Guess what?!

I've been working my arse off behind the scenes and while I haven't blogged in a while, if you follow me on social media, you kinda get a feel for what's been going on.

Virtuously B'Earthed Doula Services has received a grant from the Missouri Hospital Foundation in partnership with the Preeclampsia Foundation to distribute blood pressure cuffs as part of a research study with Harvard University!
This is a FREE service to community members!

To qualify to receive your free blood pressure cuff, you must be a Missouri resident, be pregnant or just delivered within 4-6 weeks and meet any of the following criteria listed below:
*have chronic hypertension
*history of Preeclampsia and/or eclampsia
*obesity
*advanced maternal age (35+)
*autoimmune disorders or other comorbidities (diabetes, HELLP, etc.)
*race/ethnicity (black, Native American) and/or rural location
*potentially affected by social determinants of health
*are in any of the 3 trimesters (preferably 20 or more weeks gestation)

​If you or anyone you know is interested in participating in this unique opportunity, please email [email protected] or call (636) 224-8337

 It has been a long time since I've blogged anything!  If you have been on the lookout for any posts from me, I just want to first apologize for the delay!

Today, I thought it would be important to discuss the current climate amidst the current outbreak of COVID-19 and how Virtuously B'Earthed Doula Services seeks to offer support during this time...but first...

​WHAT IS COVID-19?!
The novel coronavirus (COVID-19) is a respiratory illness that is transmitted from one person to another.  A person can be asymptomatic (without symptoms) and still pass the virus to another person.  It is important to let your provider know if you are experiencing symptoms and get permission to visit any of the drive through testing centers throughout the region if you are experiencing any of the following: difficulty breathing, cough, or fever. You can find a fact sheet from the CDC regarding COVID-19 here.

WHAT DOES THIS MEAN FOR ME AND MY BABY?!
Right now, we know that pregnant women are not at a higher risk of contracting COVID-19 than the rest of the population.  Because of the suppression of the immune system during pregnancy, I can understand the cause for concern. If you are COVID-19 positive, you cannot pass it to your baby in-utero because it does not cross the placental barrier. A vaginal birth is still very possible! If you plan on breastfeeding after baby makes it earthside, make sure you are taking the same precautions as everyone else and engaging in frequent handwashing and sanitizing, stay home, and limit visitors. If you are COVID-19 positive and breastfeeding, make sure you also wear a mask or a barrier on your face in addition to everything mentioned.  You can find more information regarding COVID-19 and pregnancy here.
​
WHAT DOES THAT MEAN FOR LABOR SUPPORT?!
Labor support has taken a huge shift from face-to-face contact with clients and families to more of a virtual approach.  Most hospitals in the St. Louis region has adopted a 1 or no visitor policy and the role of a doula in all of this is rapidly changing. As of today, here are the hospital policies in effect:

Barnes-Jewish Hospital (BJC): For obstetric patients, they are only allowing 1 visitor and that visitor must remain at the side of the patient during the duration of the stay.  So that means no cafeteria runs or waiting room access.  I recommend packing enough snacks and food to last your partner.  I am unsure of what that means when ordering food to the rooms--meaning are they going to allow your partner to order food and charge it to your room?  That may be something you ask before heading to the hospital.  You can find more information about their COVID-19 policies here.

Mercy Hospital: For visitors across the board, they are no longer allowing patients to have accompaniment to any appointments. However, in cases of parents without access to childcare, they are allowing children to accompany the parent. It is unclear what their policy is for obstetric patients specifically and the role of the doula, so you may need to ask the hospital or the birthing center for further details.  You can find more information about their COVID-19 policies here. 

St. Mary's Hospital: For visitors across all sites, they have temporarily suspended visitation.  However, they recognize certain situations require visitation.  For obstetric patients, they are allowing 1 visitor, with the permission of the nurse leader.  You can find more information about their COVID-19 policies here.

Missouri Baptist Hospital: Visitation at MOBap follows the same guidelines as BJC, however, they are taking extraordinary circumstances into consideration.  I suggest reaching out to your provider or the hospital for further details.  You can find more information about their COVID-19 policies here. 

In any case, you should pre-screen yourself before going to the hospital.  Please let your provider or the facility know if you or your permitted visitor are having any of the following symptoms or meet this criteria: 

• Signs and symptoms of an acute illness (coughing, fever, or difficulty breathing)
• If you have traveled within the last 14 days to an area with known community outbreak of COVID-19
• If you have been in contact with anyone who has been suspected of or has a confirmed case of COVID-19 within the last 14 days

If your visitor(s) meet any of this criteria, they will not be permitted into the facility. If you are sick and in labor, the hospital will take every precaution to limit your exposure to others.  You still deserve to have the same level of care you would receive if you weren't sick.

Birthing in the era of COVID-19 has made a lot of families reevaluate how they plan for the birth of their baby.  Since hospitals are tightening polices, here are a few suggestions:

• Labor at home as long as possible if your are deciding to go to the hospital.  This way, your partner and/or doula gets to physically be with you until you depart.
• Now, more than ever, make sure you have your phone, tablet, or laptop charged so that when you make it to the hospital, you can video chat or call your support team.  And please don't forget your charger.
• When looking for a doula, ask them if they are willing to do virtual support in the form of Skype, Zoom, Facetime, etc. to slow the spead.
• If you are transitioning from a hospital birth to a home birth, make sure you are a good candidate or what we term, low-risk.  If you are a high risk patient with a history of pre-eclampsia, gestational diabetes, autoimmune disorders, etc. you would not be considered a good candidate for a home birth and it is recommended that you still birth in the hospital in order to be adequately followed by your practitioner.  

Virtuously B'Earthed Doula Services is striving to move their services to a virtual platform to better service the needs of the client.  We are all doing the best we can to make sure that we take care of each other in such a trying time.  

HOW CAN I STAY HEALTHY DURING THIS TIME?!
As stated before, please continue to engage in frequent handwashing and sanitizing.  Try to refrain from rubbing and touching your face and nose. SN: I don't think I realized how hard this was until now...LOL! Sanitize frequently used surfaces often.  Start taking your shoes off once you enter the house. Limit your time outside.  If you have to go out for any reason at all, make sure you are practicing social distancing by keeping at least 6 feet between you and the next person. If you receive any packages during this time, wipe them down with a sanitizing wipe and let it sit for at least 10 min before opening. You can find a link to a bunch of DIY disinfectant spray recipes here. We do know that COVID-19 can live on surfaces for up to 72 hours.

Nutritionally, make sure you and your family are staying well hydrated.  As a pregnant person, you should be drinking at least 80-100 oz of water daily. Your family should be drinking at least 64-80 oz of water a day!  Being hydrated will help flush illness out of the body. Increase your intake of green leafy vegetables such as spinach, romaine lettuce, arugula, etc. Increase your protein intake. Some good foods high in protein are lentils (18 g/one cup), chicken breast (53 g/8oz), broccoli (3 g/one cup), tuna (27 g/one can), etc. You can find several other foods and their protein content here.  Limit the amount of processed foods and sugar you eat as this can aid in weakening the immune system due to lack of nutritional value.  Cook at home as much as possible.  Please remember to continue to take your vitamins.  If you haven't already, please get WIC! Visit or call your local WIC office to see what they are doing in order to make sure you're still able to pick up vouchers and the changes they've made to the food packages to accommodate food shortages. You can find a downloadable copy of WIC office locations for St. Louis City and County here from Mercy Neighborhood Ministries. WIC is one of the best ways to be able to supplement your nutrition by curbing some of the costs. The goal in all of this is to start building a healthy immune system.

If you start to feel sick, it is known that heat weakens this virus.  In addition to everything listed, you can stand in a hot shower or give yourself a facial by taking a bowl with hot water, placing your face over it, and covering your head with a towel to trap in the heat. You can also drink teas such as chamomile and green tea and really breathe in the steam by taking deep, cleansing breaths. 

I will you peace and good health now and always!  Stay safe. Stay healthy.

WARNING: This post is going to be very wordy with a lot of insurance speak, but we'll get through it...
**Also, this post is a compilation of a few websites to get you the most comprehensive information to get you started on your way to getting your services covered. I did not write down sites, but much credit is due.**

How to Obtain Reimbursement for Doula Services

Insurance coverage of Doula services is becoming a more common occurrence in the birthing world. Virtuously B’Earthed Doula Services encourages you to take the following steps to attempt reimbursement of your Doula services through our programs. We are happy to provide you with the necessary documentation to move forward with an insurance reimbursement.

Over twenty insurance companies have begun paying for Doula services and, now that there is a CPT code covering Doula services, this is more of a possibility than ever before. (CPT stands for Current Procedural Terminology, and is a copyright of the American Medical Association.) The CPT code used to claim birth Doula services is 99499 for Labor Support and to claim postpartum Doula services, it is 99501 and/or 99502 for Postpartum Care.

The following is a partial list of insurance companies who have reimbursed in whole or in part for Doula services:

• Aetna Healthcare
• AltPro
• Baylor Health Care System/WEB TPA
• Blue Cross/Blue Shield
• Blue Cross/Blue Shield PPO
• Cigna
• Degussa, a German Chemical Company
• Elmcare, LLC, C/O North American Medical Management
• Foundation for Medical Care
• Fortis Insurance
• Glencare Managed Health, Inc.
• Great-West Life & Annunity Ins. Co.
• HNTB (Peoria, IL)
• Houston New England Financial, Employee Benefits (Fort Scott, KS)
• Humana Employers Health
• Lutheran General Physician’s Organization
• Maritime Life
• Medical Mutual
• Oschner HMO, Louisiana
• Professional Benefits Administrators
• Prudential Healthcare
• Qualchoice
• Summit Management Services, Inc.
• Travelers
• United HealthCare of Georgia (San Antonio, TX)
• United Health POS
• Wausau Benefits, Inc.

Insurance and Flexible Spending Account Coverage:
​
Some insurance companies will pay for Doula services by reimbursing you. You may also submit to your medical flexible spending account (cafeteria plan) to help reduce your costs.
How to Request Insurance Reimbursement for Doula Services:

1. Pay your Doula in full.
2. Get a receipt from Virtuously B'Earthed Doula Services which includes the following information:
   • The Doula’s name & address
   • The Doula’s social security number/taxpayer ID number and/or NPI number
   • Diagnosis Code (V22.2, intrauterine pregnancy/ V24.2, routine postpartum follow up)
   • The CPT code for the services provided ( 99499, labor support/ 99501 and/or 99502, postpartum care)
   • Taxonomy Code (374J00000X)
   • The date and location services were provided
   • The Doula’s signature
   • The mother’s name
   • Total charge for services
   • Dates & amounts of payments
   • Payment method
3. Submit the invoice with a claim form to your insurance company or flexible spending account company’s claim department.
4. Within a month, you should receive a response telling you either that:
   • They have accepted your claim.
   • They need more information before they can process your claim.
   • This is not a covered expense.

If the insurance company needs more information or denies your claim:

1. Do not be discouraged. Prepare a new packet to resubmit to your insurance company for a secondary review, and copy everything in the packet to the insurance company’s CEO explaining why you feel services should be covered. In this re-submission packet, you should include the following:
   • Another copy of the receipt
   • A letter from you to the CEO explaining why you think you should be covered as well as why you felt the need for a Doula and how you believe the Doula was beneficial to your health
   • DONA’s position paper
   • Ask your Doula to send you the following and include in your packet:
     1. A copy of her certification (if she is certified)
     2. Other credentials or relevant training
     3. A letter detailing her training and experience and what she did for you
     4. If possible, ask your Doctor or Midwife for a letter explaining how a Doula helped you, was necessary, or saved the insurance company money. (Did you have a high-risk pregnancy or postpartum? Did the birth Doula’s presence and/or suggestions help you or your baby in the postpartum period, increase breastfeeding success or appear to prevent postpartum complications?)
2. If they refuse it, write a letter to Health Services requesting that they review the claim, as you feel it was a cost-cutting measure and they should cover the most.
3. Be persistent. Make phone calls if necessary. If your claim is ultimately denied, call and ask for a specific reason why. If they refer to your policy, ask them exactly what clause and what wording in your policy excludes Doula services. They may not pay your claim, but they will consider it for the future.

Whether you are reimbursed or not, please let Virtuously B’Earthed Doula Services know what kind of response you get from the insurance company. Each time someone requests reimbursement, it tells the insurance companies that this is an important service. They may consider it more carefully next time. If you are reimbursed, this is great news for doulas and we always want to know!

Let's Talk About It!!!
Back in November of last year, I posted a "Myth Buster" style post centered around Doulas that seemed to resonate with a lot of people who visit my Facebook Page, so I thought I'd share it here. Afterwards, I will come back and let you know what you can do to get reimbursement for Doula services through your insurance company.

Doula Myths
These are a few of the quotes I have heard over the years with regard to Doulas that really stood out to me.  They are not meant to be offensive, only to provide a glimpse into the thoughts of the communities in which some of us serve. And no, not all people in under-served communities have these thoughts. Unfortunately, many have not been privileged to have access to the same type of knowledge.  As a Doula, it is my duty to strive to tip the scales.
​
Myth #1: "Doulas are too expensive."
Don't get me wrong, some Doulas charge a lot for their services. I've seen Doulas who charge $2500 or more for their services. That's why it's important to shop around when choosing your Doula. Not all of us are here to take your life savings. Some of us provide free, low cost, payment plans, or sliding scales so that all women, regardless of socioeconomic status can afford to have a Doula. If you are in the St. Louis Area, Virtuously B'Earthed Doula Services, Jamaa Birth Village, and others do this. There may be some in your area that does the same.

​Myth #2: "Doulas are for white women."
Ok. Look. Doula work was made mainstream by white women in recent years, but indigenous cultures have been doing this since the beginning of time. All women, especially black women and women of color, NEED to feel empowered and informed of their choices when it comes to bearing life and borning it into the world. Have you heard the statistics for Black Maternal Mortality in America?! Black women are 4 times more likely to die in childbirth than white women, and its 2018. There are plenty Original women being trained as Doulas to help close this gap.
​
Myth #3: "I don't need no Doula."
Guess what? Doulas are trained professionals, educated in many areas...but if your mother, grandparent, husband, cousin, etc., helped you in labor, you had a support person. And that's great! You need to be supported in labor, regardless as to whether or not you hire a Doula! Doulas help to educate you on your choices in the hospital or wherever you go to birth baby, help with comfort measures if you'd like to progress naturally, coach you in labor should you be going at this alone, coach partner in assisting you should you have a partner, helps to keep the space sacred (because birth is a transformative experience)...among other things.
Just something to consider. If I weren't a Doula myself, I'd still advocate for Doulas because my experience with my own children led me to being a Doula. 

To learn how to get your insurance company to cover Doula services, click here.

I'd like to share one of my birth stories with you...

In late 2008, I found out I was pregnant with a little bean. My first baby. I was in graduate school in Arkansas with absolutely no family.  No guidance. No support. Just me and the father of my unborn child.  I have always been fascinated with science and research so I did just that...researched. The first book I'd ever picked up centered around birth and pregnancy is going to sound so cliche...are you ready for this??  The first book I'd ever read was "What to Expect When You're Expecting".  I needed to have some kind of basis for this whole pregnancy thing because I knew absolutely nothing. I remember getting to a little box that was titled: "To Doula, or Not to Doula" and I read about how Doulas help women through labor and the birth of the baby.  So, I got on my computer and started looking for Doulas in my area.  I found an organization called BirthWorks, who at the time, had a program where they provided volunteer opportunities for student Doulas to attend births for low income clients. 

SIGN ME UP!!!  NOW!!!

My Doulas were amazing!  They came to my house and met me and my husband at the time and went over what our goals were for my birth and took the time to educate me where she could. (She was a student Doula...btw...)  She signed us up for an eight week childbirth education class (FOR FREE!!).  We learned so much!!  We learned about pain management techniques, visualization, what happens to the body while growing your little human, what to expect at the hospital, options for where to give birth, and so much more. 

I think I panicked about 10 times before actually going into labor.  I did a lot of mistaking Braxton-Hicks contractions for labor contractions.  My Mom even came all the way to Little Rock from St. Louis to try to be present for the birth of her first grandchild.  She was with me for a week.......baby never came....*sigh*.  A few days after she left, I noticed a shift in my contractions.  IT WAS TIME!!  My Doula was at my house, ready to assist me.  When she saw I was in early labor, she told me to rest and try to get a meal in.  I rested.  Cleaned up a little. Ate. Made sure everything was in my bag. Rested some more...

When the contractions became too much, I called her and let her know that I was ready to go to the hospital.  She met us there. I had 4 Doulas there with me that day.  The "Natural Nurse" was a Doula, I had my 2 student Doulas, and another Doula  helping another client popped in and out from time to time.  It was great!!! I had the lights dimmed like I wanted, essential oils permeating the air, and Johnathan Nelson's "My Name is Victory" playing in the background.  I was able to get up and walk around as I pleased.  Labored in the tub for a while. I did everything I could to bring this baby down the canal and to Earth plain. My doctor was very patient with the entire process, and once she saw I wasn't progressing (I was at 8.5 cm for 4 hours...) she decided to take the baby via C-Section.  *sigh*  But I understood.  I reassured myself that I did all that I could to get baby here and this was what was needed to get baby here.  I got the epidural and prepped for the OR.  My Doulas were with me every step of the way.  And even though I was in another state, with my husband, I felt very well supported.  My first born son, Dylan, was born via c-section at 10:12 pm on September 16, 2009 weighing in at 8lbs and 20in long.

I enjoyed my experience so much with my Doulas that I decided that I would train to become one myself and offer this level of support to other women who needed it.

A Doula is a woman (or man...I've seen men be trained to assist women in childbirth...) who provides emotional, physical, and spiritual support to women and their families.  They provide education centered around your choices in childbirth and assist you and your partner with coming up with a plan to bring your baby Earthside.  The do not, by any means, replace your birth partner and they hold space for you and your partner during your most vulnerable moments.  Doula is Greek for "woman servant". 

Even with the support of Doulas, things don't go as planned.  I definitely wanted a vaginal birth. That's not what happened, though.  And that's okay.  Maybe I'll get the chance to do it next time...

There's always next time, right?

One day, I will share with you the birth of my second son. You will get to know and understand how his birth changed my life forever...

Be on the lookout...Until next time...

​Peace and blessings!