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You are not allowed to not allow me

When talking to families in interviews or prenatal visits or in my childbirth education classes, I can’t stress enough how important it is to choose your care provider wisely. This amazing article on Pathways for Family Wellness (a site well worth checking out) does a great deal to emphasize some of the red flags you should be aware of when meeting with potential doctors and midwives and how to empower yourself with appropriate questions to weed out those that might not be a good fit. 

I know in my prenatal sessions and classes, couples tend to get anxious waiting for me to FINALLY get around to the things they thought they were coming in for–What does labor look like? How do I know when to go to the hospital? What are the tools for having a “natural” birth?–as I spend the entire first pregnancy consultation or the first two hours of my first prenatal session talking about your birth team. 

I have to remind them that all the squats and yoga breathing and mantras in the world aren’t going to make an impact if you have a care provider who doesn’t believe birth is an event not necessarily full of management and intervention and doesn’t really seem committed to helping you have an unmedicated birth. 

One of the ways you can figure out if they are going to be harmful or helpful to your goals of a physiologically appropriate birth is by paying attention to language like “We don’t allow” or “I don’t do that.” If you’ve done your research and know you want to have a water birth, why would you stick with a care provider who says something like, “Oh some doctors/midwives do that, but I don’t.” or “We don’t allow births in the tub here.”? It’s amazing how often I hear pregnant folks say something to that extent and either don’t know that they can switch providers, or know that they have other options, or for whatever reason just don’t think it’s going to be a big deal in labor. IT IS A BIG DEAL! And though having a doula can be enormously helpful in advocating for your wishes in birth, we can’t make decisions for you or fire a nurse a doctor or a midwife for you, and so there’s only so much we can do in the end. 

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Sadly, we in the United States have grown accustomed to poor medical care, a lack of true informed consent, and being told that we can’t possibly know much about our bodies. With most women hearing horrible stories of near-death births left and right, they’ve grown to think that they must also have this kind of traumatic birth, so it doesn’t matter if they “like” their provider much, as long as they’re there to rescue you and baby. It’s precisely this culture of fear and misinformation and lack of choice and trust in care providers that is driving the rising maternal mortality rate in this country (we are the only country–developed or otherwise–which boasts a rising rate). 

So, it does matter who your provider is and where you choose to give birth. If you are currently seeing a provider who uses language that takes away choice and support, SWITCH! Even if they have a nice smile and good bedside manner, if they’re not on your team, fire them. Now and not when you are fighting them in labor. That’s not fair. If you are early on in your pregnancy interview a bunch of different providers. Seriously. How much time did you spend picking out a stroller or car seat? Spend 10 times that amount talking to care providers and staff at the place where you choose to give birth and don’t stop till you’re sure in your gut that you’ve found the best fit. Take a month to do it. Make them sit down with you for an hour and answer all of your questions. 

If they don’t want to give you their cesarean rate, but avoiding a cesarean is your biggest concern in pregnancy, keep hounding them or leave and never look back. 

You are 100% entitled to having the birth you want. There’s no being “selfish” or “smug” or “bossy” or “difficult” in asking for care that is supported by evidence and is kind and supportive. Choosing an appropriate care provider who gives you options, supports your choices, and practices according to informed consent is also not just for parents hoping to not use pain medication in labor. This isn’t you not being particularly nice to a waiter somewhere, this is arguably the most important day of your life and what happens in labor has long lasting effects for you, for baby, and for your family. It’s not about being a “smug hippie” or trying to win an award for best mom, this is about you taking control of a very normal, natural process that shouldn’t leave you battered, scarred, and needing therapy. 

Do not allow them to tell you you’re not allowed. 

If you want more information like this, sign up for a pregnancy consultation package or hourly conversation. That first investment can save you stress, time, money, and help you connect to a care provider in line with your wishes and needs in pregnancy and beyond.

Pregnancy Challenge Week #2 -- Save for a Doula

I’m starting a series of challenges to expectant parents to encourage them to take small steps toward better care, more informed decision making, and a smoother transition into parenthood.

Over the next few weeks, I’ll be posting on action item in this vein, with some information for why and some resources for how. I imagine the challenges will be steeper for some families than others. I also imagine that it will vary person-to-person which action items are more difficult than the others. Some families, too, I imagine won’t face a ton of barriers, but just needed some guidance on the fact that these things are available.

What’s on the docket for Week 2?


I challenge any expectant family to start budgeting for a doula.

budgeting for a doula


So I might need to start with answering What is a doula?

A doula is a secondary support person trained in non-clinical support in the childbearing year and sometimes beyond.

Doulas are not primary caregivers, so they work in tandem with midwives, doctors, nurses, midwife assistants/apprentices, lactation consultants, etc. Most often you will hire a doula independently, though some birth centers and hospitals have on-staff doulas you can or are required to choose from. Most doulas work primarily in a hospital setting, but can join you for an intended home or birth center birth, as well.

Evidence shows that the one of the best ways to reduce the number of unnecessary interventions, improve maternal and infant birth outcomes, reduce disparities in care and outcomes, and create more satisfying birth and postpartum experiences is to have continuity of care that includes continuous labor support. Most families are very surprised somewhat late in their pregnancies to discover that they aren’t going to get that from their primary care providers in a hospital setting (and this includes hospital-based midwives who work on a shift schedule), hospital staff, or pediatricians. This is where doulas have come in and where the evidence shows that they can help families have better birthing experiences -- both in emotional wellbeing and in reducing unnecessary medical interventions. Following the first publications of these findings, one author famously said, “If ‘doula’ was a drug, it’d be unethical not to use it.”


Most birth doula packages include 2-4 appointments prenatally to discuss your individual pregnancy and desires for birth as well as common coping practices, community resources, advice on having good communication with your primary care providers and other staff and loved ones that might be present at birth, your options in pregnancy and birth, the typical stages of labor, and some newborn advice. They are on call for you 24/7 for a window typically two weeks prior and two weeks following your guess date (it is a total guess when your baby will arrive, btw). They are available for phone, text, and email support throughout your contract. They will set a plan of communication around the early stages of labor to be your primary point person for what’s going on in your individual birthing situation. They join you when you are in active labor and need additional support and help you stay at home longer if birthing at the hospital help with the communication around when to call your midwives if you are birthing at home or a birth center. A doula will then go with you/stay with you at your intended place of birth till baby has arrived and for a short while after to help talk about baby feeding, what to expect in the first few days, and to check in on how you’re settling in after birth. Most doulas include 1-2 follow visits in your home in the first two weeks following birth to cover a wide range of topics on healing, feeding, newborn care, and other items of need.

Postpartum doulas focus primarily on care for parents and infants in the first 2-4 months after birth. Some birth doulas are also postpartum doulas and are available for extended care packages through the childbearing year. However, it is possible to hire an additional or exclusively work with a postpartum doula, too. They typically work either daytime shifts of 3-5 hours a few days a week or overnight shifts that shouldn’t be longer than 8 hours each. Though it may seem amazing to hire a postpartum doula for around the clock care, most families feel very well educated and supported with having a trained, thoughtful person come in to check on them 2-3 days or nights per week. Ideally, you are working with them on a tapered system where there is denser coverage in the beginning that fades to maybe one day or night shift a week to help you transition into caring for baby on your own once you have a rhythm established.


The cost of a doula varies based on what’s typical in your community, what their packages include, and their level of experience. It is possible to work with a doula who works on trade, sliding scale, or on a volunteer basis, though I encourage you to explore the value of the time, effort, and resources this person is putting in to being your support person in this immensely intense time in your life. Having said that, if you are really wanting to work with a doula and it isn’t in your budget, there can be lots of avenues for finding a fantastic doula that can fit your economic needs. Many doulas will be more than happy to reach out to their community to find you a good fit or to connect you with an organization that offers volunteer support.

Even in high income areas, the upper reaches of birth doula fees are typically under $3,000 for full care and the national average is around $1,500. Postpartum care, especially overnight care, can run into the tens of thousands of dollars over the course of several months. The highest fees don’t always reflect the level of support you’re getting or denote who might be your best fit, so it’s worth researching a wide number of doulas and asking even the higher fee doulas if they’re willing to work within your budget or have a strong recommendation for someone who can.

For this challenge, I want you to imagine setting aside at least $2,000 for doula support if you can. According to Fortune, folks spend an average of $1,300 on Amazon per person per year. Individuals in the US spend about $1,500 each on vacations per year. The average cost of a wedding is almost $26,000, which is also an enormously important day for many, but also just a single day and doesn’t carry quite the same lasting benefits and risks as having a positive birth experience...I mean, even the cost of the cake on average is $500. What would it mean to put that towards several hours of personalized postpartum doula care?

You can make up these costs in a lot of different ways. I have an earlier post on how postpartum preparation can help save you a ton of money you can put towards doula care I’d encourage you to take a peak at, but the gist of it is

BUY LESS BABY STUFF

Can I challenge you to try this : Every time you are about to purchase something for baby, can you either do without it (the answer is almost certainly yes) and put that same amount into a savings fund for a doula? Or can you put a matching amount in that savings fund? Many useless baby items will run you about $35 a pop and will likely wind up in the Goodwill pile where $35 is about the hourly rate of many postpartum doulas. That $120 countertop sterilizer machine…? Guess what, there’s no sound evidence on sterilizing bottles and a lot of good evidence on why not to so there’s $120 closer to your birth doula fund. There is no gadget out there that can replace having quality labor support or someone helping you to navigate the tricky first months with a newborn.

Friends, family, and co-workers are often very very excited to help you greet your little one and want to show you. This often leads to them purchasing a ton of stuff, and it’s up to you to direct them into another option, if you really want support around having a doula. Don’t be shy about talking about your process of hiring a doula, trying to reach your budget goals, and that if you’d prefer it, that you’d rather have some money to put toward doula support over another book or pile of onesies.

What about expensive gender reveal or baby showers? Can you have a celebration with friends around this that isn’t full of cheap decorations you’re just going to throw away? Have it be a potluck with fun games around baby names and the like and ask your guests to chip in to your doula fund in lieu of obligatory baby gifts you might not ever use. You can ask your doula to attend, even, and talk to your guests about how beneficial their support might be to you in the long run. If it doesn’t feel too tacky, you can put out a box/jar/whatever with the label “doula fund” and even if you just get a few bucks, you’re a few bucks closer to $2,000.

Or, if you don’t feel like making a ton of swaps to your plans for celebrating before baby arrives, can you just set a goal of how much money you’ll set aside per week till you hit your doula fee goal? If you have a partner, you can ask them to do the same and set up a mutual savings spot and even make it kinda fun somehow. Maybe get an old school piggy bank and smash it when you’re ready to hire your doula!?

Did you go out for a regular giant fancy coffee drink or regular cocktail that you’re abstaining from in pregnancy? You could calculate how much that cost you per week and put that money directly into a fund for your doula, who will be your new self care and indulgence guru.

Have you ever found yourself saying something like “I’d pay $X for a nap right now?” Well, put a number on that, start setting aside a few naps worth, and think about the beneficial rest your postpartum doula will help you take once baby’s here and think about paying them to help you achieve that when you need it most.


If $2,000 is an unrealistic goal for you or is much more than you need based on fees in your community, just pick a different amount and save away!

To read a bit more about the true cost of a doula, you can check out my article on the cost breakdown here.

If you want more information on how to find, save for, and hire a doula, you can set up a 1hr phone consultation or sign up for one of my full pregnancy and/or postpartum consultation packages where I’ll talk to you about doulas, how to save money in this process, and much more.

If you participate in these #pregnancychallenge ideas and want to share, please comment below, send me an email, or tag us @Rosewoodrepro on instagram and let us know how you are doing! Happy saving!

Pregnancy Challenge Week #1 -- Choosing a care provider

I’m starting a series of challenges to expectant parents to encourage them to take small steps toward better care, more informed decision making, and a smoother transition into parenthood.

Over the next few weeks, I’ll be posting on action item in this vein, with some information for why and some resources for how. I imagine the challenges will be steeper for some families than others. I also imagine that it will vary person-to-person which action items are more difficult than the others. Some families, too, I imagine won’t face a ton of barriers, but just needed some guidance on the fact that these things are available.

So let’s start with the challenge for Week 1:


I challenge any pregnant person, at any stage in their pregnancy, to go out and interview 4 primary care providers in their area.


While this might seem most beneficial for families earlier on in their pregnancy journey, if you are not feeling 100% supported, informed, and comfortable in your care, it is not too late to look around. Truly, most of my birth clients wind up hiring a doula in their late second or third trimesters because they thought they were going to get more education and support in pregnancy at some point from their providers and realize fairly far along that they need to outsource.

It doesn’t have to be that way. Don’t accept sub-par care for ANY REASON.

If you are not digging the approach your primary care provider is offering, or you know that the person you are seeing for primary care in pregnancy will not be the one working with you in birth to make decisions, why would you expect them to suddenly jive with you come your day of birth?

how to choose a care provider in pregnancy

Do you want to be pressured into decisions you don’t agree with when you are having a baby? Do you want to have to come in expecting to fight off things you don’t agree with? Do you want to continue care when you are skeptical of where advice is coming from? Do you want to feel like you are paying a TON of money to still feel lost after months of working with someone through your pregnancy? Do you already feel like you’re having to give up a lot of your parenting desires to appease your provider’s thoughts around your care? Do you think your visits are long enough? Do you feel exhausted from having to outsource a lot of your education to get the support you need?

The communication you are getting through pregnancy is a dress rehearsal for the big day with that provider/practice/place of birth. You don’t need to wade through care that feels inadequate and hope for the best. A doula can only do so much to help you in this circumstance, too. It really matters who is guiding you in the clinical components of pregnancy and who will be there to help make major medical decisions with you in birth.


So here’s is what I propose -- Spend 1-2 hours a week for two weeks in interview with 4 additional providers and/or go on a birth center or hospital tour or open house or to a meet the midwife event.  


I read an article recently that said that on average, we watch about 550 hours of Netflix per year. We spend an average of 53 minutes on Instagram per day and 2.5 hours scrolling on our phones total through each day on average. I’m challenging you to spend 2 full hours A WEEK for two weeks face to face with the provider who is going to be your primary point person for one of the most intense and important experiences of your life.

Except we do…that ACOJ study makes it really clear. Doc’s make decisions based on “opinion” not science.

Except we do…that ACOJ study makes it really clear. Doc’s make decisions based on “opinion” not science.

I want to encourage you to pick 4 providers who offer something different than the care you are currently receiving -- a midwife with hospital privileges, a family practice doctor with hospital privileges within your network who can transition into your baby’s primary pediatric care provider, an independent homebirth midwife team or two, or going to a free standing birth center’s open house tour.

I promise you that this won’t be a waste of time, even if you feel these providers or locations feel like a stretch for you for whatever reason. You are not bothering them, this is part of your job. If you switch providers, they won’t be hurt or care, it’s part of their job to work with new people all the time. They are there to answer your questions and address common concerns/dispel myths about their care. You will feel fairly certain in these hours that you have seen what other care looks like and if you choose not to switch, you can feel confident you made the right choice for your family. If you have been questioning your care, you have started a foundation toward understanding that something different exists and how to access it. There is a very clear and palpable difference in the styles and types of care each different type of provider can offer. It’s worth the investigation.

The Harvard School of Public Medicine did a large survey a few years back and discovered that most families choose the place they’re going to give birth (the hospital where they’ll give birth for 99% of American women) because it was the closest one to them. This is not necessarily the best fit for most families. They also found in the same research project that it was clear that the setting and provider made the most difference in whether or not a birth ended in a cesarean surgery, not risk status or how the labor progressed. This is due in large part to litigation-based care and not evidence based care, doctor opinion, and the lack of continuity of care with shift-based primary and birth care, and lack of continuous labor support in hospital settings. With that in mind, isn’t it worth spending 4-8 hours investigating your options?


Here are some questions to take to these interviews :

  • What is your training and background?

  • How many years have you been practicing?

  • What is your philosophy on pregnancy and birth support?

  • How do you approach clinical testing and exam options? Do you perform those all yourself?

  • If I hire you, how likely will it be that you will attend my birth?

  • Where are you able to support me in birth (home, birth center, hospital)?

  • What is your personal cesarean rate/rate of the place you attend births/transfer rate (for out of hospital midwife practices)?

  • How often do you attend unmedicated vaginal births?*

  • How long do your prenatal sessions typically last? What topics do they cover?

  • Do you offer centering programs or childbirth prep classes in your practice?

  • Do you encourage working with doulas?

  • How much communication can I have directly with you in pregnancy and labor via phone/text/email?

  • How many pregnant persons do you support in a month?

  • What does your follow up care look like?

  • Are you available around my due date?

  • What is your rate and do you accept insurance/sliding scale?


You should be looking for more than just a pleasant bedside manner. Many families say to me that they stuck with their provider because they felt unsure of how to switch and anyway, their provider was “nice.” Since an ACOJ paper pointed out that ⅔ of standard OBGYN practices were based in low-tier or opinion based evidence, I’d say it’s a good idea to look beyond proximity to your home and how nicely your provider might be telling you inaccurate information.

And I don’t mean to pick on doctors alone -- You might find your dream clinician by switching to a new practice or different hospital. Not all midwives are identical and it might take interviewing a few to find a fit you feel comfortable working with. Home birth might be off the table for you in your mind, but you hadn’t thought to check out the free standing** birth center in your area.

Hiring a doula earlier on in your pregnancy journey can help a lot with this. Doulas are interacting with primary providers and individual birth centers and hospitals often and can give you a pretty broad starting point for some providers who might prove to be a good fit. They can also help affirm your decisions, ease your anxieties about switching, and help you sort out some of the ins and outs of the insurance issues.

This is also a big part of my pregnancy consultations services and I can do in person or virtual consults on this topic exclusively if you’re needing further resources for how to choose a provider that’s right for you. In ten years of this work in many different states, a few other countries, in hospitals and out, I can tell you that who you have by your side in pregnancy, birth, and postpartum makes an ENORMOUS impact on your safety and satisfaction with the experience, completely independent of the outcome. You need a provider in line with your wishes in birth and parenting. I’m here to help you find them.


If you’ve accepted this challenge and want to share your story, please feel free to comment below, send me an email, or touch base with me on Instagram @Rosewoodrepro. Happy hunting!


*If that is something you are hoping for it is important to ask this that specifically. Many doctors are trained to use “natural” birth to mean “vaginal” birth, regardless of medical management leading up to that outcome. You might want to also ask for more specific information on how many inductions they oversee a month/year, how often they use vacuums or forceps in births, how often they support parents not wanting medical pain management, if they “labor sit” or spend non-management time during birth in the on call room, their thoughts on “post-dates” inductions, what they consider to be a “high risk” pregnancy, if they treat pregnancies in persons over 35 years old as “high risk,” etc.

**A note on the language around “birth centers,” many hospitals are now calling their maternity floors “birth centers” and maybe having a nurse midwife or two on staff, but this is very very different than a free standing birth center with independent, case-load midwives, something many families don’t realize till they do the hospital tour late in the third trimester and realize it’s not a separate unit from the standard hospital birth care and are disappointed.