Planned cesarean - fees?

[tlcdoula]

I saw this on an e-mail group that I am in (not sure if you ladies belong to e-mail groups and hope it is okay to bring this over here for discussion).

Anyhow, if you are hired by a mother and then she has a planned cesarean how does that affect your fees? Do your fees stay the same? Does it matter if the mother planned the cesarean from the beginning? Planned it within the last few weeks? or What happens to your fees if the mother has an unplanned cesarean?

[1stimestar]

Planned c/s, fees are negotiable. Depends on why they hire me. Unplanned, fees remain the same. Most of the births I have attended that have ended in unplanned c/s have been long, difficult labors. Another one was a 30 week premie and a friend who I was giving a deal to anyway. I didn't charge her as I never went on call for her and had no potential clients that I had turned away. She tipped me anyway for being there before they flew her out to the big hospital (350 miles away) and for the prenatals we had done.

[Kalamazoo Doula]

I have not yet had a client that has had a planned c/birth, but I was once on call for one of my backup's possible VBAC client. Unfortunatly, this momma's careprovider is not the most supportive for VBACs, and they don't LET any of their patients go over 41 weeks. So this client had the question of, if she ended up going with the planned c/birth, she would not want a doula there, because she felt that her husband and her were fine. I know that my back up and I have the same policy, I think of half of my fee is paying for prenatal meetings, and the other is for the birth and the postpartum visit. She ended up getting her planned c/birth, but I visited her at the hospital the next day. She did say that she was glad and thankful for the prenatal exposure that she had gotten from my back up! She felt better about her choice of going with the c/birth.
I state in my contract that basicly a birth is a birth, whether it is vaginal or cesarean. I did have a client who had a emergency c/birth within minutes of arriving at the hospital after a u/s that she had a hour before! I was already at the hospital for another birth, but I was able to run to the operating area to give a few seconds of support to the dad just before they took him in. (this momma had general ann.)
My point is, I think it would be a bad idea if I started to charge less for c/births, or if I started to give refunds for them to. I have seen where a few mom's have asked (not me personaly) about getting a refund because she ended up having a c/birth. I still am on call, and still give %100 support! I do try to do more postpartum support type things with the unexpected planned c/birth clients. I find that my local hospitals, the moms with c/births need more support for breastfeeding! Just my

sorry so long!

[Tiffany]

I think I'd have a hard time convincing someone they need a doula for a planned c-section. I'm thinking if they are planning a section for reasons that are not medically necessary, then they aren't into being emotionally helped and supported by a doula, or anything natural for that matter. I would be confused if I heard Britney Spears had a doula at her planned cesarean. That is just my opinion, of course.

Now that I think about it, I COULD see someone wanting a doula if they had to plan a *medically necessary* cesarean. Maybe they wanted a natural birth and it just couldn't turn out that way. I would definately offer a reduced fee, because most of my fee is for labor support. We all know how long labors can be, and with a c-section.. you could probably be in with her an hour pre-op, an hour during, and 1-2 hours postpartum. So we could be talking 4 hours of "labor". If I didn't reduce my fee, I'd probably include way more postpartum visits because she'll need it!

[Kalamazoo Doula]

Yeah, Tiffany, I agree, I would have a hard time with urging someone that was having a planned c/birth in getting a BIRTH doula, but I would inform them about all the awesome benefits of a POSTPARTUM doula! (just what you said! lol)

[susan1]

I know I would help a mom even if she having a planned c/birth. Just because the mom is having a planned c/birth does not mean they do not need the support. I feel a planned c/birth is like a mom that had a two hour labor...the mom still needs the support. just my . I offer my services to moms that are having planned c/births. I tell moms that are having planned c/births they need support too just like any other birthing mom.


I myself do not know if I would reduce my fee...I guess I would.

Susan

[Kalamazoo Doula]

It is hard for the moms in my area to see the value of doula support for a planned c/birth for the fact that 99% of the time, doulas are not allowed in the operating room . Out of the six c/birth clients that I have supported, I was only allowed in once ! That was my last c/birth, about two months ago. I'm not sure if that would of happened if my client did not have my own personal midwife in attendance (she really had my back when it came to getting me in there, she was my 'connections'.
This is just what I have heard from a hand full of moms in my area.

Susan, I hope that what I wrote does not seem like I WONT support a mom with a planned c/birth, I just don't want to push it too much. Doulas are still really new in my area, so sometimes it is like walking on egg shells around some pregnant women. I would love to see if somewhere they had done a study on the benefits of doula support during a planned c/birth.
I do know that I may personally have a issue with a primary planned c/birth, if there has been no medical reason for it. The whole, 'to posh, to push' issue really burns my biscuits! LOL (just my thoughts)

[tlcdoula]

Quote:

Originally Posted by Kalamazoo Doula Yeah, Tiffany, I agree, I would have a hard time with urging someone that was having a planned c/birth in getting a BIRTH doula, but I would inform them about all the awesome benefits of a POSTPARTUM doula! (just what you said! lol)

I have provided support to a mother who was having a planned cesarean and according to her it was the best thing that she could have ever had. I came to the hospital before she got there so as she arrived I was there and waiting. I went with her to her room, helped her change, calmed her nerves and spent a couple of hours providing support to her as she was very nervous. When she went to the OR I went with her and held her hand and comforted her while she had her epidural placed and then helped her through the entire cesarean by being there to hold her hand, explain what was happening, and be the calming face she always saw. After the baby was born I stayed with mom so dad could go over to his daughter, and in the recovery room I helped mom breastfeed, shielded out family that mom didn't want in there and got family when mom was ready. I took photos, answered questions, etc. I also did a postpartum visit with this family and answered questions just like I would at any other postpartum visit.

This birth was a birth that I got through the hospital that I am a staff doula with, but believe me if you ever were there to help a mother through a planned cesarean you would understand how beneficial you really can be.

I think the only thing that would be different would be in the prenatals because you wouldn't be talking about natural childbirth things, but instead would have to tailor those visits to cesarean info.

[tlcdoula]

Quote:

Originally Posted by susan1 I myself do not know if I would reduce my fee...I guess I would. Susan

I wouldn't reduce my fee, because you will find that if you are there from the start through the finish that you will be there much longer than a mom who has had a two hour labor. With the mom I supported there was two or three hours before the cesarean, the one hour cesarean and then about three or more hours afterwards. So that would be equal to being with a mom for about seven hours while she labored and birthed. My fee stays the same regardless of how mom has her baby - vaginally or cesarean because both I spend lots of time with the mom.

[susan1]

[quote=tlcdoula]I wouldn't reduce my fee, because you will find that if you are there from the start through the finish that you will be there much longer than a mom who has had a two hour labor.

Yeah, you are right...I guess I would not reduce my fee. Because you spend as much as time as a mom that had a fast labor...good one.

Susan

[elang99]

I am thinking about what I am going to do regarding my client who is having the C-section -she has already paid half of my fee and the rest was to be paid after the baby was born (with my doula services of course) but now she is having a c-section and doesn't need me that way - but she said she definitely wants me to come and help her out a bit when they get home with breastfeeding etc - so I think If I do that then I will ask for the rest of the money - but I think that they are so nice and sweet that they will pay me anyway regardless. We'll see how it plays out!

[ctowndoula]

I have been a birth doula for a planned c-section. It was a friend so I didn't charge, but they tipped me.
The reason I doula'ed for her was that this was her third c-section and she wanted it to feel more like a Birth. I guess the first two were rather detacted for her. We went through and worked with her cp and she wrote a birth plan. It included me being in there to help her and take pictures, slow delivery of the baby (almost like the hiemlick (sic) pressure baby gets at birth), hands free and drape lowered at birth. She got it all. I was able to take pictures and we have a great "flip book" of her birth (no video of the birth allowed, but dad had it going on mom's face...we plan to put the sounds of the birth and baby's first cries over a photo montage of the birth) so that she could see. The slow-more-natural delivery was very important to her.
I was a familar face when she showed up at the hospital. We prayed together. I did some comforting massage during the LONG time they have you wait until they are ready to take you back for surgery. We talked about her fears so she could let them out.
I was also there to help with bf afterwards, which was also very important to her. It was good I was there, b/c she had a lot of vomiting due to the new medication they give for pain releif after a spinal now. I was the only one there to hold the basin for her. Dad was off with baby and the RNs never would have made it in time even if she had the thought to push the button.

I would do it again. No on-call time. We did lots of talking about options and the possiblity of VBAC too. Mom and dad were so so appreciative. They kept talking abou the difference from the other two births. I would probably only charge about 3/4 of my fee depending on if we meet for prenatals or no.

[Doula Network of LI]

That all sounds so wonderful to be ABLE to support a mom during a birth by cesarean. Here in NY we are rarely allowed to be in the OR.
These women need the support just as much as any other. It is sad that they CANT be supported.