of put you first.

Then the 100 Shifts journal is a journal that in the beginning has got a lot of resiliency education and trigger identification and a couple of little things that can help you kind of cope with coming into nursing when you’re brand new and fresh and starting.  And it helps you keep track of 100 shifts.  Was it day shift?  Night shift?  What hours did you work?  Did you stay late?  Did you get any sleep beforehand?  How many steps?  Did you get any water at all?  Did you get breaks?  Were you fully staffed?  What was the best part of the day?  What was kind of a low point of the day?  The ultimate goal is that when the nurse has that moment of having something horrific or super traumatic happen to them, you have that moment of, oh, my God.  What am I doing?  I can’t do this anymore.  I’m an idiot.  I don’t know what I’m doing.  I don’t know any of this.  Why am I doing this to myself?  I have no idea.  And you get all this self-doubt going.  But if you had a journal where you could actually go back into previous shifts, your own shifts, and say, well, look at that day.  I advocated for my patient.  That day, I knew what the medication was for without having to look it up.  The next day, I trusted my gut.  I was able to intervene in a patient who wasn’t doing too well.  And it’s all these little tiny moments of growth that we forget about so quickly because the negative always supersedes the positive.  So when you’re having that moment and you’re just doubting yourself – and nurses recently are lasting a year or two and walking away from nursing completely.  Not even just a change of shift, not even a change of job or going from bedside to policy or some other thing.  They’re leaving nursing completely.  And so this is my attempt at kind of staunching the flow.  Let’s bring this into nursing education.  Let’s bring these into orientation programs.  Let’s try to support people before they need the support.

So beautiful.

Let’s build them up so that by the time they have that low – because there will always be a low.  It’s a guarantee, and it’s not just a one and done.  It’s a constant, depending on where you are and what you’re doing, especially a specialty like L&D.  It’s such specialized knowledge that you’re not getting your entire nursing education.  You’re lucky if you have one little six-week chunk of part-time work where you get to work with mom and babes and kind of get a feel for what it is.  Otherwise, you maybe never had access to L&D but you’ve gotten hired here because you feel like that you’re dream job.  Sometimes it is; sometimes it really isn’t.  And realizing that something that you’ve held, a specialty that you’ve held on for so long and an idea that you’ve held on to for so long – maybe it just doesn’t fit right now.  Maybe it’s just not a fit right now; maybe it’s not a fit ever.  But that’s okay.  Everybody’s going to fit in somewhere.  It’s just sometimes it takes time to figure out where you’re going to go and where you’re going to fit.  You are the puzzle piece.  You will fit into a spot.  It’s just sometimes it takes a little bit of time to find that spot.  But please don’t quit in the meantime.

Right.  We need nurses now more than ever, and I feel like there’s an issue with teachers leaving the profession due to burnout and the pandemic related aftereffects, and then certainly nurses and healthcare professionals.

Yeah.  It’s not just healthcare.  It is everybody.  We really need to kind of shift paradigm a little bit as to putting ourselves first and really not just making mental health and resilience buzzwords and self-care  being a buzzword.  Like, let’s get some tangible ways that we can care for ourselves.  And then not be met with resistance when we try to take time off for our own well-being, not get hit with guilt left, right, and center.  It takes a lot of courage to step away for a period of time to work on you, and it takes even more courage and self-awareness to figure out that you are more than worthwhile of the time that you spend on yourself.

Absolutely.  So you mentioned the website, Rx for Growth.  How else can our listeners find your books and find you?

Books are available on Amazon.  Nursing Intuition is due out October 29^th.  It’s on pre-sale for Kindle right now.  You can find me on TikTok and Instagram @ernurse.jenn.  Granted, the TikTok is just usually funny little cuts of the nursing humor, but it’s been a great way to connect with people, and humor is so integral to nursing in itself that if you’re not laughing, you’re crying.  So just me goofing around.  I’m no expert.  I’m not some super hero or anything like this.  I’m a nurse and a mom and a wife, and I’m just trying to help.  And this is just my attempt at trying to help.  So I’m pretty approachable and will probably answer any questions you ever throw at me, which will probably work to my detriment one of these days.  But there’s lots of us out there, and if you’ve got a nurse who’s dedicated to you during your labor and birth experience, ask them all the questions.  They’re not necessarily at your beck and call, but we love to educate and we love to talk to you, so if you’ve got questions about labor, right after, vaccines, anything at all, ask us.  You’ve got us right there, and a lot of people don’t actually have access to a nurse that they can just hit up with a “Hey, what do you think about this?” kind of question.  So take that time.  And it is absolutely golden, especially if your nurse has kind of stuck in there with you because you’re being closely monitored for one reason or another.  Be kind; be nice.  We’re there to help.  We don’t have agendas.  We’re not really there to do anything else but have you have, hopefully, your best and most comfortable birth.  Ask questions.  Advocate, but know that sometimes situations are out of your control.  If you come in with a two-page typed birth plan, I promise you, Murphy’s law, you will have probably an emergency C-section.  It’s one of those things.

Yeah, nurses make jokes about it.  I tell my clients, do a birth preference sheet or use the hospital’s one-page template, but don’t be so focused on things that are out of your control.  It’s up to the mother’s health, how baby or babies are responding.

That was the one thing.  My midwives were like, do you have a birth plan?  And I’m like, we’re just going to put a cap on that for right now.  Here’s my birth plan: skin to skin as soon as possible, if possible.  Breastfeeding started as soon as possible, if possible.  And the biggest IV you can put on me the second my behind hits that bed.  And they pushed back a little bit, like, oh, why would you want an IV?  I’m like, look.  I’m a career ER nurse.  The moment when you have all the time in the world to look for the most beautiful IV placement that’s not going to bother Mom.  At term, your blood volume is up 50%, which makes it so much easier to get an IV.  Let’s have that just in place.  You can leave it alone.  You don’t have to hook it up to anything.  You can just wrap it and forget about it.  But if, heaven forbid, something happens and all of a sudden you need medications in an emergency or you’re bleeding out and you need blood products, having that IV in place is the biggest safety net that you can have.  And Murphy’s law again, if something happens and you don’t have an IV, all of a sudden it is so hard to find an IV.  And then you’re messing around, losing time trying to find an IV when you could have been already being treated.

And like you said, you can just get it and have it there.

You can just leave it be.  And with you still having baby in place, your blood volume is up 50%.  That’s why your veins are huge.  It’s because your body is already preparing for that loss of blood that’s going to happen with birth, so why not take advantage of that huge gift where you’ve got all the time in the world.  Do we really need to put it in the hand?  No, let’s see if we can put it in the middle of the arm so you can bend your wrists and use your hands, that kind of thing.  Let’s do that instead of having it be an emergency where we put it in the elbow, which sucks.  It hurts.  It’s annoying.  The alarms keep beeping.  It is what it is, but had we had a chance to have you have that earlier – for me, that was just my birth plan.  And knowing full well that your body is going to take over.  It’s going to do whatever it’s going to do.  Trust me when I say you have no control over what’s going on.  You’re lucky if you can breathe through when you want to push.  Your body is telling you that you want to push, and the staff are telling you just to hold on for a minute so you don’t tear.  It’s so hard because your body is not your own.  So just know that, and truly, the longer and more intricate your birth preferences or birth plan is, the more opportunities you have to be let down.  And not only let down, but then maybe leaning in to birth trauma.  So don’t set yourself up for failure when you’re having all these expectations because really, the less expectations you have, the happier in the birth you will be.  It gives room for flexibility and it gives room for movement and change.  Things happen in an instant that nobody prepared for or that nobody was expecting, so just be flexible and try your best to just go with the flow because it will make it easier on you long term.

I agree.  Well, thank you for sharing all of your personal journey and your wisdom with us.  I would love to have you on again in the future, Jenn!

Absolutely.  Any time.  I had a blast.

Take good care!

IMPORTANT LINKS

Rx for Health

Birth and postpartum support from Gold Coast Doulas

Becoming A Mother course

Buy our book, Supported

Kristin Revere was a guest on the Plus Mommy podcast to talk about setting yourself up for success by creating a strong support team for birth and postpartum.  Listen to the podcast here. 

A strong support team can significantly impact your overall experience and well-being, from physical and emotional support to guidance through the complexities of childbirth and early parenthood.

Let’s delve into the importance of creating a solid team for birth and postpartum with insights from Kristen Revere, an elite birth and postpartum doula.

Kristen shares her expertise on assembling a dream team of professionals, the benefits of having a doula, and practical tips for finding and affording the support you need.

Join us as we explore the various types of birth support team members, the value of postpartum care, and the strategies to make these essential services accessible.

Whether you’re an expectant parent or a birth professional, you’ll gain valuable information to help you navigate this transformative journey.

Benefits of Hiring a Doula

When it comes to birth support, the first thing that often comes to mind is a doula, so let’s begin there.

A doula provides continuous physical, emotional, and educational support, reducing the need for interventions and increasing overall satisfaction, even if the birth plan changes.

Doulas are familiar with hospital policies and can help navigate decisions by providing information on the risks, benefits, and alternatives to non-emergent interventions.

The evidence is clear: doula support leads to better outcomes and higher satisfaction rates.

Finding the Right Doula

When interviewing doulas, consider their experience, personality, and budget.

Look for doulas with specific training or certification in areas that are important to you, such as a size-friendly doula who has completed size-inclusivity training.

A good fit between you and your doula is crucial!

Postpartum Doula Support

Postpartum doulas offer invaluable support to the entire family, not just the newborn.

They assist with household tasks, accompany clients to appointments, provide sibling care, and offer emotional support for the family.

This holistic approach helps ensure the family feels supported and cared for during the critical postpartum period.

Creating Your Support Team

Building a birth and postpartum support team goes well beyond hiring a doula.

Kristen emphasizes identifying your pregnancy, birth, and postpartum goals if you’re wondering where to start.

Whether it’s trying to avoid induction or seeking Vaginal Birth After Cesarean (VBAC), having a clear understanding of your goals helps in assembling the right team.

It’s essential to have open conversations with your care provider early on to ensure they are on board with your preferences.

Types of Birth Support Team Members

In addition to doulas, there are several key professionals and support team members you might consider for your birth and postpartum journey:

• Midwives: Certified Nurse Midwives (CNMs) and home birth midwives can provide personalized care throughout pregnancy, labor, and delivery.
• Lactation Consultants: International Board Certified Lactation Consultants (IBCLCs) offer specialized lactation support.
• Pelvic Floor Physical Therapists: These specialists help with recovery and strengthening post-birth, addressing issues such as incontinence and pelvic pain.
• Chiropractors: Chiropractors can help with prenatal adjustments to align your body for an optimal birth.
• Acupuncturists: Prenatal acupuncture can support overall wellness, reduce stress, and prepare your body for labor.
• Mental Health Therapists: Therapists specializing in perinatal mood disorders can provide crucial support for mental health during and after pregnancy.
• Sleep Consultants: Postpartum sleep consultants assist in establishing healthy sleep patterns for your baby, which can significantly impact the entire family’s well-being.
• Childbirth Educators: Classes on childbirth, breastfeeding, and newborn care can prepare you for the journey ahead, providing valuable knowledge and confidence.

Supporting the Cost of Your Birth and Postpartum Team

Here are several strategies for making these essential services more accessible:

• Insurance Coverage: Check if your insurance covers services like physical therapy, lactation consulting, and chiropractic care. Some states now include doulas in their Medicaid programs.
• Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs): Use these pre-tax accounts to pay for eligible services, reducing your out-of-pocket expenses.
• Employer Benefits: Some companies offer maternity benefits that include coverage for doulas and other support services.
• Community Resources: Look for nonprofit organizations and hospital programs that offer doula services and other support on a sliding scale or for free.
• Registries and Gift Funds: Instead of traditional baby gifts, set up a registry for support services through platforms where friends and family can contribute.
• Personal Budgeting: Prioritize your spending based on your birth and postpartum goals. Consider reallocating funds from non-essential items to invest in support services that will benefit your family’s well-being.

Whether through a doula, community resources, or personal support networks, having the right team in place can make a significant difference in your experience.

IMPORTANT LINKS

Plus Mommy Podcast

Birth and postpartum support from Gold Coast Doulas

Becoming A Mother course

Buy our book, Supported: Your Guide to Birth and Baby

Kristin Revere spoke about the new book Supported as a guest on the kozekoze podcast with Garrett Kusmierz.  Here’s their conversation.

Listen to the podcast! 

Welcome back to the kozekoze podcast, and happy Mother’s Day!  Wow, what a day.  This is my fourth Mother’s Day, which sounds really crazy.  I cannot believe I have a three-year-old, and now that he’s three, he’s in his fourth year of life, and it’s surreal, really.  Motherhood changed everything for me.  It not only helped me conceptualize the idea for my company, kozekoze, but it’s changed how I work.  It’s changed my day to day life.  It’s changed my perspective.  It’s changed the way I work with my nervous system.  It’s made me work on healing my own wounds.  It is everything, and so with all that motherhood can hold and the grief that is also present if we’ve lost a mom or are not in a good relationship with a parent – wow.  Motherhood and the mother – I mean, there’s just so much there.  It’s a sacred relationship.

I’m honored today to have Kristin Revere as our guest.  She is the owner and founder of Gold Coast Doulas.  They are based in Grand Rapids, and they are a force.  They were voted best doula service.  They’re a very big agency.  Kristin is a change maker.  That’s the best way to put it.  She understands the journey that you go through when you are growing a baby, birthing a baby, and then finding yourself thereafter.  So she created Gold Coast Doulas to fully support the new mom, whether that is through newborn care, birth doulas, sleep consultations, lactation and breastfeeding support, bedrest support, baby registry consultations, so on and so forth.  One of her most popular classes is her Becoming A Mother course online, but they also teach HypnoBirthing classes and they also – this is cool; she talks about this in her interview – they have a grandparents class, which I think is also super cool because so much changes over the years.  So I’m excited to get into that today with you guys, but it’s also really important that you guys know that she has a book that is out.  This book is out today.  It’s called Supported: Your Guide to Birth and Baby, and she co-authored it with Alyssa Veneklase, and they are both certified doulas and also newborn care specialists.  I just absolutely love how all encompassing this book is.  She’s going to share a little bit more about this today. 

I am hot and cold with reading, and I think it really just speaks to my enneagram 7.  I’m one of those people that’s either reading five books at once or doesn’t read for five months or, you know, two years.  But I know that so many of my friends are never not with a book, if that makes sense.  So if you are one of those people who likes reading over online courses or online virtual workshops or in-person things, this book is for you.  And it’s everything you would learn during the Becoming A Mother course.  So very, very excited for you guys to hear from Kristin today.

Before we get into it, I’m going to share a little update with you guys on my fertility journey because that is obviously one of the narratives we have on this podcast and one that we have had in the background of all of these amazing interviews over the past two years and a couple months.

So I’m actually recording this a little bit less than a week before it goes live.  I’m actually meeting with my IVF doctor today.  I have a few bones to pick with her.  The issue or interesting fact, I would say, with secondary infertility is that I have this beautiful, strong belief set in my subconscious, like in my core, this knowing that I can conceive.  I can get pregnant.  I have been pregnant, and I’ve had healthy pregnancies.  And I’m so grateful for that core belief because I cannot imagine if this was my first fertility journey.  I probably would have already gone through IVF given that I am so – what’s the word?  So excited and so ready to have this baby.  But the reason I’ve held out on IVF is because I do have that core belief that I can do it naturally because I have done it naturally before and I conceived my son, our son Declan, the first try.

And so I’m meeting with her today because I’m pretty shocked that over the last year of going to IVF consultations, she never really inquired or asked about my autoimmune conditions of celiac and Hashimoto’s and also my asthma.  Not that that’s autoimmune, but I do have that as an issue.  And it was actually my pulmonologist a week ago who was like, hey, why are they not asking you about your asthma?  I would get a second opinion, with how expensive IVF is.  So I’m going to meet with my original doctor once more before we look into getting a second opinion because quite honestly I am exhausted on this journey.  It’s been such a beautiful ride of learning and recalibrating, and at one point, I’m sure I said it on this podcast.  I was like, wow, we must be birthing a princess into this next life and she wants everything to be perfect because we had our house inspected for mold three times because mold can onset Hashimoto’s.  We have had our water checked a few times.  We have both had our health inspected, up and down, left and right, all across the board.  We’ve changed our eating habits.  We’ve just done so much, and we’re so ready to be pregnant.  But we’ll see what she says about any other fertility drugs before just going through a full IVF cycle.  So I’ll keep you posted on that. 

And then one other interesting aside that I mentioned in another episode is that I had an orthopedic doctor share that they found a cyst on my ovary when they were doing a hip MRI, which was so random, and I was so worried, and I took to TikTok and I’m like, I can’t believe this.  And someone was like, you know, it could have just been your follicle about to ovulate.  And I thought to myself, you know, you’re probably right.  And sure enough, that’s what it was.  I had an ultrasound a couple days ago, and they were like, you have no cyst.  You’re fine.  It was probably just a follicle.  So that’s good news.  I’m very, very grateful to feel like I truly am in good health after this wild last year of doing all the hormone tests, the stool tests, the hair and mineral tests.  There’s so many things we can do with our holistic health, which is great, and I’m grateful to have had the privilege to go on this journey of looking at my health and my fertility.  But I’m ready for it to come to an end, and I do feel that I’m very close to pregnancy.  So that is my Mother’s Day wish.  I am sharing it, as that is what we do with manifestation and speaking our wishes into reality.  But on the kozekoze front, I am actually in New York this weekend as you guys are listening to this.  We were a part of the gift bag for the Mysha event, the Mother Yourself event, in New York.  I will have a full update about the event after I go to it, so the following week.  I’m very excited.  Mysha is an incredible group.  They are all about community, and you basically pay to be in a pod with people that have the same due date as you.  And while Mysha does not have a pod in New Hampshire, they will probably have one soon in Boston, but they’re in New York, LA, and Miami.  Maybe one more city, but that’s all I can think of right now, or at least all that I’ve heard.  I actually met two or three – basically, three moms that are now my closest friends in New Hampshire that all have babies with almost the exact same due date as me, which is pretty cool.  So I totally get how and why that community is so powerful because I just happened upon it accidentally and serendipitously in my life, and I’m so grateful for that.  So we’re excited that Nip Gloss got to go inside the Mysha gift bags for the Mother Yourself event, and I am really excited to attend the event.  So I’ll come back with details soon.

In the meantime, you guys get to hear from the amazing Kristin Revere.  She has quite the interesting career journey, and I’m so excited for her new book, Support: Your Guide to Birth and Baby coming out.  I want to gift any listeners – new listeners, old listeners – a coupon code, THANKYOU20, to buy your breastfeeding tool, Nip Gloss, which is our nipple and lip balm that’s organic, nontoxic, sustainably packaged, and really, really thoughtfully curated to heal your nipples and lips with a mess-free application.  The code is there for you to get 20% off.  You can also pre-order a pee cup.  If you are like me, you are on a fertility journey, and you are testing your ovulation strips.  You are testing your pee strips and potentially Dutch hormone tests like I have been.  I swear I’m collecting pee almost every day of the month.  So that pee cup has been really, really handy.  Before we finally now get into this episode, I want to just read to you a little bit about Kristin Revere.

Fun fact that Kristin and I both share in common is that she studied journalism in central Michigan.  She has a master’s of management and marketing.  She also was selected as one of the 50 most influential women in West Michigan by the Grand Rapids Business Journal in 2016 and 2022.  She is an author, a speaker, an entrepreneur, and she started Gold Coast Doulas back in 2015 after having had a solo doula business.  She has been featured in Rapid Growth Media and First Time Parent magazine.  Gold Coast Doulas is also a certified B corporation.

I’m so excited for you guys to hear from Kristin today.  So without further ado, I introduce Kristin Revere.

Kristin, welcome to the show.

Hi, Garrett!  Thanks for having me on.  I’m so excited to chat with you today.

I am, too.  I had just shared with you that I was talking about cervical checks last night on TikTok, so this is very, very on the mind, to talk about all things birth today.  But before we get into it, I’ll ask you the question that I ask all of our guests, which is who are you before labels, titles, or what someone could Google about you?

Such a deep question!  I am a supporter of women.  It’s my jam.  That’s what I exist to do.  Before I became a doula and educator, I worked in politics, and I fundraised.  My passion was to get women to feel confident raising money and running for office because women often have to be asked to run and feel like they need this long bio of accomplishments, and of course, motherhood sets many women back from a career in politics.  I was actually working on a governor’s race when I was pregnant with my first child, my daughter, and was trying to navigate hiring my expert team while busy working in politics and commuting.  And I waited; I had my kids later in life.  I was pregnant at 36 and 38.

Wow, there’s so much to unpack just in that answer.  Before I go with where I want to go, I think it’s really cool to highlight that 36 and 38 birth because I’m 33 right now, and the conversations that some of my friends and I are having are – you know, I have some friends where the conversation is around, I had such a hard time with my first.  I don’t know if I could do two kids, but I’m running out of time, and I have to make a decision by 35.  Then there’s also friends who are single and 33, 34, 35, and they’re like, oh, it’s never going to happen for me.  So I guess I’m just curious off the top of my head, did you have easy, healthy pregnancies?

I did have a textbook pregnancy with my first up until I got preeclampsia at 37 weeks.  I worked with a nurse midwife group and delivered in the hospital, but through pregnancy, I had no issues up until I hit 37 weeks.  Then I was on modified bedrest.  I was going in and getting nonstress tests consistently.  Then I was induced at 39 weeks.  So my blood pressure had risen, and there were other concerns about preeclampsia.  So I had an induction, and I had done all of this planning to have an unmedicated birth, intervention-free.  I took Lamaze classes.  I didn’t know about doulas with my first.

Okay.  That was going to be my other question.

So I hired doulas with my second.  But yes, so I went through a lot of the anxiety of being on bedrest and knowing that things were going to potentially need to happen.  But I was very fortunate in that I’ve had very few interventions.  My body responded to the membrane sweep, and I only had a cervical ripener and didn’t need Pitocin, didn’t need an epidural.  It was, for a first baby, quick enough of an induction.  But my daughter was not responding well, so there was always that talk and concern of a surgical birth.  So that stress of trying different positions; if she doesn’t respond, then a Cesarean would have been needed.  But I was fortunate in that we tried different positions.  I had a nurse that helped me get a birthing ball up onto the bed.  My daughter was posterior, so she flipped and all of a sudden I was ready to push, and my nurse midwife told me, oh, yeah, I had already called in for a Cesarean.  I sort of defied the odds there.  But I found out that the cord was wrapped around my daughter’s arm, and that was some of the reason for her not responding well on the monitors.

Wow.  First of all, after I had a traumatic birth, I would walk around – and I still do, but for the first six months postpartum, every time I’d see a woman with kids, I’d look at her like, you did this too?  Like, it’s so magical and crazy, and it’s a miracle how many times that everything ends up being okay, with all the different things that can happen.  But one of the things that you said in your bio, you shared a story about being in politics.  I think to the average joe, and this would have been me pre-kids, when I think political fundraising, I think business; I think masculine.  And when I think doula – although I don’t even think I knew what a doula was until I was, like, 27 – I think, like, feminine, soft, flowy.  But now that I know doulas, I’m like, they embody both, right?  Because you have to be the backbone and communicate, be the structure behind the birthing person in so many ways, but they also know the sacred practice of birth.  So I see the embodiment in you of both, the masculine and the feminine, and probably how that’s really served you.  But what was the opening for you?  What was the introduction where you decided to change career paths and become a doula?

It was a slow transition, Garrett.  I had full time jobs the first three years of my agency.  And as I started out as a doula, I joined a collective.  I was teaching classes through them.  I went on my own, and then started an agency in 2015.  I always had a business partner up until recently.  My partner and I divided up tasks.  I was taking birth clients and teaching, as well as running the business.  I worked in a political communications firm that gave me a lot of flexibility for the first portion of owning the business and then transitioned to a nonprofit and did some fundraising for them at a women’s business center.  And then my business was making enough where I felt, instead of putting money into the business, I could pay myself.

Wow.  I think so many women – not just women, but people – get inspired, you have something that’s life-changing or insightful or inspirational, but there are those initial hurdles of, well, how is this going to change my life?  And it sounds like you had these steps along the way to support you financially and support your family and not have to go all or nothing right from the get-go.  But I can imagine that it’s also an identity change.  And there’s also the self-belief that – I mean, I will always have a doula with my future births.  I can’t wait to birth again.  And I don’t think I personally have it in me to be a doula myself.  So what was it that made you realize, like, I can do this, and I really want to do this?

Yes.  So after having doulas myself, I didn’t necessarily want to be a doula.  I really loved teaching these pregnancy and childbirth classes.  And I thought that would be a hobby for me, and I could help people have more understanding of their options in birth and the postnatal phase by being an educator.  And my students asked me to become their doula, so I decided to go and take a training in Florida, a four-day training, and I started teaching.  I should go back a step.  After my son was born, I signed up for a training in pregnancy, took my whole family for a four-day training, and then started teaching immediately after I was trained.  So I had this long relationship.  My classes were eight weeks, and so my students trusted me a couple hours a day for eight weeks, and so they really – you know, having worked with a doula, birth is so intimate.  They wanted someone they trusted.  So I took the training and thought I might take one of my students occasionally on.  And I wasn’t certain.  I don’t love hospitals.  I wasn’t certain that I would enjoy the work.  And I attended my first birth, and anything that I had fears of, whether it’s like blood or fluids or just being in the hospital, anything that could have happened, did, and I had no issues.  It was all about being in the moment and supporting women where they’re at and working within the system to make change rather than being – I want to say activist is the best word to say, that some doulas take that role on.  I wanted to work within the system and get to know administrators and make subtle changes that way and work as partners with the health care team.  And so in starting the agency, we started small.  We had six doulas and then my business partner at the time, who later moved out of state, was the first HypnoBirthing educator in Michigan.  She’s a former labor and delivery nurse.  So we had some of the understanding of the hospital system.  And we both brought our own clients into the business because they wanted to hire us again and we had a lot of repeats.  So it was a slow transition.  Now my agency has 26 contractors between educators, lactation, sleep consultants, birth doulas, day and overnight postpartum doulas.  So it’s much bigger now!  But yeah, I wasn’t certain that I would enjoy the work because as you said, politics is masculine.  Before I worked in politics, I sold advertising.  I worked in yellow pages, magazine, radio.  So I was used to working with men, being in male-dominated industries.  And I am a driver, a D personality, so it is not the typical doula, but it suits me well for running the business, and I did find that I needed the appreciation that I got for working in a unique field.  I loved the excitement of campaigns.  I worked on many campaigns, so that adrenaline rush.  But you also get that with birth, whether it’s your own or supporting a birth.  There are so many unknowns.  I found that I needed to get respect in the business community because I went from working with a lot of men and in the professional sectors to being a woman doing women’s work, and doulas weren’t really known.  They were thought of as being hippies who weren’t wearing suits.  So I started joining chambers and getting back into the business world and getting my agency in particular, but doulas on a broader scale, being known as part of the business community.  I am vice chair of my business association in the neighborhood that my office is located in.  It’s called East Town in Grand Rapids.  I’m co-chair of that.  And very involved in the chamber and Local First.  I’ve tried to get a different level of credibility in the doula space.

I think it’s really important because like you said, so many people either don’t know what a doula is or they think it’s some hippie thing.  And I had the same kind of association with it when my friend said, I’m going to go to a birthing center and I’m going to hire a doula.  I was like, oh, good for you.  And it wasn’t until I was pregnant, and this was in 2020 and 2021.  I was getting a lot of inbound messages for my podcast with – just because I was pregnant and posting about it on Instagram with birth educators and doulas and groups, and I’m listening to them, interviewing them, learning about their resources, and I’m like, wait a second.  I think I need one of these.  I think I need to educate myself.  We can get into this in a minute, but even though I had those resources and I had a doula with me, my birth still was a series of a lot of unfortunate events until luckily my son was healthy.  And I think there’s just so much work to be done in this space, and it sounds like you are doing it, to help people understand that this is just part, I think, how for thousands of years, women had support people at their births.  We kind of took some turns away from that.  And that kind of leads me to the question of – you know, I was lucky, I believe and I feel, that I was podcasting and having these people reach out to me because most of the focus of a first time mom is the nursery, the registry, the baby outfits, the maternity photos.  And it’s all so exciting for sure.  But it’s not necessarily, what are my rights at the hospital?  What can I say no to?  What do I want my birth plan to look like, and who can support me in that?  So when you were talking about how in your eight-week courses, these people were obviously connecting with you and wanting you to be their doula – were they first-time moms?  Or were they second-time moms who had maybe a less than amazing first experience, and how are you reaching those first time moms now in your practice?

Great question.  My classes were an equal mix of first and second time moms.  And I even had some third and fourths.  So either the birth didn’t go as planned, or they wanted connection.  The class wasn’t just a childbirth class.  There was a lot of discussions about relationships, how those will change, bringing partners into that class.  It was called Sacred Pregnancy, which I no longer teach, but I now teach a Comfort Measures for Labor class, so it’s very couple-involved.  It still involves communication of what their needs are, what their thoughts for their birth would be, how they plan to make choices for medical and nonmedical pain relief.  And then we have our comprehensive HypnoBirthing class.  So it’s a bit – I’ve definitely gone a bit more mainstream than the Sacred Pregnancy conversations because it was so intimate, talking about everything from body image to nutrition, bringing in different expert speakers during the time and fitness.  We brought in a prenatal belly dance instructor and talked about movement and getting your baby in a good position.  So it was quite lovely.  It was a unique connection, and I’m still friends with many of the students to this day.  And some of them contributed to my book that is coming out on Mother’s Day.

So talk to us about the book, because obviously, you have this remarkable journey and experience teaching these classes and being present at so many births and having so many doulas in your agency that are also a part of people’s births, which I really feel like is, again, such a sacred thing to be a part of ushering humans into the planet.  So what inspired you, on top of everything you’re doing, to write it?  What was the moment that was conceived?

So it all began with my former business partner, Alyssa, who is my co-author of Supported.  And she and I created an online birth and baby prep course called Becoming A Mother in the early stages of the pandemic.  That was when everything turned virtual, and all of our classes went from in person to virtual.  Our clients were feeling isolated because women couldn’t gather in person at that time.  So we decided it was time to create the course, and the course is broken up into two parts.  Alyssa happens to be a sleep consultant.  Both of us are newborn care specialists as well as postpartum doulas, and I’m a childbirth educator and birth doula.  So I taught the first half of the course, which still exists, on pregnancy and birth prep.  Alyssa facilitates the newborn care end of things, postnatal planning, and gets into feeding and sleep, and we have live monthly calls.

So we had all of this content, but not everyone can afford our course, or maybe they are very late in their pregnancy and they don’t have time to go through all six modules with the expert videos.  We have experts in the course: car seat safety technicians, mental health therapists, physical therapists, pelvic floor therapists, understanding all of the birth and baby options.  The book is the same way.  But again, more accessible and affordable.  And we will have an audiobook version.  There’s an eversion.  Then there’s the hardcover and paperback, so people can consume it however they like to read their books or listen to them, if they’re an audio book listener.

And it launches Mother’s Day?

Yes, it launches on Mother’s Day.  It’s so fitting; we’re birthing our book after a couple years of the process.  We recorded the book ourselves instead of hiring an expert.  It was a labor of love, for sure.  We just want people to know their options, because if you don’t understand everyone that you can bring onto your birth and baby team, then you don’t get a repeat of that birth or that maternity leave and postnatal recovery time.

And that impacts everything.  The mental health experience even with a one-year-old, right, because that first year is so hard.  I still joke that my son is the worst sleeper in America, and he is three.  He hasn’t slept through the night more than seven nights in a row since he was born.  And so we’re just always like, all right, it’s the eighth night.  Here we go.  But I digress.

With writing a book, it is such, like you said, a labor of love, and it’s a creative process, for sure, which is shifting into that state of consciousness – I don’t know, maybe you can, but I couldn’t just pencil into my calendar, now it’s time to write.  Sometimes it’s in the morning.  Sometimes it’s late at night when I actually feel that creative energy.  But it’s also this dance where you’re writing with someone else.  So was it Alyssa or was it you?  Were you both on the same page, or was one person more kind of leading the charge of writing and deciding to go for it?

I encouraged Alyssa, certainly, and I do have a journalism background.  She’s also an excellent writer, and my husband happens to be a publisher and editor, so he did the first edit of the book before we sent it to the publisher to edit.  For the process, we worked independently, gathered stories together from clients, so every chapter has a birth/baby/feeding/sleep story in it from clients that we’ve worked with.

And it’s called Supported?

It’s called Supported: Your Guide to Birth and Baby.  And then since doulas are not medical, we brought in medical experts to speak on topics that we weren’t qualified to.  I have a pediatrician that contributed to the newborn procedure chapter, and then a mental health therapist who specializes in perinatal mood disorders and contributed to that section.  Then I have a yoga instructor who is trained in so many fitness modalities.  She gets into fitness options and restrictions to use based on the different choices for exercise in pregnancy and the postnatal phase.

Wow.  You’ve just named so many things that it’s like, after having been through it, I see it.  I get it.  I can kind of see how all of the dots are connected when, again, most people aren’t looking at that.  Or maybe someone’s a little more focused on nutrition because of their own unique challenges.  But is there something that you think is most overlooked on the perinatal journey over the years that you’re seeing most people forgetting about?  Or if only they focused a little more on this, it would make the experience better?

I know that you mentioned earlier in our conversation about the fact that so much planning is done in setting up the perfect registry, setting the nursery up, having beautiful photos, planning for showers.  But it’s really planning for your birth, and in my opinion, the postnatal planning, maternity leave planning, figuring out childcare options, how do you want to parent together is even more important than planning for your birth.  And so we get into budgeting and even the concept for our course came out of a presentation we gave at a bridal expo because we wanted to reach families earlier when they’re just talking about starting a family and showing them what doulas are all about and understanding your options.  So we compare the process in the book and in the course to planning for other life events, like all of the experts you bring in when you build a home or when you plan your wedding.  What are your priorities?  If it’s a wedding, is it food?  Are you foodies?  Is that your number one focus and the core of your budget?  Or is it flowers or photography?  And then for birthing baby, is sleep your biggest focus, and do you want to hire an overnight postpartum doula or a newborn care specialist or as your infant gets older, hire a sleep consultant?  Or is your focus having that support in pregnancy?  I work with a lot of athletes as a birth doula, and they want to be able to run a marathon again.  So they’re going to see a pelvic floor physical therapist.  They’re going to do things to make sure that they can get back to performance once, of course, their provider approves them to exercise again.  So it definitely can vary from individual to individual.  Is this baby number five?  How will this new pregnancy impact the other kids?  There are just so many issues.  Grandparents are involved in childcare because we’re in a childcare crisis right now.  So we have a grandparents class at Gold Coast Doulas to prepare grandparents for – even if it’s only the occasional caregiving, because so much has changed.  With sleep, feeding, baby gear, car seats.  It can be uncomfortable for our clients and for parents to relay all of the changes and it puts you in this sticky conversation, so they will often gift their family members this grandparents class, and then we come in as experts and show them all the changes, tell them about babyproofing their home, all of the things.

I love that.  I was just thinking, my parents had me in their 20s, and I’m having kids in my 30s.  My husband is in his 40s, and his parents had him in their 20s.  So there’s a big gap, and even just putting my feet in their shoes, if 40 years from now or 30 years from now, my son is like, hey, I need you to watch this baby, I’d be like, what do I do?  Because I already forget the nap windows for a newborn or whatever.  I have a three-year-old.  I can’t imagine that pressure.  And unfortunately, my parents don’t live very close, and so they’re not as hands on, but I love that you’re having those conversations with people and reaching them earlier because it almost feels I don’t want to say that it feels like you’re trying to pull one over on young women, but it’s like you get the bridal shower and you get the wedding and you get the bachelorette and the baby shower and the maternity photos and it’s all this focus on you and you’re so beautiful.  Then all of a sudden, no one cares about you and you are bleeding out, leaking everywhere.  You feel like you got hit by numerous waves and you’re drowning, but you have to keep a baby alive, and not even knowing what those options are – again, I only felt like I had – so my support, just for listeners who are maybe thinking of options, and you’ve mentioned so many, but to give an example, because of the podcast – the company is no longer around, but I interviewed a founder of a company.  They sold, or something happened.  But they were kind of like a hub to schedule those things and try to get it to run through insurance.  So I had a lactation consultant teed up to come to my house the day after I got home from the hospital, and just knowing that someone was coming to my house was so nice.  And they had mentioned in the podcast that there’s such thing as a postpartum doula, and I had never heard of the term.  They were like, kind of like a babysitter on steroids.  They’re newborn experts.  They’re going to help you with things.  And so I actually was like, oh, I’m not going to need that.  And I didn’t hire one until I hit kind of a rock bottom, and I had an amazing postpartum doula come actually all the way at 11 weeks postpartum.  But she kind of helped pick up some pieces for me.

Those were my two things that we decided to invest in, and in hindsight, I wish I had had help with sleep because I had a four-day birth and I didn’t sleep for four days, and then I got sent home with a baby who had equally experienced trauma and wasn’t sleeping, so it was just a lot of sleep deprivation.  It sounds like your book is a big reminder to people that it doesn’t have to be miserable.  It doesn’t have to be this thing, and if we are so structured and scheduled and booked and busy in our culture, why aren’t we applying that structure and strategy to our births?

Exactly.  And the postnatal phase.  I mean, people are all about meal trains, but as you mentioned, during pregnancy, it’s all about the mother, and then all of a sudden it’s all about the baby.  So if you get visitors, they want to hold your baby.  They’re bringing gifts for the baby.  And then the mother feels left behind.  You had experienced some PTSD from your birth, had some trauma.  I’m sure your friends and family didn’t want to talk through that with you.  And so if you don’t have a postpartum doula like you did or your birth doula who comes for that follow up visit to process, then you’re left waiting for that six-week appointment with your provider when you only have ten minutes to talk because everything else is the exam.

Yeah.  It’s such a whirlwind, and that’s why I hesitated for a long time.  I mean, I shared my birth story pretty soon while it was still pretty raw with my husband on the podcast, and I don’t regret it.  It’s our most downloaded episode, and I think it was cool to record it close to.  There wasn’t a lot of processing.  It was more just like we captured what we could remember.  But I was scared to share a lot only because I’m not an expert, and I don’t want to fearmonger and I don’t want to share things that are so specific because everyone’s birth is different, and at the same time, the more I’m kind of opening up, the more I think it’s at least just getting people to talk about what they can access, whether it’s a book or it’s a full blown course.  It’s so important to share that message and I guess one of the things that I think a lot of my friends are kind of – it goes back to the idea that doulas are hippies and you have to have a home birth.  What percentage of your clients are hospital versus home birth, and how do you kind of talk through that decision with your clients or through your course?

So at Gold Coast, we mainly work in the hospital, and that’s honestly where I feel we’re needed most.  We do certainly support our clients wherever they choose to give birth, as long as they  have a midwife with them.  We don’t attend unassisted births, of course.  But we do have some clients who choose to birth at home, but it’s not in the budget for everyone to hire a doula and to pay out of pocket and hire a midwife.  So part of the reason that we work so few home births – I would say it’s maybe 15% of the work that we do is in the home.  And the rest is in the hospital.  We do have a birth center in my community that will be opening soon, but we haven’t had one in quite some time, so that isn’t an option.  Our hospital has some birthing rooms, one of our larger hospitals in my area, so that is an option for people who want an unmedicated birth, and certified nurse midwives do attend those.

I have a couple questions around the financial piece of this and the future.  Before I ask those questions, I have this desire to someday home birth, but more than that, I want to almost reclaim the hospital space after everything that went wrong in mine, and I joke that – you know, I did birth during COVID.  But when I went in, the first thing they did, besides COVID test me, was start to put a port for an IV in my arm, just the second I walked in.  And some people don’t like needles.  I’m pretty brave around that and it doesn’t bother me, but what was kind of ironic in telling about the way the journey went was the phlebotomist or nurse that came in couldn’t get a vein, and she was pushing around so bad that I had blood running down my arm.  So she’s like, let me try the other one.  She did the same thing, and then she left me with the blood without bandaging me, and said, hold on, I’ll be right back and I’ll get someone.  And my doula walked in while I was unbandaged with that, and she was like, what?  What is happening?  And so, I mean, obviously, we could start by maybe saying, oh, I don’t really necessarily want that.  Can we wait until we at least do the cervical ripeners to put anything in, you know?  But what are some of the more powerful births in hospitals stories that you’ve had?  Or what are some of your big – if people want fewer interventions, I guess is the best way to phrase this, what are your tips for that?  Aside from having a doula there or things that maybe your doula can say for you?

Or aside from having a home birth, which I love attending home births.  They’re beautiful, and water births are an option.  So for me when I teach Comfort Measures or I’m talking to my birth doula clients, I talk about just understanding your options.  Again, even if it’s your second baby, taking a comprehensive childbirth class like HypnoBirthing or Lamaze, something that’s out of hospital.  Because the hospital classes, unless they have a longer element, those weekend ones tend to focus more on understanding interventions, how to be a patient, doing the hospital tour included.  There’s not enough time to really understand everything your body is going through and to have that partner involvement the way you could with HypnoBirthing or gentle birth or a Lamaze class.  So doing that preparation.  If my clients want to breastfeed, taking a breastfeeding class before.  Or if they struggled with breastfeeding the first time, taking a class as a refresher.  And then understanding hiring an expert like a doula is a fantastic way because doulas understand all of your options in a hospital.  If it’s not medically necessary, you could delay or decline.  What tools you have in your hospital room, like peanut balls, birthing stools, birthing balls, getting in the tub as a way to relax or to distract from any discomfort in labor.  Walking the halls.  You know, all of those options.  Where the heat packs are and how to slow down potential interventions and ask questions.  So we do go over birth plans or birth preference sheets and the importance of making sure your provider is on the same page as you during pregnancy and then communicating what your needs are to your nurse if you don’t have a doula.  And doulas – you know, at least at Gold Coast, we support whatever our clients choose to do.  So if our client originally wanted an unmedicated birth and then all of a sudden wants to look at different pain management options, we will support that, but we can give them the risks and benefits and alternatives to any potential intervention that is not medically urgent at that moment.  If labor stalls, breaking the bag of water.  What might be done – you know, could we try some positions and wait an hour if baby is doing really well, or are they wanting to have baby sooner and fine with the fact that if they don’t have an epidural yet, that it might feel more intense with having the water broken?

Yeah, there’s so many choice points that, like you said, you can have the birth preference sheet and in the moment – you said that earlier.  It’s about being in the moment with them.  There’s go left or go right.  I’m sure it’s different everywhere, but the practice I ended up at – I started in Boston, moved to New Hampshire during my pregnancy.  You see every doctor, and I had nine weeks to try to meet 17 doctors.  There was one that I said I just don’t want him to deliver my baby, and of course, that’s who showed up.  But the last appointment I had, a woman saw that I had a doula on my team, and I had to, like, fight with the hospital and talk to, basically, the second highest up to get a doula allowed because they were saying nobody allowed.

During the pandemic, right.

They ended up letting me, but when she saw that on my sheet, she walked in, and without asking me my preferences or what I wanted – because you said, you know, what is your relationship with the provider – this woman walked in and she lectured me about how she was type A as well and that I should let go of my standards and that you never know what’s going to happen, that I don’t get to have a crunchy experience.  And I said, well, do you want to know what my choices are?  She just lectured me.

She just assumed because you had a doula.

She just assumed, exactly.  And the Cliff notes version is I ended up getting an epidural, and then it ended up being one of the 30% that don’t work.  So I felt everything.  Which is – you know, technically, I got what I wanted in that sense. 

But you can’t move without assistance with an epidural, so if you’re feeling everything, you can’t walk around or get on a birthing ball.

Right.  You’re stuck.  And what happened was eventually the fetal ejection reflex, which was really cool to experience at the last hour.  But going back to kind of the choice points, having someone there that’s not your partner, your husband, your wife, that can be that neutral but supportive and experienced person to help you with those decisions – it felt so nice, even though, again, I had a lot of things that were challenging.  I believe everything happens for a reason.  My husband didn’t get it at first, why we were hiring one, and he’ll say to this day, your birth was the hardest thing I’ve ever done.  And the doula was there for him, too.  And it is a privilege, kind of bringing it back to the expenses, and my doula was the self-proclaimed cheapest doula in New Hampshire because she really believes in access and all of that.  But one of the questions I have is how do you see the future of birthing in America going?  Because I joke that the epidural I got that didn’t work was an $11,000 thing on the line item.  The price even after insurance was still very expensive.  But as you mentioned, paying out of pocket for a midwife and a doula and whatever else assistance you might need at your home is also a consideration.  So do you think that our country is waking up to creating better maternal healthcare realities?  What do you think about the future of birth?

Yes.  I mean, there’s so many directions I could go with that.  I do feel like there is more understanding of the benefits of doula support, even under the insurer aspect of things, because continuous support from a doula is shown to not only reduce interventions, which interventions up end costing more, but also increase satisfaction.  Nurses and hospitals are busy.  They’re in and out.  They’re responsible for the life of the mother and the baby.  Where doulas are responsible for the emotional support, the physical support, and giving evidence-based information.  So there’s just a different role.  But when I started as a doula, it was basically self-pay only.  And in recent years – let’s say the last four at least – health savings and flex spending have easily covered birth doulas, as well as postpartum doulas in some instances.  And now a lot of employer-based self-funded plans have doula coverage.  So Carrot Fertility is the biggest one I’ve seen that covers both birth and postpartum.  There’s also Progeny.  There’s some healthcare sharing programs – many of them are Christian-based – that cover a certain amount of a birth doula.  And then some companies are creating their own plans.  We worked with a construction firm in our area and helped them add doulas to their benefits.  So that’s been a passion project of not only my own but also Alyssa since we got into this work, making it more accessible.  And then, of course, Medicaid coverage for birth doulas has expanded.  It used to be a handful of states, and now Michigan has had Medicaid for about a year and a half now.  So that is an option for individuals.  And I see general insurance down the road covering birth doulas.

Wow.  I mean, I believe it.  I think, to your point, reducing interventions, which would lower the cost, and then hospital satisfaction – you know, satisfaction with nurses, better overall experiences – I think those are enough for me to think it’s a no-brainer.

Right.  And there are hospital-based doula programs, as well.  There are definitely more options than when I got into the field.

That’s good to know.  I like hearing that, as well.  One question I meant to ask you earlier, and then I want to circle back to your book before we close.  Our connection to each other is through this Hey Mama group online, and you mentioned that when you started in that group, you were, you said, a fertility and something –

Pregnancy connector.  So there are all these different connectors in Hey Mama.  There’s a podcast connector, PR, health and fitness, business.  So I was the expert in pregnancy and fertility.  I would initiate conversations.  I posted weekly.  I did spotlights on different individuals who are active in the community and then attended meetings with all of the different connectors monthly for the year that I took that role on.

Got it.  So the reason I ask is because you said the word fertility, and we haven’t spoken about that.  I just was curious if your work with your families or your patients circles you back to fertility, only because I’m on a secondary infertility journey.  I’ve been trying now for 26 months.  I didn’t start trying until I was done breastfeeding.  And I’m kind of falling into that unexplained.  And I’m curious if you’ve seen that with any of your clients and if it is connected to how their first birth went or anything like that.

Absolutely.  There are fertility doulas.  I’m not one, but during the pandemic, I helped facilitate a fertility support group for women across the US with a mental health therapist under a nonprofit group called Mothership.  And so I got to hear women’s stories.  And then I had clients that I either personally worked with or that were in our agency that had struggles with secondary infertility, wanting to plan their family and have kids close together, and then it wasn’t as easy.  Maybe it was breastfeeding related or getting back on birth control for a while and then wanting to expand the family.  So I often give referrals both locally and across the US for different practitioners, whether it’s a functional medicine doctor or a doctor of naturopathy, in addition to seeing your physician or suggesting going to a fertility clinic.  Looking at gut health, sleep; stress can be a big factor.  All of the different options you have, whether it’s going through a fertility clinic and that process or looking at surrogacy or adoption or however our clients want to expand their families.  So the book does touch on support for fertility and surrogacy and different groups both in person and certainly especially virtual support groups that can be accessed.  Many of them are free or different fertility specialists.

Amazing.  I mean, it makes sense, of course.  You’re so in the space, and it’s all always connected, and it just sounds like you’re very entrenched, in the best way, in all things birth and the cycle of life.  And I think it’s amazing to meet you and really learn more about your work because it’s so needed in our world.  I mean, not only are we in a fertility crisis in our country, but we don’t have the best maternal health care right now.  Your work is just so imperative for our nation.  Really, really, really excited for you to launch this book.  I know you’ve already said the title once, but if you could say the title, where it’s launching.  I know some authors have separate websites for it, or they’re launching straight to Amazon.  Talk to us about where people can find it on Mother’s Day and anywhere else that you personally want to be found.

So my book is Supported: Your Guide to Birth and Baby.   This is an advance copy, and it’s basically going to be on Amazon.  There will be an ebook option and then a hardcover and a paperback.  The launch is Mother’s Day for those three options.  By mid-June, we’ll be on Audible and other audio versions.  And because I decided to not do pre-sales, it’s been challenging to get my book into book and baby stores, but I have a big goal of getting into maternity and baby stores across the country.  So we’re working on some of that in Michigan right now.  I do have a website for the book.  It’s www.supportedbook.com.  And then my website for the doula agency is www.goldcoastdoulas.com.  The book can also be found on that page, as well as the Becoming A Mother course.  The website for the course is www.thebecomingcourse.com.

Okay.  Amazing.  I am so excited for this launch and your book, and congratulations on birthing again. 

Yes!  Thank you, Garrett.  I really appreciate the support, and I’m excited to get it out into the world, and I hope that it’s the shower gift that everyone brings their friends or family members to help them to better birth.  And also the postnatal preparation, especially.  Understanding all of those options and who they might want to bring on their team is, to me, so important.

Absolutely.  Well, thank you so much for coming on and sharing all of this with us.  Hopefully, everyone can just scroll down in their show notes and go find your book.

Thank you!

IMPORTANT LINKS

Kozekoze

Get the book Supported!

Birth and postpartum support from Gold Coast Doulas

Becoming A Mother course

Kristin Revere of Gold Coast Doulas talks about the types of birth and postpartum doula business models.  She also talks about the role of a newborn care specialist.

Hello!  This is Kristin Revere with Ask the Doulas, and today will be my first solo episode.  I was inspired after speaking at a doula conference in Parker, Colorado this past week called DoulaCon, and one of my speaking engagements there was a panel of agency owners and doulas who were experienced working in a variety of scenarios.

I was really surprised by some of the questions from the audience.  The audience was mainly made up of doulas and other healthcare professionals.  I really thought that our audience and doula clients may be interested in some of the options for them as they’re looking at choosing their perfect birth doula, postpartum doula, or newborn care specialist.

BIRTH DOULAS

There are a variety of different options, and I may have personally experienced some, and others, I may not be as familiar with at all.  I’d love to hear from you if you’re a doula and work in a different model of care, or if you have hired a doula and they practice a bit differently than I have personally experienced or other panelists that I talked to were experiencing for themselves.

Solo birth doula: The client hires one doula to support them during pregnancy, labor, birth, and immediately after baby is born.  You get to know this individual well, and the doula is on call for you.  Many solo doulas are available between 38 and 42 weeks of on-call time.  Some doulas make themselves available before then.  They would rely on backup in case they’re at another birth, they’re sick, or they have an emergency.  The backup may be pre-selected, or you might know who that is, or it could be a last minute call and you don’t know that doula at all.

I was a solo doula myself for a couple of years before starting Gold Coast and was a backup for other doulas and went into births without every knowing the client.  I also relied on them for backup for my own business, and I did my own personal marketing and had my own website as a solo doula.

Partner doulas: This is when two doulas partner up.  They may or may not share a website.  They usually interview together and present themselves as a team.  They would either share calls equally, or one doula would be the primary and the other would be the backup that they know.  This ensures that you know who will be at your birth in most cases.  You wouldn’t need a backup unless for some reason they were both unavailable.  It’s often a more sustainable model for doulas.

I did this partner model with my then-business partner, Carly, before we launched Gold Coast because we worked on the business for six months before doing our launch tour and rolling out our website, and we were both taking clients but really wanted to try out that partner model.  So as individual clients hired us, we met with them together, and they were open to that option.  It worked beautifully for both of us, and we were able to be at our kids’ birthday parties and sporting events and important dates and still be there for our clients.

Gold Coast was founded with that partner model of care, whether it’s for birth or working in teams with our postpartum clients.

Collective: A collective may not just be for birth doulas.  I could also be for a mix of birth and postpartum doulas.  The collective that I was in was a group of individual doulas who shared a website and shared marketing costs.  We took turns attending events and were there to support each other.  So we had backup within that collective, and I taught my classes under that collective, as well.  There are many benefits to that model in that it gives a sense of community.  Doula work can often be isolating.  And it can reduce individuals costs for marketing and website expenses, expos.  You can all pool your money.  I know there are other ways that doulas run collectives besides the one that I personally experienced.  They are sometimes called doula associations, and doulas pay an annual or a monthly fee to join, and they may have Meet the Doula events or Doula Speed Dating, similar to what I had with the collective I was in, and then the potential clients could hire whichever doula they want.

Doula agency model: This is the model that Gold Coast uses.  As the owner, I do all of the marketing and the business end of things.  I do the invoicing and collections from the clients, handle accounting, and it frees up the time for the birth and postpartum doulas and newborn care specialists on our team to work directly with the clients.  It allows them to take more clients because they’re not doing all of the marketing and the sales and customer service, the business end of things that not every doula likes to do.  Or if they have kids at home or another job, it gives them more time and can increase their income.

Some doulas within our agency in Gold Coast share call as birth doulas, or with some clients, we have multiple doulas working with the same client, whether it’s daytime support or overnight newborn care, which is our unique special niche.

All of the doulas in Gold Coast follow the same standards.  They’re all certified.  They carry liability insurance.  Our postpartum doulas are background checked.  Our birth doulas are, as well.  Our postpartum doulas are CPR and first aid certified.  And our clients have a similar experience, especially with the postpartum doulas.  We keep a log and try to have that seamless experience no matter who’s attending.  If a client hires only one doula with us and that doula is sick or has an emergency, or if she’s a birth doula with us and gets called to a birth, then we have a big enough team that a client can always have support if they choose, or they can reschedule with their doula.

There are other agency models that operate differently than Gold Coast, but I wanted to talk about that.  I personally match the clients with the perfect doula or multiple doulas for them and really find out what they’re looking for experience-wise, what their ideal personality is, see what our availability is.  As an agency owner, I can often find a postpartum doula that day or night that a client is calling because we have a big team.  I know their schedule, and we’re able to make it happen because many of our clients are tired and they need sleep.  And a solo doula – we have due dates often six months ahead of time.  We could be fully booked up and may not be able to help a client, and our postpartum – again, with that urgency, the doulas could be limited in the number of clients they take, especially if they’re a birth doula as well as a postpartum doula.  So that is one of the benefits of an agency.

Other models: Other models that I’m not as personally familiar with are hospital doulas that work for the hospital and don’t know the client in advance.  They work a shift, similar to other hospital professionals.  There are also some doula groups that are similar to, say, a medical practice that follow a practice model where there are a variety of birth and/or postpartum doulas, and they have a set call schedule, the way a provider would when they’re attending their patient’s birth in the hospital.  So a doctor would have set days that they’re going to be attending births.  In the practice model, doulas have a similar philosophy and would be on call certain days and times of the week, and the clients know that going in.

There are also community-based doula programs that are often grant-funding and either sliding scale or completely free or very reduced rates to the community.  Doulas have mentoring and usually some of their other fees covered, and they’re given a set fee for the length of the grant.

POSTPARTUM DOULAS

This refers only to trained, certified postpartum doulas.  Some birth doulas sell postpartum support without being formally trained outside of their birth doula training.

Solo: Postpartum doulas may work solo.  They work for themselves; they pick and choose the clients and the hours that they’re available.  The client knows their doula.  The con would be if the doula is sick or has an emergency; the shift will be canceled unless they have a relationship with a backup doula and the client is okay with having a doula they’ve never met come in to work in their household.

Agency: This is Gold Coast’s model.  It allows for 24/7 care, at least within Gold Coast.  We have the ability to work 7 days and/or nights a week with care.  The agency model may have postpartum doulas only, or it could be a mix of birth and postpartum doulas.  It could be a mix of birth doulas, postpartum doulas, and newborn care specialists.

A newborn care specialist is trained to support baby only and is focused on baby’s care, and that’s often within the first several months.  It could be 24/7.  They often travel and then do a lot of overnight newborn care.  Their training is focused solely on the newborn and their development and care, and sleep is a big part of newborn care specialists.  Postpartum doulas, depending on the doula organization that they’re trained under, they may have a different scope of practice.  Some doulas are focused more on that recovery support of the first six to nine weeks and working themselves out of a job and focused on caring for the family, the mother.  Mothering the mother.  Household tasks, light meal preparation, light housekeeping.  They may or may not do overnight support, depending again on their training and their availability.  Some postpartum doulas, like many on our team, are also trained in infant care and work a longer amount of time and can do all of those household tasks and focus on recovery and feeding but also include more overnight care to ensure that the entire family gets rest while supporting the mother and partner emotionally, giving resources, referring to experts if there are any issues with colic or any medical concerns like tongue tie that would need to be evaluated by an international board certified lactation consultant, a pediatric dentist, and so on.  So we can help get the right resources for our clients.

An agency may be a model for you if you know you want a lot of support.  For example, multiple nights or days of care a week; longer periods of time.  If you know that you want access to the owner or the scheduler, depending on how the agency runs, then you know you get that customer service that you would expect from other companies.

Some newborn care specialists work with a referral firm that would operate more like a nanny agency who would help give them choices of newborn care specialists.  The client hires the newborn care specialist directly and pays a fee to the newborn care specialist agency, the same way that they would to a nanny agency, and the client pays the newborn care specialist based on that individual’s own contract and their terms.  That is a bit different of a model.

We’ll get into how to pay for your doula and some of the other scenarios in the future, but I thought this would be interesting for you as you’re beginning your search for a birth or postpartum doula or newborn care specialist and the choices you have for the different models of care and models of business out there.

Thanks for listening, and can’t wait to chat with you soon.

IMPORTANT LINKS:

Birth doulas

Postpartum doulas

Classes from Gold Coast Doulas

Becoming a Mother class