Hey everyone,

I have a few questions, and below is why I'm asking them:

1. Are any of you willing to share what topics you go over in which particular prenatal visit? (i.e. visit #1:, visit #2; etc.)

2. Do you stick to these plans with each client, or do you find yourself deviating depending on the clients' present knowledge level/wishes and time you have to work with them?

I'm trying to figure something out. I'm a person who likes to be very structured (lesson plans/outlines) when it comes to instructing and can't seem to be that way because each time is so different from the others. I've read how most doulas seem to have a set # of prenatal visits and set planned topics for each visit. My problem has been that in the past, the majority of my clients seem to come to me just 2-3 weeks before EDD, causing me to feel very pressured to give an enormous amount of info in maybe 1-2 long visits (i.e 3 hours each!!!). I know that this is neither ideal for the client, nor for myself; I'd prefer to break things up more into shorter visits. Now, I have a first-time client who isn't due until the end of Jan. (2nd baby, previous hosp. CBE class, previous epi. & wanting a natural birth this time). I have more time to work with this couple than I'm accustomed to. I'm trying to figure when to start Prenatals with her and how to make them really good, informative,....maybe 3-4 shorter prenatal visits? Any thoughts?

Another thing is that each client comes to me with differing expectations/needs. Some come to me knowing NOTHING , and they are nearly due, (causing me to go into crash course of Childbirth Ed.), while others are very educated and don't need the basics (just going over relaxation, comfort measures, interventions/options). So.....how do/would you handle such scenarios? I'd like to be somewhat flexible for my clients needs, but each time has been so different that I always feel like it's my first time trying to figure out how to do good prenatals! It's driving me nuts! I'd love a system to stick with and not feeling so "new" at doing prenatals every single time I have a new client; is that expecting too much? If you have any advice for me, I'd be so grateful.

If this is confusing, please let me know and I'll try to clarify. I was thinking as I typed, so I'm afraid I ended up rambling.

Edit: Fixing typo..."driving ME nuts, not MY nuts". I don't have any of those!

i usually do #1 Nutritional counseling #2 fetal positioning and emotional concerns #3 comfort measures for birth, birth plan and fathers concerns. i've sometimes combined them for clients that live far away or for moms that hire me late in pregnancy.

Lynne,

My goodness, girl.....that was quick!! No sooner than I hit the submit button...there was your reply, it seemed!

for answering so quickly. So....would you stick to that agenda regardless of what knowledge level your mom and dad are starting? Do you ever feel the need to teach basic info, i.e. stages of labor and basic childbirth terms (i.e. one of my moms didn't know what "ruptured membranes" meant when I first mentioned the term!). She was one that hired me 2 weeks prior to EDD; I ended up doing a crash Childbirth Ed. course (2, 3 hour long visits for that). It felt like a necessity to me; I find it difficult to work with a couple in labor if they have no knowledge base. Maybe I'm making too much work for myself???

i pretty much stick to it, if theres certain procedures they think they want we'll go over th epros and cons too, but the mini childbirth ed course usually gets thrown in with the comfort measures class. i also sometimes do a mini breastfeeding course as well. but yeah it sounds like you could be doing a little too much work unless it makes life easier for you in the long run.

I feel the same way often but I also started out just teaching CBE and transitioning to just doula work is hard. I feel like they need to know it all and there isn't enough time to provide the info. So I change often but am starting to feel a groove and realize if parents want to know more then they have to take on the responsiblity, not me. So I will suggest a CBE class or a book to read. My first meeting is doing an intake form, this helps me identify their knowledge, their needs, and how they want/see their birth going and what my role is for them. We may jump all over talking about different things in labor, I let them lead for the most part and just listen, then I go over all their choices so they can start working on their birth ideals, I give them some basic pros and cons and encourage them to read "thinking womans guide to a better birth" or research more on individual topics. The 2nd meeting is all about comfort measures and addressing fears ( I do activities from Creating a Joyful Birth Experience and Birthing from Within). I give some handouts so they can educate themselves as well without me babbling for hours. I really encourage independent CBE classes as it helps to just expand on the info they are getting instead of trying to present it all in such a short time. I find that if at least fear is addressed everything else can take care of itself once labor begins.

i encourage them to read thinking womans guide and birthing from within as well. we just dont have time as doulas to do a proper cb class. bradley teachers do 12 weeks! we dont ahve that nor do most of us get paid enough for it.

Hey Lori,
I'm the same way, like to have things laid out and planned ahead of time but lately have been getting clients who aren't taking classes or some that take the classes but get nothing out of them I've had to abandon what I normally do and wing it lately .

Anyway, I learned a trick from a friend of mine here, she has a "homework" sheet for her patients (she's a MW) to take home and complete. I lend them books and videos (sometimes I write down websites too) based on what they want to learn and mark those on the homework sheet. Ask them to specifically look for and study things that pertain to them (if they're being pushed to induce for example I ask them to do a little reading and research on induction) At the follow up we review what they learned. It's amazing to see all the work they've done! They come away with a better understanding of their individual situation, and then I can build from that.

Hope that helps some

I want to thank everyone who has responded so far! Your tips are helpful. It is sounding like I'm doing too much work and that I should have the parents do more of it instead of me feeling like I need to "spoon-feed" them (especially if they didn't take the time for CBE classes!). From reading your comments, it also sounds like I should be able to come up with a plan and pretty much stick to that. Parents can get that extra info needed from books and videos at this stage of the game.



Yes!!!! You've hit the nail on the head. It sounds like our situations are very similar! Thank you for sharing the "homework" idea. I really like that. It places the responsibilty back on them (as it should be). Lately I've been coming out of prenatals either thinking to myself, "...that visit was waaayyyyy too long; I probably overstayed my welcome!" OR "They have so many learning gaps; I guess I'll have to start from scratch with them". Your suggestion might be the perfect thing for me. I think I'll try to make up some kind of worksheet for that first visit! Thank you so much!

i wuold love to see your homework sheet!! i've ben trying to make up something like that but not sure what i should include on it.

Thanx for bringing that up, Lynne.

I'd love to see it too, but I was too shy to ask!

Don't know why....the worst MamaBellies could say is , right?

MamaBellies....I do understand if you aren't at liberty to share. If you could, though, that would be AWESOME!

I'm not like that Let's see if it'll copy/paste...

Labor Preparation Homework
Thought you were done with homework? 
The goal of our 1st meeting is to establish how I can be most beneficial to you and to get to know each other better. For our 2nd meeting I would like to get further into labor and what to expect, variations from the normal, comfort techniques and what you can expect the 1st few days postpartum. Below are some items I’d like for you to review before our next meeting. This will expand on what you’ve learned in Childbirth Class going into subjects of particular interest to your labor and birth; it will also give us a base to build on in your preparations for a healthy baby and peaceful birth.


- Books, Videos or Websites-








- Handouts from your folder -
Road Map To Labor- look it over if you can; noting the differences & techniques used
Optimal Fetal Positioning- try to practice this every day






- Exercises -
Baby Breathing Exercise- at least once a week
Positive visualizations- daily (your body gently laboring, your baby gently being born)



- Other -
Talk with your HCP about your preferences pertaining to labor and birth

Well that's sort of it, I have it in a graph form though?

awesome thanks. i kind of indirectly give homework but i dont think the moms always take it seriously. i think if i could hand them an actual list of assignments they'd be more inclined to do them.

for sharing, Mamabellies!

I do think that I can use this to make up a worksheet. You're a big help!

Welcome

Well I only do two prenatals with my clients, and yes I stick to a certain plan on what I go over with every family. I tell them right up front that even if they know what I am talking about to please bare with me because I have had clients in the past say they knew something and then I skip it and later on they realized they didn't know the exact direction I was going in.

For me I choose to do only two prenatals because sadly I do not want to be wasting time traveling back and forth for each visit. My clients never live close to me so if I did four short visits that would usually still entail an extra hour of drive time for each visit - resulting in me being gone from my family much longer.

If after I go through everything or during the time I am if they have questions then sometimes we go off on another topic, but I still cover it all. Here is what I go over prenatally:

!st prenatal:
[INDENT]Medical / Personal Interview
Prenatal Interview
What is a doula?
Watch DVD (3 R’s)
Birth Planning
Go over models of childbirth
Go over binder
Medical interventions
[INDENT]Medications
Pitocin
Antibiotics
Pain medication (do pain preference scale in resource binder)
AROM
Blood drawn
Internal exams
I.V. / Heploc
External monitoring (do simulation)
Internal monitoring / Intrauterine pressure catheter
Episiotomies
Vacuum extraction / forceps
Cesarean birth [/INDENT] Foot massage – relaxation [/INDENT]

2nd prenatal:
[INDENT]Go over birth questionnaire and birth plan
Comfort measures:
[INDENT]Massage
Relaxation – music, lighting
Heat / cold packs
Hydroptherapy – tub, shower, wet clothes
Positioning
Birth ball – model and try various positions
Positioning – share handout and try some [/INDENT]
Avoiding episiotomies / perineal massage
Typical signs of labor (handout)
SROM (handout)
Timing contractions (handout)
Stages of labor
Lochia
Newborns
Appearance
Bathing
Umbilical cord care
Circumcision care
Breastfeeding (handouts)
Positioning
Engorgement
Plugged ducts / mastitis
Sore nipple / thrush
Pumping / hand _expression
Signs baby is getting enough[/INDENT]

I also make sure that I leave "homework" for them each time I leave. I expect all of my clients to be proactive at least a little bit. Even the free births I have done with teen mothers who didn't want to work with anyone else (ie didn't attend their childbirth classes) I told them right up front that working with me meant doing some "homework" and participation. I have yet to meet someone who wouldn't do it - even the teens did it which at times surprised me.

I forgot to say that I also have created a resource binder which I leave with each family. It has information that they might find interesting on the topics above, but I chose to do it in binder format so that I don't have to copy 50 or more pages for each client.