My prenatals usually total 9 hours. My CBE series is 12.
We have plenty of time to chat and I do have set topics that I cover with every client. Over and above that I tell them we can use our prenatal visits to cover whatever *they* want. Our first visit is a get to know you, what are your hopes for this birth, what have you done to prepare, how do they envision us working together, etc. The next two prenatal visits are whatever they want to cover plus a video on positions for labor and birth, a values clarification exercise for birth, and a breastfeeding video. Both videos are under 20 minutes and I show one video per visit, with the breastfeeding one being at our last visit.

I used to do a lot of teaching of the stages of labor and comfort measures for each stage, but I've moved away from that.

Some clients hire me for CBE and we do a full series and the just work in our prenatal visits around a full series of classes.

My prenatal visits last about 3 hours typically.

I do one intitial visit, and one 2 hour prenatal visit. I used to do more, but decided that since my prices were already pretty low (350) that I could not spend more time.
So.. I lend them an info binder, we hit the high spots, pretty much what to expect, and pros and cons of inductions, pain meds, and c-sections, and what comfort measures we will use.

Then she is free to call and email as much as possible. Its not much... but its really all I can do and yet keep my fees low. If they want private classes I charge them extra.

I am currently running a free Moms to be group at the parent link center. I encourage my clients to come and we discuss the hot topics relating to pregnancy, birth and post-partum. I do not get paid to do this..but alot of the moms opt to hire me after attending, and the center advertises my group by saying it is run by Michele O'Callaghan, Certified Birth Doula.

To me covering comfort measures and birth plans is far different then talking about the physiology of birth and stages of labour.

And I do touch on stages of labour too... it kind of all depends on what questions they ask. It kind of falls in the 'what to expect' catagory. I certainly do not go into alot of anatomical details.
A doulas role is physical, emotional and informational support. I am way more comfortable providing eduation than I am in using techniques such as a rebozo...which I think is out of SOP.

My clientele has never needed to discuss physiology of birth and stages of labor. All of my first-time parent clients have taken a CBE class, independent of my services. I ask them and they all have. Why beat a dead horse?

It has been my experience that those that hire me tend to KNOW what a birth doula is. I've never felt that I was expected to teach them.

Sure, there are questions from every mom. Something like, "At how many centimeters does the bag of waters usually break?" But, if it's them asking me a question AND if I happen to know the answer then that is well-within my SOP.

I have no outlines or course curriculum, nor do my clients anticipate I will.

ETA - In the future, if a first-time parent will not be taking some type of CBE class I will recommend certain books for them to read.

I guess I disagree with this as a generalization. While I think it's a good idea and certainly beneficial for someone who wants to teach CBE to take a formal training of some sort, I don't think it's *necessary* for everyone. Just like one can be a great doula w/o a formal training, I believe one can be a great CBE w/o a formal training. I personally have spent the last (almost) 12 years doing personal study on childbirth. Do I think I'm as knowledgeable as I could be? No. Do I think I would still benefit from more education? Absolutely! Which is why I'm studying with PfB (Lamaze) and why I haven't begun teaching formally. But I do believe that I have a good base of knowledge ~ and like I mentioned before, after observing a CBE series, I realized that I could easily teach right now if I needed to. There are things I want for my CBE classes, though, that I am not sure I'm prepared for at this point. But that's just me being a perfectionist and wanting things the way I want them...not as much about lack of knowledge.

Some of the best classes we have in this (expanded) area are taught by CBEs who are not certified (or even formally trained). I wish that these classes were close enough for my clients to attend easily.

Every CBE program has begun by an individual or individuals who have somehow sought out the knowledge themselves and put the training/study program together. So why can't an individual do that for herself, without an "organization" behind her?

I'm not really advocating the substitution of CBE classes with prenatal visits. But if there are no GOOD options for clients in a particular area, I don't see doing some education as outside my scope of practice at all. Call it "information" if you want, but much of sharing information is educating. My prenatals aren't really like CBE classes at all, but I find out from my clients what they want more info on and what questions they have, and from there I put together *some* education for a visit. Then in our conversation, questions and answers naturally flow, which consists of education. Even if a couple has taken a formal class, there are still bound to be gaps to be filled for their personal needs/desires/questions. Education doesn't have to be one's forte in order to be able to offer some education.

I see myself as there to help the client in whatever way I can informationally. If I don't have the answers, by all means I refer them to someone who does, or give them resources. But I would never shy away from answering questions that I can answer in the name of making sure I'm not doing any "childbirth education."

This is interesting...how differently each doula practices.

I think that I may be a little confused also. I offer information about different comfort measures I help with birth plans,etc... is this being a CBE? I don't mean do to so by far, but I don't like to get answers for my clients if they have questions.

I believe the two roles overlap to some degree. I have knowledge and I share it when asked. If a client is asking about some aspect of birth such as why some positions are better to labor in than others, they want me to know the answer and be able to communicate it in a way they understand and they can use. I have no problem pulling out a pelvis model and baby and showing them... This is education which empowers them to make decisions about their own birth. I find the better prepared my clients are by taking a good CBE class the more questions they have at our prenatal. I never assume the CBE class was deficient I applaud her because she motivated her students to want to dig deeper. It is the clients who have no questions who make me nervous going into a birth:lol

I'm curious why do you think techniques with a rebozo is outside a doulas SOP?

See this is another major issue I have.... are we providing services beyond what we are being paid fairly for? I mean if you are spending 6+ hours prenatally then 12-24+ hours at the birth, then 3+ hours on a postpartum visit. Then that works out to $16-10 per hour before expenses! I'm glad you've set some good limits for yourself, Michelle. Don't get me wrong, I love doula work but I just couldn't sustain my family budget at that rate. It would also be a recipe for burn out for me.

It kind of boils down to "why buy the cow if you can get the milk for free?" if they know you will provide "childbirth education" during prenatals then of course they won't pay for classes. If you say CBE is a separate service you provide and here is my package rate for doula/CBE... then they can choose to pay for that. I think people value what they pay for more highly and are more committed to it. Of course this is all my opinion only.

Thats why I had to set limits. I love what I do..but this is my job. I expect to make an income from it..and dammit I want to make a good income.

I talked about it in another thread I posted...but I am in a hurry and have no time to look.
I just feel that anything I do as a doula to try and turn or shift or rotate a baby is totally out of my scope. I know lots of doulas feel differently, but for me thats how I operate.

i do make my visits with my clients a childbirth education class, when I can. I really do let the client lead the way though, some dont need as much education as others do, and some dont want it. But I do my 4 prenatals with them more than anything to get to know each other and build a rapport, that way it is all done before labor, and they arent getting used to my presence while trying to get used to the nurses, the doctors, the residents, etc... I dont really have a set format, just following what my clients want/need based on their questions etc. I do have a reading list that I like them to pick a book from and read, and we talk about ways to stay healthy during the last phase of pregnancy,how to prepare for a natural birth, breastfeeding, newborn care, the importance of resting, fresh air, good food, and lots of peace and love surrounding them.. ( yeah... im a hippie born a generation late... so what.. :P )
But It works for me and my clients
Love and Light,
Denise

i don't think this is cbe. in our practice, we do one prenatal where we go over their questionaire, what they want for their birth and comfort measures. If they need CBE, we offer a labor support plus package, which for an extra fee includes 2 cb classes. Covered are the anatomy & physiology of labor and birth, stages of labor, interventions, comfort measures, positions and the newborn and pp period.

This is one of those "hot button" comments for me, and I acknowledge that you are clearly stating that this is your opinion only.

However, I just so totally disagree to the core of my being when it's stated as a general statement. We have a group practice, and we've had grant funding in the past and we currently pair up student doulas with people who can't otherwise afford doula services, in addition each of the doulas in our practice agrees to do one pro-bono birth per year if necessary.

While I totally acknowledge that there are people who will go for the "free stuff" and not value the service, there are plenty of people who can afford the service, pay for the service and don't value it either. It's a status symbol for them, and sometimes a cop out. "I hired a doula but I still couldn't <insert x,y,z> here because of <x,y,z> reason."

Then I have people like the woman who called me last week in tears. She had no one. No support, no friends, no family, no one. She couldn't afford a doula and she was terrified to give birth alone and she could no longer disassociate from the upcoming birth which was just about 2 weeks away.

I'd have taken her on the spot, pro-bono except for the fact that I'm out of town Thurs-Sun for the CAPPA conference around her EDD, and then we're leaving for a week on Monday to go on vacation. Before I hung up the phone I told her, "I will find someone to be at your birth, you will NOT give birth alone." In the meantime I told her if she went into labor before I called her with the name of her doula to call me and I'd be there.

It took me a few hours but I secured her a doula and she was beyond greatful. She totally understands the value of the services she's receiving and she deeply values and appreciates that she was able to obain them." There are just as many who are like her as there are those who would take advantage.

I see a lot of "don't do your cert births for free" advice on here, and I remain in the quiet minority of disagreement. I've never had someone who used a doula flake on me, since I took over running our doula practice I haven't had a client flake on a student doula. We did institute a small administrative fee, but even those client who don't pay that fee because that $60 is a financial hardship for them haven't flaked. Maybe we're just lucky, I don't know, but it's certainly NOT my experience that one doesn't value what one doesn't pay for.

I'm eternally grateful for a lot of things I've been given in my life. Just because we received a vacation to Lake Tahoe for free (we only paid for food), doesn't mean we didn't appreciate it, value it and enjoy the heck out of it.

Some of the best things in life are free.