Tricare's Childbirth and Support Demonstration Overview - Part 1

First doula client in California

My first experience as a doula remains vivid in my memory, especially now as I reflect on those early days when insurance coverage was just a brief overview in our trainings. Doula support at the core has remained steady, but everything else to do with it has rapidly evolved. I recall that birth walking through the halls of Naval Medical Center San Diego (Balboa), guiding my client through her contractions. Her husband was deployed, and I had volunteered with an organization that provided doula support for military families. While she was the first of many clients, I often think of her. Little did I know, that moment was the beginning of my journey to where I am today.

That initial foray into doula work plunged me into a world filled with unique challenges, navigating the regulations of overseas military bases, leading doulas when I was still learning as a newer doula myself, educating our military families and community as a whole about doulas. There were times when I’d be supporting families without a backup doula due to fellow doulas either moving or having a baby of their own. I often found myself in uncharted territory I was completely unprepared for, embracing the rhythm of the season, trusting my instincts and staying attuned to God's guidance. I prayed that I was making the right choices throughout the journey. I ventured alongside clients to learn about Japan's birth cultures and delved into SOFA status regulations when military families faced bogus restrictions on home births or placenta encapsulation, taught new doulas, built relationships with our local base programs and hospitals, said goodbye to many great doulas who became close friends. Consistency and continuity became a key player amidst the constant turnaround. When the time presented an opportunity I was able to attend a Senate of Armed Forces Committee Meeting back in the states and yes, I was that person who boldly handed out educational material to other attendees about doulas and the military. Not sure if that was allowed, but I did it anyways. Always hoping it would fall into the hands of the right person.

Camp Lester Naval Hospital, Okinawa. Photo Credit: Military Bases.Com

During this period, I dedicated myself to establishing private organizations on military bases and cultivating relationships within the Military Treatment Facility. I recalled advice to find a champion in the hospital, and I did—an incredible nurse who sadly lost her life and baby to HELLP syndrome. It would not be the only time a difficult circumstance resulted in another pivot. One particularly memorable moment this nurse and I had together; during a birth, the provider was visibly irritated as the parents asked questions to better understand their care. Afterward, she encouraged me to keep pushing forward despite the ongoing attitudes from some providers, a message that resonated deeply with me because at this point in time, I was one of the only active working doulas on island and I felt like I had no one in my corner to call and talk me through these experiences within the Military Healthcare System. Yet I persisted because there was a need for change and support not only for families but birth professionals who supported within and outside our military structure.

“ To all healthcare providers: if your hospital has a doula policy, I encourage you to review it, involve your trusted local doulas, and familiarize yourself with other certifying organizations. Ask your team what purpose does this serve and why it’s being implemented. I do not, as many others, align with just one certifying body, hold a membership, or answer to organizations that I am not certified through. Therefore, I will not be signing any policies that reflect them. ”

In the beginning there were times I would often look for support from my certifying body. They had little to no presence overseas, limited experience with military contexts nor did they offer support to fellow military spouses like myself. When I finally touched base, it was advised not to reinvent the wheel, but the reality was that there was no wheel to begin with. That was an eye opening experience which told me they were not in a place to provide guidance or feedback regarding doula support in the military system. Support and resources for birth professionals in my community were truly non existent aside from what was created on a local level. This was also a time before the internet became what it is today, making connections while living overseas resulted in limited access to information and being shared like it is today. Despite limitations, our community flourished. Ways were sought to educate military leaders, I participated in working groups on the island, and connected with larger organizations to raise awareness beyond the Pacific—even though we often felt dismissed or overlooked. No one wanted to talk about birth apparently even though there were glaringly big issues that needed addressed the system.

One of many educational group talks with military families. 

At times, it seemed the hospital might stop allowing doulas altogether, and those moments were isolating. Eventually, I found strength in two remarkable mentors, Gerri Ryan and Linda Herrick, close friends and colleuges, and a military community that courageously advocated for better birth experiences and options. Despite harsh interactions and criticism from those unwilling to learn or support, I knew I was on the right path.

I remember discussing Tricare coverage with fellow doulas, feeling uncertain about where to begin. I just knew it had to come from the top. I never imagined that I’d be here today talking to you about Tricare and doula coverage, witnessing how everything seems to come full circle.

Here we are 2024 and I’ve been back stateside since 2017. When the news broke that Doula coverage for Military Families was being introduced as a bill, it was a moment filled with anticipation and apprehension. A group of doulas who had dedicated much of their careers to understanding the needs of military families came together to make formal recommendations to the appropriate personnel. Yet, no one ever reached out or followed up with us after it was submitted. To this day, when I read the Federal Register, I can’t help but notice some of the very same language from our documents appearing in there.

I remain skeptical that any doulas were consulted or had a seat at the table, despite our numerous meetings and phone calls. There are only so many people one can speak to before realizing they all seem to lead back to the same individuals.

Nearly three years after the CBSD demonstration was voted into the NDAA and integrated into Tricare, I anticipated challenges. Some of which I hadn’t foreseen or fully understood, especially since, as a doula, I’ve never worked with insurance. With many states now adopting Medicaid coverage, doulas are grappling with this new territory of billing, medical terminology, insurance codes, and everything else that comes with it. When this demonstration launches overseas, it limits access to coverage only in the private sector. It also creates another obstacle of military spouse employment, navigating SOFA status regulations, the ability of military spouses to work in host nations, and the fact that many military members give birth on base OCONUS limits access of the program those who are seen by a host nation provider.

Another shift I'm noticing is an increasing interest from organizations and businesses that are suddenly keen to connect with the military doula community, despite having shown little to no interest in the past 16 years of my experience as a doula. I can’t help but question whether their motives stem from a genuine desire to support our military birthing community or if they're simply looking to profit or gain influence. As a result, I’ve chosen to approach these interactions cautiously, especially with those who have never engaged with military doulas, birth professionals, or families, or who seem to have ulterior motives.

In closing this section, I find the current guidance from the DHA and its contractors to be quite chaotic. While one contractor has made commendable efforts to keep new doulas well-informed, the overall lack of support remains troubling. Recently, it has come to my attention that only one certifying body is being consulted by one of the Tricare contractors, despite its limited grasp of the unique needs within our military doula communities, both CONUS and OCONUS. This exclusive approach risks fostering inconsistencies and misunderstandings throughout the system.

More to come….

The Birth of Loralai Elaine

The week before I had Loralai, I started trying to do a few things that might induce labor. My sister had arrived from North Carolina and I wanted to make sure she would be able to be my doula birth before she had to head back! I went and got an adjustment from my chiropractor to make sure baby would be able to settle into the best position for birth. She flipped back and forth ALOT the last week and couldn't seem to decide on whether she wanted to be LOA or ROA. I did a lot of exercises from the Spinning Babies website as well. I also went back to chiropractor and had some acupuncture done to see if that would induce labor, but all it did was make for some slightly more intense Braxton hicks contractions. I walked and walked and walked and ate my eggplant parmesan casserole, but to no avail. I was hoping for baby to come either a day before or a day after the 4th of July but that wasn't in the cards for me.

That whole week, I would wake up around 3 or 4 am with some intense consistent contractions, but they would always fizzle out around 7am. Leaving me disappointed and tired. I can only assume I was experiencing prodromal labor and that was incredibly frustrating! Friday morning those contractions started again. I tried to not get excited when they lasted past 7am.

I woke up and got breakfast for Hayes and I, then we went on a walk. When we got back, they were still happening, but only about 1 every 45 minutes. I tried to rest, bounce on my exercise ball, and distract myself with watching TV. My husband, Nate, got home from work and I was able to take a nap, but not for long as the contractions were starting to pick up. They weren't very strong but they were noticeable enough to keep me from being able to rest well. We ate supper, got Hayes ready for bed and rocked him to sleep. I continued to have contractions. They just weren't consistent whenever I timed them, so I tried to ignore them and rest. It was around 10pm when they were getting stronger and I think I called my sister to let her know they were picking up, but I figured it would be a while before we’d need to notify the midwives.

With my first child, Hayes, everything moved so slowly and I assumed it would be the same. I was waiting for that point when they'd last for a minute, be 3-4 minutes apart for an hour. I would lay on the couch and time them. They'd just be all over the place! No real consistency and vary in intensity.

Nate fell asleep. I'd get up to go to the bathroom. They'd be really hard to breath through and it would be like one long contraction until I laid back down. Then they'd space out again. I woke up Nate and he kind of helped me through them, but apparently I was handling it well enough that no one felt like it was getting close.

I honestly didn't think it was close! I had called my sister again and wasn't sure if she should come over yet. She sounded unsure if she should yet either, but we decided to have her go ahead and come since I was feeling like needing more help with focusing.

I texted Brandi, my midwife, and told her that I had been having contractions since 11pm. Also that they were starting to pick up and lasting about 1 minute, happening every 7-10 minutes and that we'd be calling her in a while. This was at 1:34am. I was starting to get nauseous and got up to go to the kitchen and get some frozen grapes to eat. I had one LONG and INTENSE contraction the whole time I was up and quickly went to go lay back down. I was feeling pretty sick and started to wonder if I wasn't going into the transition phase as I remembered feeling that way with Hayes. But I thought that surely it couldn't be the case as my contractions were still so inconsistent and not quite 2-3 minutes apart. I was definitely starting to lose control of my emotions. Nate was airing up the birth pool and I was feeling pretty concerned about everything that was happening. Just as I was having another contraction, my sister stepped in the door. I felt my water break, which I immediately told her, and I felt the baby’s head drop. I pretty well knew I'd be having a baby soon. My sister sat on the floor by my head, kept me calm and helped me breath. It was such a relief to have her there as her presence was very calming. I finally felt in control again. I told her I felt like pushing and I believe at that time, Nate got on the phone with Brandi, who was headed our way, and told her that. I was trying VERY hard to not push with contractions. But it was getting impossible. My sister told me she might have to look to see if she could see the baby’s head.

It was then that I had another contraction.

My body took over and I pushed.

I stood up and immediately felt the head drop down and out!

Nate and Amanda were on the phone with Brandi while she was talking them through the delivery process. I just remember praying that everything would be okay. That God would protect me and my baby. That baby would be healthy.

My sister stayed very calm and kept me calm. I don't remember feeling scared or anxious. I just knew I had to finish the task. With one last push, Nate caught our baby girl at around 2:45am.

I had no real pain with pushing. I never really felt like we were in danger. I can only assume that the Holy Spirit was very present with us throughout the whole process and He was keeping everyone calm and collected. And obviously kept our baby from any complications that can come from childbirth.

I sat on the floor and held Loralai who was crying and pooping everywhere. I was just in absolute awe of how quickly and easily she came.

Now as all this was happening, Brandi got into a car accident while trying to tell Nate and Amanda how to deliver the placenta. Nate had to call our other midwife, Kathy, who is Brandi’s mother, to tell her what happened but also that we still needed help with the placenta and other things!

Things were getting a little stressful because it seemed like it was taking a little too long for me to deliver the placenta. The midwife had told me to stand up. As I did, the placenta was delivered and fortunately there wasn't too much bleeding afterwards. I was helped into bed where we waited for our midwives to arrive.

We all just sat there. Pretty dumbfounded at the events that had just taken place! My photographer, Jenny Good, had arrived (she showed up shortly after Loralai was delivered) and took pictures. I was a little disappointed she had missed the birth but it was no fault of her own as she didn't get a phone call to come out until I was pretty well pushing!

The midwives finally showed up, checked me and Loralai out and we both were just perfectly healthy. No tearing for me and she was a healthy 8lbs 3oz.

Brandi seemed to be doing fine. As it turned out though, he hurt her foot pretty bad and also had a concussion! I felt so awful for her and her new vehicle also got totaled. I felt almost like I was to blame for her accident. If only I had called her to come out sooner. All of this could have been avoided. But I know that everything happens for a reason and looking back I don't know how the situation could have really been remedied as I really never felt like it was urgent that we call sooner.

Hayes woke up shortly after they got there; I'm still surprised he didn't wake up sooner with all the commotion happening. Nate brought him in to meet Loralai and he seemed pretty unimpressed and mostly just wanted mommy to hold him. I'm sure he was pretty confused with everything happening and probably pretty tired since it was around 4am, but it didn't take long for him to warm up to her later that day. I didn't have any issues getting Loralai to nurse, and the whole healing process was so much better this time around. Hayes’ birth and recovery was just all around difficult, so I felt very blessed to have an easier second time around. Looking back, the birth of Loralai still amazes me. It's crazy what our bodies can do when we just let them take over and not try to intervene. I thank God for His provision over us and over the birth, but hope the next time around we can have our midwives present!

Photo credits: Simply Good Photography by Jenny Good

She's going to take my place.

Maybe you’ve heard of a doula.  Maybe not. When I first meet a woman and begin to explain what my role as a doula is, I usually get the comments of, “So you’re like a midwife.” Or “My friend had a doula and she left because she got an epidural.” (Insert tounge in cheek and continue to kindly smile as I pull together my thoughts and prepare for a more in depth discussion of the do’s and don’ts of doula services).

After a delightful debrief on what my service entails, mom is now on a doula high, ready to whip out a pen and sign my contract.

But wait. Here it comes. The response that usually leaves me hanging in the valance wondering if I will ever speak to this individual again. “This sounds great! I’ll need to talk to my husband and get back to you soon.” I agree wholeheartedly! I believe 100%  both parents need to be on board with hiring a doula. The majority of the time I won’t sign a contract unless I’ve sat down with them making sure they understand and agree to my role. I may or may not ever hear back at this point. If I have the contact information I will follow up. Often times we don't hear back.

So let's address this here and now.  Yes, I’m speaking right to you Dad, Birth Partner, or whoever is chosen to fill that role. I want to use this opportunity to help you think outside the box after reading this.

*Disclaimer. I understand every situation and personality is different. Not everyone may need a doula at their birth.*

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  Imagine you’ve taken all the childbirth classes and feel relatively prepared. Relaxation techniques have been rehearsed, bags are packed and your contraction app ready to go. Kind of like all the training done to prepare for a big basketball game. It’s 2:00 am in the morning and let say you've had a rough day at work.  Let’s throw in a couple of visits to the hospital a few days prior for practice labor. It wasn’t progressing and they sent you home. Now she's waking you up saying it’s real deal. Reluctantly, you roll out of bed and start getting stuff together. Now momma is telling you to hurry!  You’re trying to remember if her purse has been packed and if there are kids, they still need to wake up, get dressed and ready for the sitters.  Out the door everyone goes. Finally making it to the hospital. Time to check into Triage. The questions start to ensue. 

“Has her water broken?”

“How long are the contractions?” 

“When did labor start?”

"When was the last time she went to the bathroom?" Dad is thinking,"What? Wait. You mean taking a crap? Is that even supposed to happen?" 

"Have you seen any bloody show?" Bloody what! There's so much stuff! I don't remember being told about this.

  *Insert- deer in the headlights look.*

  Of course momma is able to answer theses questions. More than likely though she's not in the mood to be thinking about her last bowel movement. Labor is progressively getting more uncomfortable.

"Ma'am, we need you to stay laying down so we can get a good read on the monitors."

She's having a hard time staying in the bed. Now mom is asking to get something to drink or go to the bathroom.  You’re still trying to wipe the sleep out of your eyes but high on an adrenaline rush. So much coming at once.

Mom gets admitted and depending on where baby is at delivery could be imminent or it may be hours. We will say in this case mama has some time to go.  You get over to the delivery room and try to get settled but now paperwork to be filled out. (Yes some places parents have to fill out admission paperwork at the time of delivery.) Momma is working hard. She may be asking for medication at this point. You haven’t even had a chance to give anyone the Birthing Preferences aka Birth Plan.  People have left the room and you were able to get the lights dimmed and review the plan with your staff. Things seem to be back on track. But now you, the dad or birth partner, has to go to the bathroom! Momma is begging you to stay to hold the counter pressure on her back. She starts getting to a point where she’s saying she can’t do it anymore. Asks for medication. Starts crying and saying she doesn’t know what to do.  There’s some staff in the room and they are saying she can have the epidural but it was stated she didn’t want one. Your head is spinning. Trying to remember everything taught in class. Mom is tired. You’re tired.  This didn’t happen how we planned.

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  If I run into mom again or I follow up with her about hiring a doula, often times the answer is, “We decided to not hire a doula because my husband didn’t want one.”

  Deep down inside I was truly hoping that they would have at least entertained the idea of a interview. After all, it's  free with no obligations. I feel like once I can sit down and have dad ask me those difficult questions, we can now address those concerns. Then I hope they feel well informed about whether or not a doula would still be a good fit for their birth.

“Sidenote: I’ve seen one too many sticky situations where a doula gets into a relationship with a mother who wants her at the birth, but dad is not on board. A lot of tension and division is created. That is not something we want for this birth experience.”

  These reasons listed are legitimate concerns and great questions to ask. Partly why I insists on speaking with both parents at some point. If dad is unable to be present for an interview, I will be sure to let the mother know I do expect dad/birth partner to be on board. whether he wants to be really involved or not before moving forward. I want him to understand I value his presence, participation and thoughts too.

Let's review those reasons why a doula may not be hired. 

I want to reiterate. I am not there to take the other parents place or anyone else for that matter. The in-law, family member or friend.  I am hired as a trained birth professional in the room. To help provide you with information to make informed decision about your care. Assist in comfort measures, emotional support, or encourager to just name a few. I feel like it takes the pressure off of dad feeling like he has to be the one stop shop for everything. I give him the space to take that much needed bathroom break while mom gets continual support. If he’s a really hands on kind of person, sometimes he needs to be reminded to rub moms back like a wave. We aren't sanding a block of wood. Let's be real. You can be just as nervous and scared. You might need someone to tell you this is normal and help talk you through some of the progress. .I feel a doula can help dad fit in where he is most comfortable.

  The inevitable money topic. A lot goes into a doulas fee. Prenatal meetings that last 2-3 hours, presence at the birth from start to finish, follow up care. My longest labor was over 72 hours. This didn’t include the time spent with the family before the birth and after.  You can learn more about what goes into a doula’s fee HERE. So much knowledge and resources are shared. Giving the parents everything they need to feel prepared. From assitance in preparing and discussing birth preferences to how to proactively address the hospital staff if situations should arise that parents would need to have more information on. Sometimes the medical staff can say things parents don’t understand. We can break it down to the basics.  Dad also needs to know he’s doing a good job and that what the mother is experiencing is completely normal. Words of encouragement really do pay off with a dad and birth partner. Fees for doulas vary and so do personalities. It’s important to have that good fit. Like birth, one size doesn’t fit all.

  Heard about a bad experience? Unfortunately the stories are out there.. Just as with any other profession in life. I don’t always know the full story and do my best to guarantee to parents I will remain professional and uphold my end of the contract. Follow your gut on a person's intergrity. It's ok to ask for referrals. Keep in mind there are doulas starting off who won't have a list of people to put you in touch with. I think good business practices and a positive representation of their services speak volumes about an individual.

  We are on baby number 4. I don't think she needs to have a doula. I’ve worked for several families who’ve never had a doula for the first couple children then decide to hire one for their 3rd, 4th or 6th baby. Maybe the experience from the mother’s prespective was traumatic or not fulfilling. Perhaps she didn’t feel like she had a voice or wasn’t able to have the birth she wanted and desired the extra support. Whatever the reason may be, many families have sought out doula support with subsequent children.

  Now let’s visualize the scenario from earlier again.

  You’ve hired a doula, taken all the childbirth classes and feel relatively prepared. You’ve got all the relaxation techniques down pat, bags packed and your contraction app ready to go. It’s 2:00 am in the morning and you’ve just had a long day at work. You’ve been in communication with your doula about the days prior. She’s given you and mom suggestions to relax at home and different suggestions for positions if warm up labor has been off and on. Mom wakes dad up saying it’s real deal. Dad collects himself and gauges what’s going on. He calls the doula and she comes to your home as agreed upon earlier. Your doula is now with the momma and you are able to get the bags packed, sitter called, while the doula is helping her through those contractions. It’s time to go! At the hospital everyone’s asking questions,

“Has there been any leaking water?” “

"How long are the contractions?” 

“When did labor start?”

 "When was her last bowel movement?" Oh yes, she has been pooping all night. Because you know that it's a normal part of labor as the doula reminded you of earlier.  Your doula has been keeping tabs on what has taken place and can give you that information to tell the staff if you’ve forgotten.

  You’re calm and excitedly standing by her bed and helping her breath through contractions. She’s admitted. The mood in the room is filled with commotion and more questions, but now the lights have been dimmed, mom is relaxing and breathing. Dad was able to answer questions from the staff and discuss the birthing preferences. You take a quick bathroom break while the doula stayed in the room with momma. Everyone has left. Mom is asking to get something to drink and go to the bathroom. You and the doula can help mom move to the bathroom. You’re still trying to wipe the sleep out of your eyes but feel confident and at ease having that extra support. Things start to intensify. She may be asking for medication at this point. Your doula looks at you and tells you this is normal and suggests moving off the toilet, applies counter pressure while she leans into you. She starts getting to a point where she’s saying she can’t do it anymore. Starts crying and saying she doesn’t know what to do. Your doula reminds you to tell her what a good job she’s doing, where to massage her and continues to provide that emotional and phsycial support for the momma. The staff was mentioning an epidural earlier, you are able to politely refer back to your birth plan. Not too long after she start involuntarily pushing. The staff is notified. Baby is close to being born. You are in a daze and can't believe this is happening. You are about to meet you baby! Your doula asks you if you still wanted to help deliver the baby if the provider agrees. The provider says yes it's fine. You get into position and feel your new little baby greet your hands for the first time. Your doula is at the top of the bed taking pictures and helping mom through that last little moment. Deep breath. You did it! You both did it! You both are on cloud nine!

  If there's anything to take away from this post. I don't want any parent to think they are just going to be spectators on the sidelines of the birthing experience. I meet a lot of dad's who really want to be involved. Initially it feels like when their wife tells them she would like to have a doula, they think this person is going to take the place of that emotional bond between them. Trust me. I'm not there to fill that spot. I know you want to be the one momma relys on during labor if that what best suites you.  If it's a money issue, then let's talk. I do value what I offer and I know it's important for a family to value my services as well.

“My mission has and always will be to provide resources and a continuity of care for families in the military through the use of birth & postpartum doulas and other birth professionals who contribute their life to this amazing work.”

Working with honesty.....

Being a birth doula and entrepreneur was a very lonesome journey in the beginning while overseas. The first few years were hard to work on establishing a continuum of care and awareness in a place where people move all the time. While I had peers who worked in the birth community here, I felt like I kept hitting brick walls as growth was ever impending on this island. There were times I felt like no one understood the dynamics of our birth community. I am lucky to have a great, supportive birth community in San Diego, but sometimes when you need someone to talk too, calling on the phone with the time difference makes it more difficult. Many times, I found myself relying on my husband to lend a listening ear and mentorship.  I am proud that, even through the rough patches and learning curves, I held on to what I believed and did my best to hold up integrity.

Hindsight is always 20/20.  As I reflect on the past 5 years, I wouldn’t be where I am today if it wasn’t for being consistent, dedicated, and good old fashion hard work.  Even through all the frustrations, ups and downs, just the sheer roller coaster ride of emotions in learning how to establish an organization and a good working relationship with others. I am happy to see what we’ve become today and how this network has grown.

 I want to take a few moments to talk about how getting frustrated and integrity pertains to our profession as a doula. 

Let’s look at what happens when frustrations mount with a doula trying to get her business started and gaining cliental might not be working out for her as easily as hoped for. A choice can be made. Operate with integrity or give into being upset.

What is integrity? By definition: the quality of being honest and having strong moral principles. 

“When I felt those frustrations, I quickly learned to take a step back, reevaluate what my goals were and speak with my mentors back in San Diego to help me grow.”

Giving into those frustrations begins the slippery slope of what I would call The Cascade of Interventions for Doulas. When frustration develops, a doula might start throwing oneself at the foot of any expectant woman who walks by. Whether at the store, gas station or soliciting services for free. In some cases,  a doula may begin pleading with the mother to have her come to the birth even when the birth partner doesn’t want a doula. If that route doesn’t work, jealousy and anger may start to rear its ugly head. The individuals may start acting out of emotion when they see other doulas working.  These negative emotions often lead to  hurt feelings and ultimately relationships destroyed. 

For a doula that is starting to grow a business, I have found that integrity does play an important role.  When confronted with situations requiring integrity, I will take a step back and reflect on what the pros and cons of my choices will be and how it could affect what I represent in the community.

Let's ask ourselves, “How can any of this benefit our expectant families?” 

I want to share with you some tips that as a doula and businesswoman have worked for me and I hope can work for you.

·      Be consistent. This does take time to establish when you are first starting up a business. Remember in everything you say and do, consistency leaves a good reputation with the people you serve. The external impression of your business shouldn’t differ much from the internal.

Bottom line- be consistent in what you believe about being a doula, pricing, and services you offer. Don’t be a butterfly floating from one flower to the next.

·      Be a likeable and reliable. I do understand we will not jive with everyone who crosses are path, but we should respect the other person for whom they are. If we are always being negative and gossiping with a down right bad attitude about everything, people will notice and probably will get tired of being around you.  Being reliable is crucial to someone being able to trust you.

Bottom line- Our reputation and relationships are all we have and it takes time to establish a good rapport within your community. I wished it were easy to say building strong relationships happen overnight. It just doesn’t. I often run into skeptics or those who’ve had bad experiences with doulas before. So their guard is up. Build bridges. Don’t burn them.

·      Online Presence. *DING *DING! This is a HUGE factor in the growth of a business. With social media dominating the Internet, it’s imperative to keep integrity. I recently read an article about companies starting to research potential employees through social media. In a 2014 Social Recruiting Survey, data shows 93% of hiring managers will review a candidate’s social profile before taking on that person.

Bottom line- I can’t say it enough, people are always watching. Be mindful of mixing online friendships and business. Do you want potential clients seeing your personal profile and what’s being posted daily? 

·      Learn your area and audience. Every area is going to have unique differences and a diverse audience.  Think about who your audience will be. Maybe you want to keep things low key and take on limited cliental. Perhaps you want to reach out and go big. What if you desire to volunteer?

Bottom line- There are plenty of pregnant women to go around. We can’t serve everyone.  We each have something to contribute to our community and if it hasn’t been done yet, then connect with those who can help and get something going.  Some areas will have next to nothing. It takes a lot of time and dedication to establish even the understanding of what a doulas role is. You may find yourself walking into a well established community. There’s a place for you too if we treat one another with courtesy and respect.

I hope that something can be taken away from this. I remember being that new doula and wanting to take on the world. I was willing to help anyone. I was ready to hit the ground running. Therefore, I understand what it is like to want to at least have more than one woman on the books. Integrity plays a big role in how not only how the community views a business but how long term people can trust. Be honest. Be genuine. Be humble. Treat others with respect and be courteous. Maintain healthy relationships that lift you up and get rid of the negativity. 

My mission has and always will be to provide resources and a continuity of care for families in the military through the use of birth & postpartum doulas and other birth professionals who contribute their life to this amazing work.