Some of the most precious and beautiful moments you will have as a doula will be during your pre-birth meetings. This is where you lay the foundation of trust and connection between you and your clients. As I became a more knowledgeable and experienced doula, I honed my prenatal visits down to an art. I notice how much smoother births go when parents are informed and confident in their choices. I always include two prenatal visits in my package and offer more for additional cost if desired. Meetings range anywhere from 1-3 hours depending on how many questions they have or how talkative they are. Occasionally I have very quiet parents, with little to no questions (often homebirth families have shorter prenatals because much of their emotional support and birth planning is covered by their midwife). Here I outline what gets covered in each meeting:
First Prenatal Visit:
Preparation: Upon being hired I email my new clients a contract and intake form. I also ask for the first half of my fee to hold their spot and explain that the second half is due at or before 36 weeks. People can print and sign the contract and mail me a check or e-sign (docusign.com is great) and Paypal me the deposit. I ask that they fill out the intake form and email it back to me before the first meeting so I have a chance to review it.
Check in. I always ask how they have been doing and what has been been coming up for them emotionally, spiritually and physically. I explain what we will go over in the visit and ask if they have any questions or comments before we get started.
We go over their intake form together. My intake form gets their basic info (name, birthday, address, all pertinent phone numbers, etc). I also ask for relevant medical history - previous births, miscarriages, losses, cancers, etc (these experiences can inform their upcoming birth emotionally). I ask about their mother’s births and how they were taught about birth growing up. I ask questions like: Do you have any fears or concerns about the birth? What would your dream birth be like? What type of support do you want from your partner, doula and care provider?
We go over risks and benefits of procedures. I have a list I give them naming many of the things they could be offered during their birth or pregnancy: ultrasound, membrane sweep, cervical softeners, vaginal exams, foley bulb, pitocin, fluids, pain management including morphine sleep shots, Nitrous Oxide, IV narcotics, epidural, episiotomy, vacuum, cesarean birth, etc. Then we talk about post birth procedures: chord cutting, skin to skin, new baby exam etc.
I help them craft a Birth Preferences Sheet(aka Birth Plan) based on everything we have discussed. I encourage them to go over it with their care provider during their pregnancy and bring a couple copies to their birth for the nurses. If they have a care provider or hospital that does not support their desires, I encourage them to seek out a care provider who does. I have become very emphatic about how a particular doctor, hospital or midwife can impact their birth outcome and experience. It’s a very fine line to walk because I don’t want to scare them but I do want them to have their wishes for their birth respected and supported.
More checking in. Throughout all of this, I am asking questions based on their body language. While I want them to have all this amazing information, I feel like my most important job is to hold space for them emotionally. For example, if I start talking about vaginal exams and the mom starts shifting around and diverting her eyes, I ask her how she feels about having exams during her birth. Sometimes mamas will divulge important information - like they find exams very unpleasant. Or perhaps they have a history of sexual abuse (I ask about sexual abuse on my intake form but have found people who have experienced abuse sometimes leave it blank and it later comes up in conversation). I encourage them to discuss these things with their care providers. I am constantly shocked when OBs do not ask about sexual trauma history. I have found that when clients discuss it prenatally, even the most rigid doctor softens a bit and is more accommodating during the birth.
Second Prenatal Visit:
Check in first with how they have been doing.
**Go over comfort measures.**I show the partner some basic massage techniques like the double hip press (squeezing the sides of the sacrum) and pain relieving acupressure points on the feet and shoulders.
**We go over when to call me during labor and when I will join them.**I give them a worksheet to put on their fridge with my number, two backup doulas’ numbers, and signs of labor. I ask them not to notify me in the middle of the night unless they need me or have a question (i.e. no texts like “first contraction -yay!” at 3 am).
So there you have it! That’s the nuts and bolts of my prenatal visits. I’ve found that as long as I hit these main points and keep it as simple as possible, I don’t overwhelm them and still forge a strong bond between us.