When you are looking for a doula, there is much to take into consideration. The most obvious is: personality. You must believe that you can establish a comfortable rapport with your doula. You want a doula who you can feel comfortable with, who is personally relaxing, and is knowledgeable. Then, there’s another obvious one: cost. Can you afford this particular doula? I’m happy to tell you that a many doulas will negotiate fees, while some will take services or exchanges instead of money (I paid my doula with a professional camera!). Even more exicting is that some brand-new doulas offer their services for FREE while they are in training!!!

   One thing that you may not have considered, though, is that doulas have differing birthing preferances and beliefs just like you do. Some doulas have very rigid preferences; for example, some will work only with midwives and may specialize in homebirths. Other doulas are happy to work with OBs, Family Practice Physicians, and Midwives. Beliefs range from “natural only” to acceptance of drug-assisted childbirth. It is important to know if your potential doula agrees with what you expect of your birth. This is why it’s important to have have somewhat of an idea what you expect of your birth prior to your interviewing potential doulas.

   Another important consideration is: doula involvement. Do you want your doula to act as your primary coach or as your partner’s assistant? If you prefer your partner to be the primary coach, your doula can be there to suggest positions and stretches to your partner and show your partner how assist you with them. Most doulas are willing to work on either end of the spectrum, but there are some who are very specific (mostly in their beliefs of assisting the partner/husband).

   These are just a few of the things you must take into consideration when deciding on a doula. Feel free to contact me if you have further questions!

     Since the beginning of time, experienced women have been helping new mothers through their birthing experiences. Research has shown that having a doula present at birth puts the mother at ease, gives her feelings of security and comfort, and increases confidence. After birth, the new mother is more likely to be successful at breastfeeding and is less likely to have postpartum depression. Clinical studies have shown that having a doula:

• Results in shorter labors and less complications;
• Greatly cuts the need for labor-inducing drugs, birth by forceps, vacuum extraction or by cesarean;
• Reduces mothers’ requests for epidurals or pain medications;
• Reduces negative feelings about birth experiences.

       I have had people argue that having a midwife is enough, but I truly believe that a midwife and doula each hold their own important place in your birth. Having a midwife is great because they tend to be with you more of the time (as opposed to an OB), but a doula never leaves your side. Your doula will be with you from the time you call her to a few hours after your child’s birth. She helps with laboring at home, goes to your birthing center with you (if a birthing center is what you choose), fills in while your partner rests, suggests laboring positions and comfort measures, and offers support with your baby’s first feeding. There are many more things that your doula can help you with, but there is too much to list.

      I hope that my brief article has shown why you should consider having a doula present for your next birth. Consider going to DONA International’s site (http://www.dona.org)  for further information. Article research and clinical studies information found at: http://www.dona.org/mothers/why_use_a_doula.php

As foster parents, we’ve often found ourselves with questions that we can’t find information about in books or on the Internet. Even if you find something in one of those places, who knows if you can trust it? Some questions are just too important–where do you go to find good, solid answers? There are a number of places and people that you can contact, and based on the question you have, you will want to talk to different people/organizations. These are not necessarily in the order that you should contact.

1) Fellow foster parents/care providers: Meet them at foster conferences, seminars, support groups, even childrens’ consignment shops and sales! Be sure to save their contact information, along with how you know them and what ages they take, along with how long they’ve done foster care. You’ll find that keeping this information can really help when you’re trying to find an answer to something specific.

2) Foster parent organizations: The people who work for these organizations have an amazing wealth of knowledge regarding foster care and adoption. They can give you information about foster parent rights, procedures, support/training meetings, respite care providers, and so much more. If you have an organization in your area, take advantage of it! It’s really quite a privilege! 

• http://nfpainc.org/ is a great place to start. Go to the “State Organizations” tab at the top and choose your state to find a local or state association. We’ve used our organization time and time again–they’re truly a God-send!

3) Forums and Chats: Meet and communicate with other foster care providers, caseworkers and medical personnel from around the United States. Ask your question, do some errands, and come back to (sometimes) a wealth of answers!

• http://www.fosterparentforum.org/
• http://forums.adoption.com/foster-parent-support/ and http://forums.adoption.com/foster-care-adoption/
• Chat at: http://chat.adoption.com/

4) Your child’s caseworker: Some caseworkers are great and others aren’t. If you’re lucky enough to get one of the great ones, and they’ll have information for you regarding how you can help with the child’s current situation. If you have questions regarding Medicaid or other state/federally subsidized programs, they’re a great starting point. Ask your caseworker for their email address and send them messages for quicker responses to your questions.

5) Foster care agencies: I am not agency-based at this time, so I haven’t had the opportunity to utilize this resource. Employees and caseworkers at these agencies can be very useful; I’ve found that many of them have been around for quite a while and can share a wealth of knowledge. They’re also typically very friendly, which helps tremendously!

6) Support Groups: Contact your local foster parent support organization (see above, #2). The great thing about support groups, is that they usually count towards your required training hours. You can also find great respite providers and new friends at these meetings!

7) Online communities: Join a community (group), get to know other foster care providers, and grow your own network! Answer questions, ask questions, gather a group in your own area, and offer some emotional support! Just one warning–they’re addictive!

• http://community.babycenter.com/groups/a2285/foster_parenting?intcmp=Rel_SP_group

ASK ME! I’m always happy to talk to anyone who calls me with questions or needing a shoulder to cry on.

I could go on forever, but I think I must attend to my family once again! Please leave a comment if you have any further questions, and I’ll get back to you!

     My husband and I started the long process of high-risk adoption 3 1/2 years before the adoption of our 4 1/2-year-old daughter was finalized. It took 1 month to wait for a class, followed by 3 months of PRIDE Class training, followed by another 5 months of insufferable waiting and 2 Home Studies. We were lost in the system due to a “re-organization” as they put it, so this is not the standard–theoretically. FINALLY, 9 months after the start of this whole process, we got a few phone calls here and there offering kids that we’d accept and then they’d never show up for whatever reason. One time they didn’t even call to tell us they weren’t coming after all. I called the next business day and they non-challantly told me that “oh, we found a family member to take her.” NICE. It was very disheartening, but we were desperate and were not about to give up after all we’d been through to get where we were. Then, one day, July 23rd, 2007, I got a phone call about a sibling group of 2 that needed placed immediately. They told me the kids were half-siblings and the girl was 2-years-old and her brother was 10-months-old (he turned out to be 7 months old–but apparently the case worker didn’t take the time to figure out how old he was). They said that the girl (I’ll call her A) had headlice (try a RAGING case of headlice) and both children were from a neglect situation and would need a bath right away. Understatement of the year. I asked if there was a chance they’d be adoptable, but they told me they couldn’t even guess. From what I heard, I decided that it was worth a chance. Within 2 hours of that phone call, Mark and I picked up the kids from the Department of Health and Human Services and took them home.

     Not one month later, we found out that I was pregnant after 2 1/2 years of infertility. It was an amazing month–until I miscarried in September. The loss of my child was horribly painful and left me completely broken. More like shattered. We almost sent the kids back because I was such a mess and we couldn’t get the help we needed. We called NFAPA (The Nebraska Foster and Adoptive Association), and they were able to find us respite care. I thank the Lord for NFAPA, because if it wasn’t for that kind act, we wouldn’t have ended up adopting our daughter. In January of 2008, we found out again that I was pregnant and, thank the Lord, our son MJ was born on September 25th, just a year and a week after the death of our first child. A and MJ bonded very quickly, while K came to know what the term “sibling rivalry” was all about. 

     Anyway, things were very slow with the foster kids’ case until their mother relinquished rights to them, leaving A available for adoption. Her brother, K, was not available for adoption at that time because he had a different dad, and his dad was working very hard to get him back. We adopted A on April 15, 2009 and changed her name to Zoe. This was by far one of the best days of our lives.

     Soon after Zoe’s adoption into our family, we were suprised to see her brother go home to be with his bio-dad, leaving yet another rip in the already-hurting family. My daughter seems to be doing fine regardless of her bio-brother being gone. K seems to be doing well too, from the little I am allowed to know. I hope that they will have the opportunity to grow up knowing one another. I also hope that they will have the chance to meet their two other siblings–an adopted sister in Florida and a brother who’s currently in foster care right here in Nebraska. Until then, I pray that God will keep his gentle hand on all of them, raising them up in the way they should go. If God will take care of the sparrow, I know He will care for them.

Ten Steps to Successful Breastfeeding

Every facility providing maternity services and care for newborn infants should:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half an hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
7. Practise rooming-in – that is, allow mothers and infants to remain together – 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Source: Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services, a joint WHO/UNICEF statement published by the World Health Organization.

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

1. Offers all birthing mothers:
   • Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
   • Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
   • Access to professional midwifery care.
2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
5. Has clearly defined policies and procedures for:
   • collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
   • linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
   • shaving;
   • enemas;
   • IVs (intravenous drip);
   • withholding nourishment or water;
   • early rupture of membranes*;
   • electronic fetal monitoring;

   other interventions are limited as follows:

   • Has an induction* rate of 10% or less;†
   • Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
   • Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
   • Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
7. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
8. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
9. Discourages non-religious circumcision of the newborn.
10. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
    1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to implement this policy;
    3. Inform all pregnant women about the benefits and management of breastfeeding;
    4. Help mothers initiate breastfeeding within a half-hour of birth;
    5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
    6. Give newborn infants no food or drink other than breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

Source: The Coalition for the Improvement of Maternity Services