What is missing from our care for women having babies?

Women today in this country are very lucky to have access to exceptional prenatal care from midwives, physicians, and obstetricians (and locally from Healing Hands Chiropractic!).  They have a variety of options available to them for labor and delivery as well:  hospitals, home births, free standing birth centers, etc.  Prenatal care and choices for birth have really come a long way over the last few decades in the United States.  However, I believe there has been a detrimental decline in one large area:  postpartum care.

Throughout pregnancy, women are consistently seen by their care providers.  However, after having the baby they are lucky to have a two-week follow up appointment with most only having a six-week follow up appointment.  An OB nurse practitioner who I spoke with recently said she feels badly for her patients that she sees at their six week check-ups.  “I’m supposed to be checking their physical recovery from birth,” she said, “but they all come in here crying and I just don’t have time to give them the support they need.”

Enter the postpartum doula!  Postpartum doulas are knowledgeable professionals who assist families during the critical period immediately after the birth of their baby.  They “mother the mother” and offer physical, emotional and informational support to the family, as well as practical help.  The doula’s expertise in mother and baby care enables her to assist with postpartum comfort measures, breastfeeding support, non-judgmental guidance in infant care techniques, information on normal postpartum restoration, and family emotional assistance through this major transition.

These doulas provide essential support during the modern postpartum experience, a time when many mothers today feel uninformed, isolated and anxious.  Traditionally, the postpartum period was a “nesting period,” when a new mother was attended to by other experienced mothers.  They helped take care of her and her family, so that the mother could focus on the vital tasks of postpartum recovery, emotional adaptation to great change and getting to know her precious little one.

Today few families have such support, and frequently become exhausted and overwhelmed by the immense work of becoming parents.  Postpartum doulas gently guide and support families through this transition so that they may get off to the best start with their new baby.


Instead of focusing on changes that need to be made with our healthcare system, I’d like to focus on societal changes that we can instantly start working on now -on an individual basis.

So, what can you do?

If you are pregnant:

  1. Complete a Postpartum Plan which can help you draft a list of postpartum resources that are available to you:   http://www.dona.org/resources/doula_practice_postpartum.php
  2. Hire a postpartum doula, to find one in your area, click here: www.dona.org
  3. Call your insurance company now to find out if they will cover postpartum care and if not, if your Flex Spending Account will.
  4. Line up friends and family to cook meals and deliver them to you.  If your friends are lousy cooks, hire a personal chef like The Dinner Goddess in Epping (http://www.thedinnergoddess.com/) or check out some meal registry sites like www.mealbaby.com
  5. Search out places to meet other new moms, like the La Leche League meetings at Healing Hands, Mom & Baby Yoga or Music classes and other Mommy & Me groups.   www.meetup.com is a great place to find people!   Include these ideas in your Postpartum Plan so you have them written down once the baby arrives.

If you have a new baby:

  1. Ask for help!  People always ask if there is anything they can do to help – take them up on it!  Say “Yes, please come hold the baby so I can shower.”  Or “Please cook me a pot of soup.”
  2. It’s not too late to hire a postpartum doula if you need to.  To find one in your area, click here:  www.dona.org
  3. Reach out to other new moms.  Get out of the house at least a few times a week.  See #5 above.
  4. Remember you are not alone.  Motherhood is hard and is better when you are getting the support you need.
  5. Push aside the thank you notes, step over the laundry basket and GO TAKE A NAP!

Darcy Sauers is a certified postpartum doula and the owner of Dover Doula (www.doverdoula.com) in the Seacoast area.  As a member of both the Seacoast Doula Group (www.seacoastdoula.com) and Great Bay Doulas (www.greatbaydoulas.com), she is passionately committed to helping new moms find the support, resources and information that they need. Darcy is very happy that moms in Southern NH are lucky to have such a wonderful prenatal and postpartum resource in Dr. Jess and Healing Hands Chiropractic.  Please do not hesitate to contact Darcy with any questions at darcy@doverdoula.com or 603-988-5945.  For more information on the postpartum period and local resources and events for new moms, follow her on Facebook (https://www.facebook.com/#!/profile.php?id=100000200069253)

Massage Therapy and Postpartum Depression

By Shalon Da~Nai, LMT
May was a beautiful month as the world  came alive and new beings were birthed into existence.  The grasses grew, trees budded and blossomed, and flowers sprouted and bloomed.  Pairs of birds filled their nests with chirping young and many human babies were also born.   It couldn’t be a more fitting time to focus our energies towards the health of new mothers.   May is the official “Postpartum Depression Awareness Month”.  Earlier this month we hosted a charity event at Healing Hands Chiropractic Family Wellness Center to raise money for the cause.  We had a successful “Day of Relaxation” as participants enjoyed sample treatments from the team at Healing Hands.  There was massage therapy, acupuncture, reiki, yoga and local healthy foods.

In honor of May and mothers who experience depression, I want to discuss the benefit that massage therapy can have.  Unlike drug treatments that medical doctors might prescribe, massage has no negative side affects to a mother or nursing baby.  It is gentle, safe and effective.  Women who receive massage therapy during pregnancy have less pain and lowered stress levels.  This translates to the fetus’ and the infant’s stress hormones are also reduced.  We can continue these affects after birth with postpartum massage  and infant massage.

Massage for moms helps to reduce pain and trigger points developed during pregnancy, allowing her body to quickly transition back to its pre-pregnancy state.  It aids in the balance of hormones, which play an important role in depression.  Massage can help regulate sleep and induce relaxation.  Without proper rest it is very hard for the body and mind to heal.  Fatigue is a contributing factor to depression.  And most beneficial is the ability of massage therapy to reduce the stress hormone cortisol which puts stress on all body systems.  Taking time to receive massage gives Mom time for herself, where she can be nurtured with healing touch and be able to offer more nurturing care to her new child.  Infant massage can help to lessen the effects of postpartum depression.  Through massage a mother learns to calm the discomforts of the infant from digestive issues and colic.  Massage has the same affects on baby as they do on the mother, balanced hormones, reduced stress levels and enhanced sleep.

A relaxed baby means a baby that cries less and therefore a relaxed mom.   Performing infant massage enhances the bond between mother and child.  Communication becomes clearer because mom can learn to identify the body language and other cues their baby uses to express themselves.  With this understanding she will have more confidence in her new role as a mother.  Shalon Da~Nai, LMT is Certified in Prenatal and Postpartum Massage Therapy.  She offers one on one Infant Massage classes to parents and caregivers.
All appointments and classes can be scheduled online at ShalonLMT.com or http://www.healinghandsnh.com/massage-therapy/massage-therapy-online-booking/



http://www.medscape.com/viewarticle/471895_4 for research on Massage/infant Massage for postpartum

To reach the Postpartum emotional support group  call 603-663-8927

What is a Doula Worth? How We Come Up With Our Fee.

by guest blogger, Allison Connor of Birthroots Doula

How a doula sets her fees is a mystery to many people; We offer this information so that you have a better idea of what you’re paying for. (adapted from www.gentlebirth.org)

Hours – Couples having a first baby may imagine that their doula will only be spending a few hours with them during the labor and birth.  In reality, an eight-hour labor would be considered pretty fast; most first labors last at least 24 hours; the longest continuous time we’ve spent providing labor support is 51 hours.  The average time we spend with a woman for her labor and birth is about 13 hours.  We spend another 10 hours in prenatal and postpartum visits, another hour or two in phone calls or email, and up to six hours travel time.  Using those averages, our fee translates to an hourly rate of about $25/hour, before expenses and self-employment taxes.

Clients per Week – When we make a commitment to be available to attend you in labor, we have to limit the number of clients we put on our calendar so as to avoid birth conflicts and to ensure that we are reasonably rested when you go into labor.  The rule of thumb for birth professionals providing in-home services (compared to someone working a shift in a hospital or sharing call with another provider) is that one client per week is a full schedule.  Because we also do a lot of teaching, we find that two to three clients per month is a full-time workload.

Clients per Year – When we put your due date on our calendar, we commit to being available two weeks beforehand and two weeks after that date.  This means that when we schedule a vacation, or attend a conference, or have a commitment that we cannot miss, we have to add another four weeks during which we cannot accept clients.   We have averaged about 25 clients a year the past few years.

Being Self-Employed – The rule of thumb is that a self-employed professional’s income is only half of what they earn, after deductions for vacation and sick time, self-employment taxes, insurance, and business expenses. As you may imagine, our communication expenses are high – business phone, cell phone and computer connection.   We also have typical professional and office expenses, continuing education expenses, and unusually high transportation expenses since we primarily travel to people’s homes.

Putting It All Together – Although we are dedicated to this work, being on-call all the time requires a very high level of personal sacrifice, including a willingness to be awoken after half an hour of sleep to go attend a labor for the next 40 hours.  About 25% of our clients have some kind of early labor which starts and stops, resulting in multiple phone calls – often in the middle of the night.  In past years, we have spent our birthdays at a labor, our families have spent Christmas day without us, we’ve had to cancel (and then reschedule) numerous classes and appointments, and find middle-of-the-night childcare when our husband’s were away on business.  We cannot take weekend trips away from the area, and even day trips to the spa or the mountains have to be judiciously chosen.  We never know what we’re going to encounter at a particular labor – we may end up wearing out our body’s supporting the woman in different birth positions; We may take catnaps sitting in a chair; we may eat nothing but crackers and dried fruit; we may end up holding a vomit bowl for someone vomiting with every contraction during transition; we may end up with blood, meconium or worse on our clothes.   Thank goodness we LOVE our work!  But the financial reward for this?  The annual income of someone providing labor support services with a responsible client load and a strong commitment to being available for birth is 1/2 the number of clients per year times their fee per client.

Experience Factor – When we step into a birth, we bring not only our hearts and hands and training, but our experience from over one hundred fifty births and continual research on subjects relating to birth.  As a doula and educator, we must keep up-to-date on the latest studies, procedures, protocols, and policies surrounding birth and area hospitals and providers.  Did you know that doctors, midwives, and nurses usually only know their way of doing things?  As a doula, we see the variations from hospital to hospital, between care providers, and over time.  Being able to work with many different care providers, we learn all their different approaches and tricks, which we think is unique to the doula profession.  And considering that every birth and every family teaches us something new, we have a wealth of knowledge and skills to bring to birth.

Bottom Line – Nobody’s getting rich doing doula work.  But every doula should be able to make a decent living as a doula without making her life unbearable.  We wish we could offer our services at a rate that everyone can afford, but that would require that we make even greater financial sacrifices than we are already making to do this work.  We are a self-supporting professional, and our options are to earn a living wage working with birth or to have a more conventional job, which would pay much more. There are people offering doula services at significantly reduced prices.  They are either offering less time and services, are still in training, or are in a financial position to offer free services.  If you need free doula services, there are many ways we can help you find a free doula; otherwise, you are doing future birthing women a disservice by making labor support an underpaid profession that cannot attract or keep talented, skilled individuals.  If you end up selecting a doula who is undercharging for her services, we strongly encourage you to pay her more than she is asking; otherwise, she may not be around to help you with your next child.  The most common cause of doula burnout is feeling overwhelmed by the commitment and uncompensated for one’s time and dedication.

Advocacy Suggestions – Doula services are rarely covered by medical insurance plans, even though the statistics prove that doulas can save insurance companies lots of money by reducing the use of medications, interventions, time in the hospital, and surgical (Cesarean) births.  You can talk with your Human Resources representatives to ask them to lobby to include all doula services as a covered option in your plan.  Also lobby your State legislature to include doula services in state-funded healthcare so that low-income women have access to experienced doula support and doulas don’t have to further their financial burden by attending these births for free (that is what we do now).  Additionally, you could talk with your midwife or doctor to encourage them to offer universal doula care to their clients.  By hiring several doulas to be on-call for their clients, they could substantially reduce the cost per birth (and make their job easier) – although in this model the doula might be someone you’ve never met before.  You could also advocate for the hospital to provide universal doula care, so that it would be covered in the same way as their in-house lactation consultants are covered.  By all means, tell everyone you meet about the support you received from a doula – spread the word about doula care so that more doulas are needed and are well-paid and can continue their work for generations to come.

BirthRoots Doulas
offers labor support in Southern and Central New Hampshire.  Our doulas provide caring support to birthing mothers and their families.  They attend births in hospitals, freestanding birth centers and homes in Southern and Central New Hampshire, including greater Concord, Manchester and Nashua areas and the Monadnock Region.

Dr. Jessica L. Caruso, is the owner of Healing Hands Chiropractic Family Wellness Center. Dr. Jess is certified in the world renowned Webster Technique for pregnancy. She is also a proud member of the American Pregnancy Association, Holistic Pediatric Association and International Chiropractic Pediatric Association. Dr. Jess highly recommends doulas to all her pregnant patients. Learn more about natural pregnancy care at Healing Hands Chiropractic Family Wellness Center‘s website.