The "due date" has come (or not) and you are beginning to feel changes in your body that might indicate that your baby is preparing to meet you! 

These changes might include:
- Pre-labour contractions (previously referred to as "Braxton-Hicks" contractions)
- Low back pain and pelvic pressure (although this may not be new in late pregnancy!) 
- Release of the mucus plug
- Hind waters leaking (a slow leak of amniotic fluid) 
- Fore waters breaking (a big gush of amniotic fluid) 
- Early labour contractions: contractions that follow a clear pattern but are less than one minute long and mild to moderate in intensity. 

Especially for first time parents, the instinct when these signs begin is to gather your belongings and rush to the hospital, or call the midwife immediately to settle in for an out-of-hospital birth. But, birth may still be days or weeks away! The biggest piece of advice I give to clients at this stage in labour is to REST. Rest as much as possible until you cannot ignore the contractions, and then keep resting more. Imagine not sleeping for 2 or 3 days and running a marathon. Many many parents (and I used to struggle with this too as a new doula) get overly excited during early labour, go to the hospital sooner than needed, and exhaust all energy and tools before the really intense part of labour sets in. Then when things get ramp up towards transition and pushing, there is no energy store to draw from. Exhaustion is usually the first step in the cascade of interventions that lead to an unwanted surgical birth. Additionally, seeking clinical care earlier than needed often leads to unnecessary augmentation or so-called failure to progress. 

So, here are a few ways to spend your time in early labour: 

- Sleep or rest between contractions. You may even be able to sleep through contractions in very early labour. 
- If it is daytime, go for a long low impact walk in nature, taking in the sensory experience of a slow walk. 
- Date night or time with friends and older children and pets. 
- Immerse yourself in water. Take a long bath or shower. 
- Listen to a birth-focused meditation, practice intention setting, or pray. Get into the zone of the mountain of birth you are about to climb. Breathe deeply and notice how it feels to surrender to your body's timeline. Talk to your baby! Tell them you are excited to meet them soon and that you will take care of them as they embark on this journey of labour with you. One of my favourite birth meditations is linked here. 
- Do a short, low stakes project that is easy to abandon, like a puzzle, knitting, or low-stakes household task.
- Low impact movement, like lunges, cat-cows, and hip-openers. 
- Put your phone away! Don't record the space between contractions until they become regular and unavoidable. You may note the time that contractions began, but expect things to stay mild for a long time, especially if you this is your first pregnancy. 

And did I mention REST?! 

Have other favourite rituals for early labour? Leave a comment! 

Whether planned or due to unexpected complications arising during birth, needing a c-section can invite different type of needs from a vaginal delivery. One of the most common fears with a c-section is that the birth isn't "real" or doesn't hold the same type of gravity that giving birth vaginally does. This is simply not true. Having a baby via cesarean is still giving birth. Both types of entrance for baby can be beautiful and meaningful for you, your baby, and your family. 

It is important going in to your experience, whether it is medicalized or non medicalized (or sits outside of that binary) to know that ALL birth is inherently meaningful and sacred. Whether a through surgery, at the hospital, or at home it is possible to tap into that spiritual significance while adapting to the circumstances. No matter how baby comes to meet us, we can tap into the magic of birth when we find pathways to do so. 

This post will include a few practical ideas for highlighting the spiritual transition of birth in surgical settings. 

First of all, if you are planning a c-section it will be easy to incorporate spiritual or religious significance into your plan. This may mean playing a certain piece of music in the OR while baby is emerging (yes, this is allowed in many hospitals), or having your support person read a poem while baby comes. In the OR, you can also request delayed cord clamping and skin to skin  once baby has arrived, the same as if a vaginal birth occurred. Skin to skin can and should happen in the OR! This may look like your support person placing baby against your chest while the tissue is being repaired postpartum. You may ask for the placenta to be saved for your observation or keepsake. Once you reach the recovery area after surgery, you can continue skin to skin and baby may begin to root to try a first feed if you are planning to breast/chest feed. 

Another wonderful idea that one of my clients with a planned cesarean had was to have her friends and family all light a candle in their respective homes during the time of her scheduled surgery. This is one of the beautiful things about a planned c-section - your community and loved ones will know when it is happening and be able to send you well wishes or say a prayer or thought for you on the day. 

While recovering from a cesarean can bring its own pains and challenges, there are many resources to support in recovery and it is okay and a good thing to ask for support. One of my favourite resources that I often draw from is nurturingthemother.ca. Janelle provides many resources that support expectations and needs around cesarean birth, and has a recovery guide available on her website. 

The most important takeaway is that giving birth via c-section is still giving birth. It will still release the hormones that move through the body to promote bonding between birthing person and baby and support lactation. There are so many ways that c-sections can be made meaningful through ritual, music, poetry, and bonding and it is more than possible to leave your c-section feeling satisfied with your birth experience! 

Attention ALL pregnant people! 
Have you visited a pelvic floor physiotherapist? I cannot stress enough how much misinformation is out there about pelvic floor health for all people and how much a pelvic floor physiotherapist will help you in preparing for birth and postpartum. Below are a short list of benefits of pelvic floor physiotherapy for the pregnant and postpartum person. I won't touch in this post about pelvic floor health for non-pregnant people, though I recommend it for all. 

Education 
Dr Juan Michelle Martin, PT and doula is an advocate for skilling up in information about pelvic floor health (Listen to her speak here). She attests that unfortunately, gynecologists and doctors often do not voluntarily offer information about pelvic floor health, forcing the client to initiate questions that can feel vulnerable and uncomfortable, especially when they pertain to sex or incontinence. This creates a widespread culture of uncertainty and shame for all people around asking questions about pelvic floor dysfunction. Speaking with a pelvic floor physiotherapist, you will likely have more questions asked and issues addressed than with a doctor who does not specialize in the field. 
​
Prolapse Prevention 
Out medical system is more reactive than preventative. This is why it is prevalent for doctors to often under stress the importance of pelvic preparation for birth, because they are comfortable supporting repair and reconstruction from perineal tears and pelvic prolapse. I have spoken with birthing people who tell me that their doctors say not to worry too much about tears because "we can fix that after". But, what if we worked to prevent injury as much as we do to repair it? Your pelvic floor physiotherapist will help with strategies to stretch the pelvic tissues, to prevent common injuries that occur with a pelvic floor that is either weak or too tight during birth. In her book The Fourth Trimester, Kimberly Johnson writes that, to many of her clients' surprise, more pelvic floor muscles she works with are overly tight than they are weak. The goal not always strength, the holistic goal is to create a responsive pelvic floor to cede to let baby through. The overprescription of pelvic floor squeezes (also commonly referred to as "kegel" exercises) is a lazy, sometimes harmful lapse in care when we are aiming for RESPONSIVENESS in the pelvic muscles, not strength. 

Reducing Back Pain
Pelvic floor physiotherapists offer exercises to reduce and manage back and sacral pain during the third trimester. Additionally, physiotherapists will help with addressing back pain that can occur during breast/body feeding. This is because the musculature of the pelvic floor is closely linked to all of the lower parts of the body including the spine. 

Safe Strengthening and Recovery 
Postpartum pelvic PTs will know the level at which to work at to support a safe recovery of the core muscles. They may also be able to massage scar tissue from perineal injury or cesarean section. 

Pleasure 
Sexual pleasure and access to sexual pleasure is a basic human right. Let's throw out the idea that new parents shouldn't get to choose to have good sex when they are ready, please! Becoming a parent does NOT mean that your sex life is over, or that you will be wearing pads or feeling pain perineally for the rest of your life. Pelvic floor physiotherapy gives the postpartum body tools to strengthen and recover to feel pleasure and comfort again at the pace that the postpartum person wants and consents to. 

In summary, your pelvic floor health is not disposable and your comfort is important. So much of our medical model teaches pregnant people to see themselves as passive vessels for their baby's growth and health. There is no reason to allow for preventable injury just because it can be fixed afterwards. It is never too late in pregnancy or postpartum to visit a pelvic floor PT whether you are struggling or not, to support your comfort and well being! 

Looking for a pelvic floor physiotherapist in Toronto? Ask your care provider, or explore this​ list of providers linked here. 

This week’s blog post is all about what to expect during a membrane sweep, otherwise known as a “stretch and sweep”, a common method used by practitioners to release labour-inducing hormones. 

A stretch and sweep is different from a cervical exam. During a cervical exam, a practitioner will use their fingers to feel the cervix. This may occur before labour, to gather information about the state of cervical softness, thinness, and level of effacement. Cervical exams may also occur during labour, to estimate cervical dilation and assess your baby’s level of descent through the pelvis (also known as pelvic station).  However, during a cervical exam, a practitioner will not manipulate the tissues to induce labour. 

It is important to note that consenting to a cervical exam does not mean automatically consenting to a membrane sweep. You may choose to request a membrane sweep at OB or midwife appointments within your due window (usually 37.5 weeks onward), or it may be important to you to avoid any interventions to a spontaneous onset of labour. It is important to be clear with your provider your wishes for or against a membrane sweep or any other intervention offered. You always have a right to refuse cervical checks and interventions at all times throughout pregnancy and labour.

However if you are wanting to get labour started but are wanting to avoid induction through synthetic oxytocin, a stretch and sweep alongside other less invasive induction techniques may be a wonderful choice for you! 

What a stretch and sweep involves: 
A stretch and sweep involves your provider inserting one to two fingers into the vagina to feel the texture of the cervix. If the cervix is soft and thin, the provider may choose to use a finger to gently “sweep" the amniotic sac away from the uterine wall, in an effort to move membranes away from the wall of the womb. This action helps release hormones called prostaglandins, which, along with oxytocin, stimulate labour.  If the cervix is hard and closed, the provider may use their fingers to massage the tissue in an effort to begin cervical softening.

Is the procedure painful? 
A stretch an sweep can cause discomfort and may feel alarming, especially if the provider performs the procedure without consent. Always ensure your provider is aware of your preferences and knows you require warning should they choose to perform a membrane sweep. Lubricating jelly will help ease some of the discomfort, though you may wish to implement some pain management strategies like deep breathing or visualization during the procedure. 

What happens after a stretch and sweep? 
After a stretch and sweep, it may be common to experience bloody “show”. This show is a clear mucous plug which, when released, may continue to be produced during labour. It is normal for the mucous plug to contain a small amount of blood. You may also begin to feel cramping which comes and goes, which may be a sign of early labour contractions.

What are the benefits of the procedure? 
Studies show that membrane sweeps may improve your chance of having a spontaneous labour. Alongside other non-invasive induction techniques, it can be an effective way to avoid induction through synthetic oxytocin. It is also a zero cost intervention, and relatively non-invasive. It does not come with other interventions and can be repeated if desired. 

Does a stretch and sweep include risks? 
The risks of a stretch and sweep may include a higher chance that the membranes will rupture before labour, especially in the absence of cervical softness (read more here: https://evidencebasedbirth.com/updated-evidence-on-the-pros-and-cons-of-membrane-sweeping/). When membranes rupture before labour, there is a risk of infection to you and/or the baby and medical induction is recommended. 

For more information on membrane sweeps, talk to your provider! The bottom line is, consent for membrane sweeps needs to be verbal and informed. A membrane sweep is not a routine part of a cervical check. A membrane sweep is a relatively non-invasive and low risk intervention that may help your body naturally begin labour. 

Still have questions? Leave a comment on this post with your email, or contact me! 

Traditional Chinese Medicine teaches us that warm foods support uterine health and restore energy and balance in the body. Warm foods should be consumed both postpartum to promote healing of the uterine wound and during menstruation and ovulation. 

Cooking delicious homemade food is a wonderful way to care for a postpartum on menstruating person in your life. 

Here are some favourite warm womb foods I have made this fall and winter! 

​Pearl barley and beluga lentil soup (gf without barley, can be made vegan with vegetable broth) 
Makes 8 servings (good to freeze half for days with low cooking capacity) 

Adapted from Melissa Clark via NYT cooking 

Ingredients 
3 tablespoons EVOO 
2 sliced leeks or one diced onion 
3 carrots, diced
1 cup chopped fennel with fronds reserved 
1 bunch chopped cilantro, leaves and stems
3 cloves minced garlic 
salt to taste 
2 tablespoons tomato paste
1 tablespoon garam masala
½ teaspoon turmeric
1 cinnamon stick
4 cups chicken broth
1 cup pearled barley
1 cup beluga lentils
1 to 2 tablespoons lemon juice

Step 1
In a large Dutch oven or soup pot, heat oil over medium-high. Add leeks and cook, stirring often, until tender and beginning to brown, about 10 minutes.

Step 2
Stir in carrots, fennel, cilantro stems, garlic and salt. Cook until the garlic is fragrant, about 2 minutes. Stir in tomato paste, baharat, turmeric and cinnamon stick, and cook until the tomato paste begins to caramelize, about 2 minutes.

Step 3
Add the broth, barley and beluga lentils, and bring to a boil. Lower heat and simmer for 1 hour to 1 ½ hours, stirring occasionally, until the barley and lentils are tender. (Add some water if the pot starts to look dry; can be as thick or soupy as you like.)

Step 4
Stir in a tablespoon of lemon juice and the chopped cilantro leaves. Taste stew and add salt and lemon juice if needed. Serve with bread and cheese or butter! 

Butternut squash congee (gf, can be made vegan with vegetable broth) 
4 servings, leftovers can last in the fridge for reheating around 3-4 days 

Adapted from Hetty Lui McKinnon via NYT cooking 

2 cups leftover rice
1 tablespoon neutral oil 
1 tsp salt 
6 cups vegetable or chicken stock
4 garlic cloves, peeled and crushed
1 small butternut squash, peeled, seeded and diced in 1-inch pieces
2 scallions, finely sliced
Chile oil or chile crisp, for serving (although it may be good to avoid spicy foods to reduce cramping) 


​Step 1
Place the rice, oil and salt in a large pot and stir to combine, breaking up any clumps of rice. Add the stock, garlic, and butternut squash (if using). Bring to a boil over medium-high heat. Once it boils, reduce heat to low, cover and simmer for 30 minutes. Check frequently to avoid burning. 

Step 2
Uncover and stir. Increase heat to medium and simmer for another 5 to 10 minutes, until the rice has broken down.

Step 3
Turn off heat. Using a wooden spoon, stir to break up the rice, butternut and garlic. Some of the butternut will stay intact, while some of it will break apart. Add salt to taste.

Step 4
To serve, top with scallions, and a few drops of chile oil or crisp if using. ​

Sweet and sour soup (gf, can be made vegan with tofu instead of pork/shrimp) 
10 servings, can freeze half or save in the fridge for 4-5 days. This is a great option for leftover vegetables and meat with a broth made of ingredients likely already in the pantry. 

Original recipe inspired from the Around the World Cookbook


8 cups chicken broth or vegetable broth
Lemongrass to taste (i used one stalk cut into 4 shorter pieces) 
1/4 cup rice vinegar, or more to taste
1/4 cup soy sauce (or tamari if making gf) 
2 teaspoons ground ginger
Desired vegetables (can include snow peas, carrots, enoki mushrooms, celery, shitaake mushrooms or any other veggies on hand) 
1 can boiled bamboo shoots
1 cup shrimp, peeled if desired 
1 lb protein such as pork butt or chicken breast, sliced to bite sized pieces
1 tbsp chili oil, or more to taste 
4 green onions, thinly sliced


Step 1
Begin by making hot and sour soup base: Combine broth, rice vinegar, and soy sauce with lemongrass, ginger, and garlic. Salt broth. Bring to a boil and simmer for 20-30 minutes until desired flavour of broth has developed. 

Step 2
Add vegetables and bamboo shoots. Salt broth again to taste. Bring to boil then reduce heat and continue to simmer for 30-40 minutes. 

Step 3
While the soup is simmering, add protein to a lightly oiled pan and brown for 2-3 minutes on each side. 

Step 4
Add protein and shrimp to soup and simmer on medium low for 10-12 minutes. Drizzle with chili oil and garnish with green onions.​

​There is a trend toward hiring night doulas at the moment, and many seasoned birth professionals have taught me to feel that it is not always in the best supportive interest of a family to have frequent night support. Night support can be a great idea once or twice per week, to really offer a restful reset, especially when cluster feeding is making sleep impossible. However, postpartum doula support is about nurturing a sustainable transition into parenthood, and while night support can be an important tool for single parents, twins, and parents with other reduced capacities, I would urge new parents to consider whether the trend towards overly frequent night support is offering a nurturing transition, or a crutch to put off adjusting to the transition. There may be other ways to make nighttime work, through learning how to reduce cluster feeding, expressing breast milk to share feeds with a partner, safe co-sleeping, setting boundaries for how time is spent in the day, and adjusting your own rhythms to allow for rest when baby is resting. 

*Please note that night doulas may be necessary in reducing the risk of postpartum depression and psychosis that can come from lack of sleep. I am not discounting times when night support is a necessary mental health intervention.*

Because of the alienation of parenting from the rest of society in late capitalism, many people who are pregnant for the first time are unskilled in knowing how truly demanding postpartum recovery and adjustment is on the body. And, because of the devaluation of mothers and reproductive labour, the idea of postpartum lying in and rest is seen as modern western culture as indulgent. The reality is that a postpartum body is at its most vulnerable that it may ever be in life. The separation of the placenta from the uterine wall leaves a wound the size of a dinner plate that takes an immense amount of internal energy to heal, not to mention the calories that are drawn from a breastfeeding parent's body to produce milk, or to repair tissue damaged from tearing or cesarean delivery. Postpartum bodies need tender rest and care, and a rewiring of internal rhythms to meet the needs of the newborn. 

There is a saying within postpartum doula communities to eat when baby eats and sleep when baby sleeps. And though it seems impossible, it is so important to strive for this. This comes not from hiring a baby-sitter for every night to avoid this new rhythm, but from arranging life to adjust to this new relationship to time and sleep, creating cycles of resting, waking, and eating that shift outside of the normal (capitalist) cycle of 8 hours sleep at night and 3 meals per day. Your baby is eating 8-10 times in a 24 hour period, and taking small naps in between these feeds. Remember, a newborn baby’s stomach is the size of a walnut — the digestive system moves quickly. You will want to have many small meals and naps whenever possible, day and night. 

When you have a new baby, your life and schedule is going to change and your capacity will be automatically limited. You will need to train not only you baby’s body but your own body to sleep in the day, to be able to wake 4 or more times in the night to feed. The other need is to train the mind to not tend to any other responsibilities other than the needs of your baby and older children. Postpartum and breastfeeding parents should not be doing dishes, laundry, errands, and cooking. Postpartum parents should by no means be working. This is where the support of a doula/partner/grandparent during the day comes in, tending to the outside responsibilities so that your body can focus on milk production and uterine and/or cesarean healing. The other need is to set boundaries to advocate for this rest. Time with family and friends during the day should not be using the energy bank up ——and yes, you are allowed (and encouraged) to go take a nap while others visit your home. If you are feeling that your energy is depleted from visits, it is reasonable and fair to advocate for no or few visitors during the lying in period (first 40 days) or as long as you need to feel nourished by the presence of others.

The reality is, the way you rest and times you are able to rest will change when you have a newborn. Especially if new parents are exclusively breastfeeding, cluster feeding will happen and there will be nights where, shockingly, 30 or 60 minutes of sleep will be all a breastfeeding parent can find the time for. So, what are the other options? By all means, one night a week where a doula sleeps with baby in their room and cleans up, sterilizes pump parts, and gets you and your family a full night of sleep is invaluable. But, what are the other skills  that need to be nurtured and advocated for in order to create sustainable and manageable cycles of rest and waking for the feeding parent? How can we shift the culture of productivity towards seeing this time and new rhythm as a vital development, and mothering as hard, important work. 

There are harm reduction fixes and then there are culture shifts. And both are necessary in building a postpartum sanctuary full of rest, bonding, and care! 

Living in capitalism, we are taught to invest in things over experiences. 

You are partway through your pregnancy, and hearing friends suggest that you should hire a doula. It sounds lovely to have a support person, but you feel well supported by your partner and family and you attended childbirth classes. You're wondering whether you should save the $1000-$2000 to spend on other baby items because the expenses are racking up. 

It makes a lot of sense to be questioning whether doulas are worth the money. I am obviously biased towards doula care because, well, I am one and I have seen firsthand the impact that a doula can have on creating a positive experience in birth and postpartum. Here I will touch on the unique offerings of a doula in navigating birth in the current climate, as well as the importance of investing in your birth story as it becomes lore and ancestry. 

While some may think that continuous labour support may be the bulk of a doula's value, I would argue that the real value of doula care exists in informational and advocacy support. There may or may not be others attending your birth who are able to offer counter pressure and emotional support. However, the value of the prenatal work that a doula does to prepare for an effective and confident labour is truly unique to a doula's role. On top of that, having someone on your care team who intimately knows what is important to you and is comfortable advocating for that at your birth is also unique to the value of a doula. It is invaluable to have the support of someone who can confidently slow down the pace of decision making and politely challenge the authority of the doctor who just walked in who you've never met telling you to deliver with forceps. 

One of my doula teachers spoke during training on the particular value of doulas as support people who aren't also going through a transformation as the birth occurs. When the members of your family support you in birth, they too are going through a birth; the birth of a grandmother, of a father, sibling, and auntie is a transformation that also requires and deserves embodiment and attention. Your doula is not becoming anything new at your birth, they are simply there to hold space for your becoming. Having a calm person present who is not processing their own transformation is one of the unique magical elements of having a doula. 

The other thing that a doula offers in birth and postpartum is holding space for you, in particular. Something that I have found at births is that right when baby is born is when the birthing person often needs the most support. The care team and often family turn towards caring for the new human who has just arrived, and of course they want to, what a joy! But your doula is there to turn to you. I will not leave your side when your baby goes to the warmer. And when you are at home in the first forty days, I will be there to ask you what YOU need, not just what your baby needs. Of course your needs are entangled with your baby's needs but there are so many ways that a doula can bring you back to your own needs --- sometimes, you don't want to talk about your baby, you need a window opened, a shoulder to cry on, and a warm meal in your belly. 

We live in a culture obsessed with emergency preparedness and this often makes its way into the ways we plan for birth. I often speak with pregnant people who look for a clinical care provider based on how much experience they have dealing with the worst case scenarios; hemorrhage, shoulder dystocia, so-called "failure to progress", infant distress, and more. While it is important to be prepared for complications should they arise, pregnant people are often convinced to seek out specialist care at high risk hospitals for pregnancies that are low risk and normal. What if pregnant people searched for providers who want to give them the birth they want, rather than the birth they fear? 

Birth is a process led by hormones. Release of the "love" hormone oxytocin sends a signal to the uterus to contract, causing the cervix to dilate. Release of oxytocin occurs when the birthing person feels loved, supported and safe. Fear and anxiety can stall the progression of labour, because the flow of oxytocin is interrupted. Oxytocin release is best supported by a calming environment, a caring and attentive team, and continuous labour support. When this flow is interrupted, it is more likely that augmenting interventions such as rupture of membranes, synthetic oxytocin, vacuum and forceps will be suggested by a care provider. And, this isn't just my opinion - this is research supported!*

Yes, issues can arise even when the birthing person is prepared, healthy, and calm. But, your care team is prepared for these complications. A colleague of mine attended a home birth in the summer where a shoulder dystocia occurred that was solved by the midwives without the doula or birthing parent even knowing it was happening! I would therefore urge pregnant people to ask their care providers, how much experience do you have with the birth I WANT? How often do you induce? What kinds of stalls compel you to introduce synthetic oxytocin? What kinds of positions and movement do you encourage during labour? What is your experience with unmedicated birth? How do you care for the perineum, and do you have pelvic floor physiotherapists that you work with? Asking these questions can help you search for green flags in midwifery and OB care that encourage preparedness for the labour you want. 

Most of the time, we don't need a specialist for our pregnancy and birth! Pregnancy and birth are normal, healthy and natural parts of having a body, not problems to be solved. I hope that this post encourages you to find care providers that are prepared to support you in the birth you WANT, not the birth you are afraid of. 

*https://www.dona.org/wp-content/uploads/2020/02/DONA-Birth-Position-Paper-2022.pdf

Oftentimes when I tell people I am a doula they ask how I trained, and if the training was similar to midwifery. They are surprised when I tell them that doula care is actually unregulated, meaning anyone can say they are a doula and work as one. This kind of sounds like a nightmare, especially when thinking about the uprising in anti-vax anti-science ideologies. And, you really don't want someone at your birth making baseless claims about the choices you should be making or arguing with a care provider that you really trust. But, what I like about the openness of certification is that doula care has us rethinking what it means to be an expert, and whether you really want an expert at your birth, or another human who really cares about what's happening. 

When I first became a doula, I was drawn to this work because our profession relates to certification differently than other perinatal care providers and many healthcare providers in general. Doula support is not a clinical practice, and while clinical knowledge is core to effective, evidence based support, doulas are also spiritual care practitioners, support people, harm reduction workers, mediators, and counsellors. We kind of fill this role of sponge in the birth space, melding together the visible and invisible players in the process of birth. And, on the practical side of things, not needing to be certified right away was helpful to me as someone who needed to be working another full time job to get doula experience at first. 

What I will say about certification is that it helps clients get money back from insurance, and that is undeniably important when it comes to accessibility for care. And, as I mentioned above, it does help to prevent the spread of misinformation and pseudoscience that exists so rampantly in the perinatal world. This is what made me decide to certify. But, the thing is, people are taught culturally to value experience and expertise over care and attention. And maybe while you want to look for expertise and experience from your clinical care provider, care and attention from your doula isn't something that comes from a certification necessarily. You might want a doula who exists close to your experience and is able to show up for you. Incarcerated birthers deserve access to doulas with lived experience of incarceration. Birthers who do sex work deserve doulas who are sex workers or have a respectful understanding of that work and its relationship to perinatal care. Queer and trans birthers deserve queer and trans doulas. Religious and spiritual birthers deserve doulas who can show up for the ceremony of birth. And the list goes on. Thus, certification might not be accessible to the doula who is best suited for a client. And even for families who are not marginalized by the healthcare system, the doula that might be best might not look the most impressive on paper but may just be a compatible and caring person to you. Attention and care are skills developed over lifetimes, not over a training period with DONA. 

So, when thinking about hiring a doula, while the question of "are you certified" and "how many births have you attended" may be on your mind, what I hope this post might also bring to mind is the questions of, "what is important to you" and "how will you care for me"? 

A very common query for families when looking for doula care is around OHIP coverage. Whether you choose to hire a doula for birth support or postpartum, care can come at a cost and money can cause barriers to accessing care. Doula care is currently not covered by OHIP, but that doesn't mean you have no coverage for care! It is becoming increasingly popular for insurance companies such as SunLife to offer some coverage for birth and postpartum doulas who are certified through a regulated body such as DONA, CAPPA, and Doula Canada. The best course of action is to reach out to your insurance provider to ask about doula coverage. 

Questions you can ask your doula when interviewing surrounding insurance coverage: 
- Are you certified in birth and postpartum or only birth/only postpartum? 
- Do you issue a receipt for services? 

If your provider currently does not offer coverage, there are a few options: 
- Request employer support: If you employer builds your care package, consider speaking to them about offering coverage for doula care!
- Request a doctor's recommendation for doula care: You may be able to secure insurance coverage if a doctor recommends doula care as a medical necessity for you. 

If cost is still a concern after taking these steps to investigate insurance coverage, speak with your doula about creating a payment plan or sliding scale offerings.