How many prenatals? plus another question

teachinmamaof4 · 08-23-2006, 11:08 AM

I have on my website and in my contract that we'll do at least two.

With my current clients I really think we need an extra one. I want to be sure we're all on the same page because of her being a VBAC.

There are also some issues I want to discuss with her about the feelings she had/has regarding bf'ing. Some red flags have gone up making me wonder about a history of abuse. I'm also curious if it cause her first labor to stall at 5cm. Any tips on how to approach that subject gently?

Anyway...I digress.

Prenatals...do you have a set amount then add in extras as you see necessary???

Luv2bemommy · 08-23-2006, 11:15 AM

I'm not much help since I am in the same boat you are but I put down for two also.. You might could get it all done in two or end up like me, talking and talking and getting nothing done. ROFL I would just do the two and maybe ask her if she would like one more, tell her you feel like there is more stuff you wanted to discuss?

I have no idea about the abuse, I thought I had seen some sort of questionare before where the client fills out that mentions abuse, I don't remember where I seen it at though. Are you thinking her labor stalled because the abuse? What was her reason behind it?

Kim Trower · 08-23-2006, 11:16 AM

i do two...I have in my agreement if any others are needed it is $15 and hour but I have done a 3rd and not charged...I put it in there because I had a client want to meet with me like 5 times and it was very draining plus phone calls daily and e-mails, research, etc. I learned a very valuable lesson...don't do everything for the client..but I have not had that happen again but just cover myself incase.

earthgirl · 08-23-2006, 12:06 PM

I state two or more prenatal visits in my contract, for that reason... some need more. So I personally don't charge for more visits, but if you need to charge I would say $15.hr is a good rate like Kim said.
Just stating the fact that past abuse may affect labor for information sake, may get her to thinking. Then later if she discloses it, you could refer her to a therapist, and tell her for an optimal birth she must work through it.

MyDoulaStacia · 08-23-2006, 12:22 PM

I have 2-3 but then it's all different.
#1 Is just to see if we are a good match.
#2 Is working on the birth plan.
#3 I ususally go to a Dr. Appt. with them.
If it's really far from her due date when I am hired I will get together another time to present the birth plan and go over things. Otherwise I just e-mail it.

AmandaB · 08-23-2006, 12:30 PM

I have a very set plan.

prenatal #1>>> Client intake, I want to know everything
prenatal #2>>> Comfort measures, breathing techniques, OFP
prenatal #3>>> Baby Care and Breastfeeding.

And thanks to all of you I have much better handouts and directions for all of those.

As for you Heather, women attempting VBACs need much more support. I would certainly meet with her as often as she needs, you really need to be able to get into her head and heart. I don't know how to bring up the topic of abuse, maybe with an example and watch for a reaction? I don't know, I am lost for an answer on that one. Best of luck.

teachinmamaof4 · 08-23-2006, 12:56 PM

Thanks!

We have talked about three prenatals. When we met last week we agreed that two would probably be enough. Since then I've been thinking maybe we really do need a third one.

They do want to meet my back-up so maybe I could use some of that time to go over a few things. I thought asking her if she would mind setting our time to meet at like 6:30. Then see if my back-up could come at 7:30. That would give us an hour to cover a few more things.

gemasita · 08-23-2006, 01:18 PM

I've had one VBAC and looking back on it, I should have done another prenatal. And I think what I would do in the future is put together a resource that includes suggestions from other VBAC clients. Like quotes. So that we can talk about what *some* woman have experienced. And then they can think about what applies to them. That way, I'm not saying you will or won't feel this way but you *may.* Because I always had a rough time talking about *if* the VBAC is unsuccessful without putting negative ideas in their head. So I think this is a more objective way to do it and it allows you to address all of the potential issues. And you could include in there something about abuse and maybe it will strike up a conversation. If you can find quotes, maybe you can find statements out of some books and compile them as a list.

AussieDoula · 08-23-2006, 01:54 PM

I'd suggest maybe trying to squeeze that 3rd prenatal in.

Just explain you want to make sure everyone is on the same page for the VBAC (you can possibly even get her alone to bring up a few issues about the suspected history of abuse).
Do you think it is domestic abuse that is still occuring? Or a past issue she may need to work through?

If it's the former, I would sneak in some screening questions, such as:

Is your partner excited about the baby?
How are you and your partner getting along?
Is he helping you complete tasks that you are unable to do?
How does your partner handle stress or bad news?
How is your family reacting to your pregnancy?
How are things at home?

More straight-forward questioning would include things like:

Since your pregnancy began, have you been physically hurt or felt threatened by anyone?
Has anyone forced you to engage in sexual activities that you felt uncomfortable with?

Since domestic violence is so terribly common in this country, I also include a sheet of paper with a "Safety Plan" on it that she can personalise and keep (let me know if you want an emailed copy - I actually have it on hand so it won't be months until you receive it, LOL). Even if she doesn't suffer from abuse, it's likely that she knows someone who does and can share the paper with them.

If you feel the problem may be the latter and she is still suffering the effects of an abusive past, I would do as gemasita suggested. Bring up a few positive stories or examples of women who have survived abuse and gone on to birth and breastfeed their children (do the same for VBAC stories). This may help open a line of communication where she feels comfortable confiding in you.
Remind her that the abuse is not her fault, and help refer her to a specialist that can work with her to move past her fears.

Good luck! Once again, your intuition is working wonders for you.

MothertheMother · 08-23-2006, 01:59 PM

though I have not put this into motion yet since I don't have any new clients right away I have decided I am going to talk briefly to all of my clients about the fact that a history of abuse can affect labor. Just a blurb to say that I tell all of my clients this since so many women have a history of some kind of abuse and I don't want to assume that it has or hasn't happened to any one. I plan on adding some info to my binder about it so I can tell them it is there and if they look it over and decide it is something they need to discuss we can do it later. Adding that it will help me help them if it is an issue. With that said, does anyone have any great handouts and websites??

teachinmamaof4 · 08-23-2006, 02:09 PM

Quote:

Do you think it is domestic abuse that is still occuring? Or a past issue she may need to work through?

Oh no! It would be something from the past. They are issues she had with her dd who is from her first marriage. I might make a separate post later explaining a bit more and asking for any tips. I have emailed an IBCLC I know for her input but haven't heard back yet.

Quote:

Just a blurb to say that I tell all of my clients this since so many women have a history of some kind of abuse and I don't want to assume that it has or hasn't happened to any one. I plan on adding some info to my binder about it so I can tell them it is there and if they look it over and decide it is something they need to discuss we can do it later.

I like that idea.

AussieDoula · 08-23-2006, 02:22 PM

Just wanted to quickly recommend the book "When Survivors Give Birth" by Penny Simkin. Not only for any of your client mamas who may have issues with past abuse, but also as a general read for Doulas.

MothertheMother · 08-23-2006, 02:37 PM

there is going to be an advanced doula workshop in Atlanta and a great deal of the day is spent on this topic. I posted another thread about it before but I am really going to try to go to this...

AussieDoula · 08-23-2006, 02:44 PM

Quote:

Originally Posted by MothertheMother

though I have not put this into motion yet since I don't have any new clients right away I have decided I am going to talk briefly to all of my clients about the fact that a history of abuse can affect labor. Just a blurb to say that I tell all of my clients this since so many women have a history of some kind of abuse and I don't want to assume that it has or hasn't happened to any one. I plan on adding some info to my binder about it so I can tell them it is there and if they look it over and decide it is something they need to discuss we can do it later. Adding that it will help me help them if it is an issue.

Christy, I think that is a great idea. At the moment I indiscriminately give my mamas information about safety plans and domestic abuse, but have not yet tackled putting information together to address past abuse issues.
Studies have shown that women were more than six times more likely to disclose violence than if they were left to mention it without being prompted. Bring it up at your prenatals!

Quote:

Originally Posted by MothertheMother

With that said, does anyone have any great handouts and websites??

You know I do, LOL! Very quickly, here are a few about abuse during pregnancy (I'm sure others will have some great info and point you in the direction of resources for a mama with past abuse issues):

Domestic violence and your unborn baby.
Domestic Violence During Pregnancy (and another version here) - includes useful links at the bottom.
A small little info section from the March Of Dimes about abuse in pregnancy.
Domestic Violence In Pregnancy - some great information, including this alarming fact:

Quote:

It is estimated that one in five women will be abused during pregnancy. As homicide during pregnancy now surpasses the previous leading causes of death (automobile accidents and falls), it is more important than ever that we know the signs and properly screen women for domestic violence.

Speaking specifically about a previous history of abuse, the GentleBirth website has some good information on Childhood Sexual Abuse and Its Effects On Childbirth.
Also, taken from the 'Journal Of human Lactation' is this guide about Breastfeeding & The Sexual Abuse Survivor (also found on the LLL website).
Lastly (for now LOL) a good answer about Limiting The Delivery Room Crowd for mamas with issues of previous abuse (you might have to scroll down).

Ok, I gotta go to lunch, my family is glaring at me and getting impatient, LOL! Lurve my AllDoulas a little too much!

woodenwoman · 01-02-2009, 12:24 AM

thanks ladies, this was very informative on 2 fronts and i´m thankful the topic came up, also midwiferytoday.com is having a conference in feb 2009 and i believe the lady who wrote the book- "When Survivors Give Birth" by Penny Simkin.- will be there speaking on this exact topic, plus i´m under the impression that one can pay per day if you don´t want to attend the whole conference! good luck all and thanks for the handouts(unfortunately the site is down so i couldn´t read them but i excited to...)