On Episode 47 of the Edge of Innovation, we are talking with Enza Lilley, a doula from “A Mommy’s Friend Doula Service” about her experiences as a doula and small business owner on the North Shore of Boston.
What is a Doula?
Culture Shift – Hospitals to Doulas
The Value of a Doula – What a Doula Does
Enza’s Doula Story
Enza’s First Doula Births
The Business Side of Being a Doula
How a Great Website Helps!
A Mommy’s Friend – Enza Lilley
Paul: Well, hi. I’m here today with Enza Lilley. Say hello, Enza.
Enza: Hello. Thank you for having me.
What is a Doula?
Paul: You should have said, “Hello, Enza.” But yeah. We’re talking today with Enza Lilley. Now you’re something that I’ve seen… The first time I saw this word was on a bumper sticker that said the word “doula.” I had no idea what this meant. And it was like this mythical thing. I have no idea what it is. So what’s a doula?
Enza: I had no idea what it meant either, just so you know. A doula is, in the Greek it means, woman slave or woman caregiver. So we give, basically, physical, emotional, education, and spiritual support to a mom in labor — usually a little bit before labor, during labor, and within those couple of hours after labor.
Paul: Okay, but, I mean… I haven’t been a mom, at least not yet. We’ll see if that’s possible? I don’t know. We’ll talk about that later. But, millions of woman give birth all the time, and they don’t have doulas because I lived a long time, and never heard the word. So what’s the big deal? Why, is it special? Is this just an indulgence?
Enza: No. So we make the process a lot easier. We help moms cope with the pain. We help them cope with the emotional feelings that they’re feeling. We educate them so they know what to expect, how to talk to an OB, how to talk to a midwife. And I think the most important thing is that we offer continuity of care. Nurses and midwives are wonderful, but they come and go. They have shifts. I don’t have a shift.
Paul: Okay, so let’s stop. Let’s imagine somebody doesn’t know anything about this because we have a fairly eclectic audience from single guys to engineers, to woman who are professionals to moms, you know — all sorts of different people. So they’re all going to come at a different level. So let’s try and define some of the terms. So, a woman gets pregnant. She goes to her doctor. You’re pregnant, and they then tell them something. Probably this is how you have to take care of yourself. This is all the different things. This is what to expect maybe, when you’re expecting. That’s a book.
Enza: That’s a book.
Paul: Not that we’re plugging the book, but it’s a good title. And so at some point, somebody must introduce this concept of a doula or, well, a midwife. Or I’m not going to go and have my baby in a hospital. And so there’s all these things swirling around, and I can’t imagine having to make all of these decisions with such a life-changing event. And so why does somebody go out and choose a midwife or a birthing center or a hospital? So what are some of the reasons and the thoughts sort of going on and swirling around in couple’s heads as they’re thinking about how to get this human here?
Enza: Okay. So some of the questions that they deal with are…Like how crunchy are they? And by crunchy, I mean, how natural are they. Are they seeking no medical interventions at all?
Paul: So can you have a baby with no medical interventions?
Enza: Totally. And that’s usually where I play a really big role because you’re not giving an epidural which stops the pain from your waist down. You’re not getting narcotics.
Paul: So, okay. So “crunchy” is a good word. So I’m not interested in natural things. So I don’t want to buy canned fruit. I want to buy fresh fruit.
Paul: Okay. And I want crunchy granola as opposed to processed food, processed cereal. So that’s a predisposition, I guess, with a person generally. You know, somebody that says, “Gee, I’m not going to buy processed food. I don’t go to McDonald’s. I’m going to eat real food that came from a farm or even from a farm nearby. So there’s sort of a spectrum.
Culture Shift – Hospitals to Doulas
Paul: So you have a woman who’s pregnant. I mean, that was a shift it seems like because everybody I know — almost everybody 40 years or older — was born in a hospital. What hospital were you born in? Oh you were born in this hospital. So that change occurred. When did that change occur? Do you know? Or how did you perceive that?
Enza: Okay. Let me take you back, way back when. You know, our grandmothers, great-grandmothers. They had babies at home. It was all about home birth. No one ever thought about going to the big city hospital. So I’m not quite sure of the year, but somewhere in maybe early 1930s, 1940s, everyone decided the safest place to be was in a hospital. So the trend towards home birth and birth centers went away because now you had these OBs who had medical training. And now, as the years have gone by, we’re going back.
Paul: Well what was the reason why the hospital sounded good? Because if there were complications…
Enza: If there were complications, they’d have—
Paul: They’d have the equipment and the people.
Enza: Equipment, the surgeons. Correct.
Paul: Okay. So that was the reason. That seemed like a valid reason, at least sitting here with… looking at it back 70 or 80 years ago. Isn’t that still the case now? Or can we just see better? You know, because I imagine you can tell, when working with a client, whether they’re going to be complicated or not.
Enza: Correct. We have the technology now. We have ultrasounds. We have blood tests. We have midwives who are now trained professionally whereas in the good old days, you had grandma.
Difference Between Midwife and Doula
Paul: Okay. Well, what’s a midwife though?
Enza: So a midwife is usually a certified nurse who has trained in midwifery care. So they can do everything an OB can do. They deliver the baby. You know, they’re hands on.
Paul: But they’re not a doctor.
Enza: But they’re not a doctor. They’re not a medical doctor. So they don’t perform C-sections.
Paul: Alright. So a midwife is really just a doctor. It’s like a physician’s assistant. If you go to your doctor, and they’re too busy, you can meet with a nurse practitioner, I guess.
Enza: They’re a little bit more than that. They do the whole care through the whole…from the beginning to the end and…
Paul: Okay. So you go. So let’s just zoom forward to time around delivery. And I imagine this is where… Well, I don’t know. It will be interesting how your value breaks down because you’re there. And your job is to be there for the mom to support the mom, and I would imagine even the family — the dad, etc. — to offer a continuity as opposed to a nurse that just stops in every hour and goes to lunch and then goes home. Do you stay with the mom the whole time?
Enza: I do.
Paul: Oh, come on. I mean, you must leave and go shower and change.
Enza: I do not.
Paul: Wow. So you’re there with her and supporting her.
Enza: I am there whether she’s in labor for two hours or two days. My longest birth has been 73 hours.
Paul: 73 hours. Wow. Gosh. How many days in that? 24…
Enza: A little over three days.
Paul: Three days. Wow. Oh, my gosh. Just let’s take a little brief eddy here on this stream. Was she…? How crunchy was she?
Enza: Very crunchy. This was a home birth.
Paul: Okay. So she was committed.
Enza: She was committed.
Paul: Was there waxing and waning during that, at the 50th hour? At what point…? What was the emotional rollercoaster that she went through? It’s like, “Well, maybe I’ve bit off more than I could chew. Get this baby out of me.”
Enza: Actually, she was amazing. She really stuck to her guns. She had a birth plan. She knew how to execute that birth plan. She was very patient. We took it hour by hour. The midwife was there for most of it, and we just walked her through the pain. We walked her through her emotions. It was beautiful.
The Value of a Doula – What a Doula Does
Paul: Wow. It seems as we’re sort of peeling this onion back, it seems obvious, that you’d want to have somebody there that’s chief concern is the mom. I mean, if you care about the mom. I mean, so the institutionalized medicine world thinks that we can just, they stop by the rooms, and they’ve done their whole duty. They look at the chart, read it. “Okay. Good. You’re good. Fine.” But there’s a huge amount of emotional support there. Would you say…?
So 72 hours is a lot of time, but there’s also value you bring before and after the birth. What, what happens before?
Enza: So I usually meet with my client at least twice. The first time, it’s just a bunch of question and answer session. I ask tons of questions. I get to know them both. And husband plays a great role in this as well. I teach them pressure points and the way to massage their wives. And so I always include them. So I get to know them. I feel like the closer that we are, the better relationship we’re going to have in the birth room. So it’s get to know them. Then I meet with them another time. We discuss different birth positions and pushing and just talk about what happens the moment they get to the hospital or the birth center or whatever they want to birth. And take it from a the beginning to the end. And then they call me when they’re ready. And I either meet them at the hospital or meet them in their home, depending whether they’re ready to go to the hospital. And then afterwards, I meet with them two more times.
Paul: Okay. So it sounds like in the beginning, you’re demystifying things. So especially for a first time, mom, there’s gotta be a lot of uncertainty and who knows what. I mean we’ve all seen, TV, where we’re disconnected from it. So you give them that guidance as a couple, and you work through that with them, and I guess, give them some reassurance that I’m going to be there because one thing I could say, “Well, you could just cut out those and just arrive at the hospital or arrive at the birthing center, and we’ll just do it now.” But if you’ve talked to them about all of the different things, it’s going to be a lot to take in, and that’s not the first thing on their mind.
Enza’s Doula Story
Paul: So, what in the world made you do this? I mean, is it a family tradition?
Enza: It is not. So right about the time I hit 39 and was about to hit 40, a couple months after that my youngest has started kindergarten, and I just knew there had to be more than just scrubbing the pee off the back of the toilet every day. I was a medical assistant before I had children, and I worked in the OBGYN field. And I loved it.
Paul: What did a medical assistant do?
Enza: We did a lot more clinical things, like draw blood, take blood pressure, give injections. I know I didn’t want to go back to that. So I thought I would do some midwifery, look into some midwifery classes, perhaps become a midwife. When I looked into it, I realized that I needed nursing school. At almost 40 years old, I was way too tired to go back to college.
Paul: How long would it have taken to go back?
Enza: Four years.
Paul: Four more years. Wow. Okay.
Enza: Plus your midwifery training. So probably an, at least, another five years. So, a midwifery friend of mine knew that I was struggling to do something back into that maternity care, and she knew how much I loved the maternity world and had a love to take care of women and children. And so she pointed me to the doula direction. And like I said before, I had never heard of the word doula. I had no idea what it meant. So I just did the research, found a certifying organization, and voila.
Paul: Wow. And how many kids have you helped bring into the world?
Enza: I am at 202.
Paul: Wow. 202 moms. Well actually, probably… I don’t know. Have you done multiple births.
Enza: I have not. I have not done multiple births. Or, you mean twins?
Paul: No. I mean like a mom who has had three kids.
Enza: Oh, no. I have done that. Yes.
Paul: Okay. So it’s little less than 200 moms.
Enza: Exactly. Yes.
Paul: And now, when you were thinking about doing this… From now, from our point of view now, if you could go back and wave a magic wand and become a midwife, without the four years plus the internship and all the different practicals, you could have just snapped your fingers, would you go back and do that, or would you still be a doula?
Enza: I would still be a doula.
Paul: Wow. So that sounds like a really neat… So she introduced you to this idea, and you didn’t know what it was. What did you do? I mean, what did you say? What did she tell you?
Enza: She just told me that she thought I would be a great doula, and I should look into—
Paul: And you took offense at that? What’s a doula? You know, is that a good thing or a bad thing?
Enza: Well, I didn’t know anything about it, so I had to do the research and found out. When I saw that, I thought, yeah, that’s me. I love the relationships that I form with my clients. And I think as a midwife, as wonderful as they are — because I work with amazing midwives — they just don’t get to form that relationship.
Paul: Sure because they’ve got to get to the next patient.
Enza: And I form a relationship with them. There’s a bond there, and I enjoy that. I enjoy getting to know my clients.
Paul: So, I looked at your website, and it does a good job of sort of allowing somebody to connect with you and get an idea of who you are and your personality. I would imagine that’s a big part, is how you click with the mom and the dad. But, you’re going to be there to support them. So if your personalities don’t mesh, it’s not a good fit.
Paul: So you’ve had 200 births. The people that come to you, what’s the percentage of them that say, “Yes, Enza’s the woman I want to have to do this”? Is it 100%? Everybody you interview? No. I imagine there’s some non-fit.
Enza: It’s probably 98%.
Paul: Really. Wow. That says a lot. So it either says you’ve got a really good website or you really… Well, it says you’ve got a decent website. You’re able to communicate well. And then do you ever get any returns? Do people come back and say, “No, I want my money back because…” Or put the baby back in because she didn’t help me or…?
Enza: No. Never. I have had, in 10 years, I had one lady who did not pay the remainder of my fee.
Enza: Yes, she ended up with a C-section, and I think she was not happy that…
Paul: Oh, and that’s your fault.
Enza: And that’s my fault.
Paul: Well, if you’ve got that kind of power over other people. So, tell me some of the anecdotes. You know, the interesting things that have happened that you wouldn’t have expected sort of when you first got into this.
Enza: Wow. That’s really hard. You put me on the spot here.
Paul: That’s okay.
Enza: So many interesting things.
Enza’s First Doula Births
Paul: Well, your first one. Did you do that alone? Did you do that with somebody else? Or how did that happen?
Enza: I did it alone. Meaning just I was the only doula there.
Paul: Yeah. You did it alone. No mom, nothing. You know, it worked really well.
Enza: I want to make sure people know I’m doing this with an OB and not without supervision. Actually my first three, which were what’s called my certifying births — you have to be evaluated by OBs and midwives and nurses and the parents so that you can get your certification — were absolutely horrendous.
Paul: Really? What do you mean horrendous? The people were hard to deal with or just it didn’t go well?
Enza: It just didn’t go well. I had heartrates decelerating and moms’ blood pressures dropping, and dad’s passing out and…
Paul: Oh, so they were technically hard.
Paul: As, as hard as they could be?
Enza: Oh, yes. We had an emergency C-section in one. Baby’s heartrate had decelerated so low that it was like [claps] off we went.
Paul: So how are the kids now? Are they…?
Enza: They’re great. They’re great.
Paul: So we can talk about this and not feel bad. So you went into this. And are you thinking, “What in the world have I gotten myself into?”
Enza: I was ready to quit.
Paul: On one or two or three or on all of them?
Enza: On three. On three. I was done.
Paul: You said I’m going to, I’m going to power though this, but three I’m done.
Enza: I’m done.
Paul: So what changed your mind?
Enza: My husband. He’s really good about saying, you know, “This is something you’ve started, and you’re good at what you’re doing, and I want you to continue doing it.”
And I reluctantly said, “Okay. I’ll give it one more shot.”
And actually, birth number four was fantastic. It was everything that I expected it to be.
Paul: So how were your reviews after one, two, and three, and then after four? What were the feedback from the moms and the parents?
Enza: Actually the feedback was great. They know that it wasn’t something that I had control over.
Enza: You know. I mean, there was little things. I can’t remember that far back, but, you know, just little things that I could improve on. You know, maybe a technique or maybe not to be so timid.
Paul: Okay. Good points.
Enza: Nowadays I’m a little bit more…
Paul: Yeah. You know what’s best.
Paul: You’ve been there. You’ve been there.
The Business Side of Being a Doula
Paul: So you’ve moved around a lot because I know you’ve shared that your husband was in the military, so the military has this habit of moving people all around the country. So you’ve actually started this business how many times?
Enza: Wow. One, two, three, four times.
Paul: Four times. And you were successful on all of them. So that’s a pretty big deal. I mean, you know, 99% of small businesses fail, I think. Or some ridiculous number. Now you’re not in Massachusetts on the North Shore and you have started… When did you start offering your services in Massachusetts?
Enza: November of 2011.
Paul: Okay. And how has that gone?
Enza: Well, the first six months were really rough. I had no bites at all. But that’s pretty typical of all my moves. And then after that, I started with a few in the Concord area, actually of Mass. Then it kind of trickled a little bit into Boston, and then finally into the North Shore.
Paul: Interesting. Well, that’s interesting. So what’s the difference between now and then?
Enza: I think now I have a better relationship with the midwives and the OBs, especially at the local hospital.
Paul: So community. Really building up that community.
How a Great Website Helps!
Enza: Yes. And, actually, I have a great website. From the moment my website was redesigned last year, and within a year my business really has doubled, and I really do think it’s because of the website with fresh and new content.
Paul: Right. Well, we do a lot of websites. We actually helped build Enza’s website. But you know, a website, in your position, in your career, your product that you’re offering is really, you know… If you’re buying a car, you see them on the road, and you see say, “Oh, that’s a cool car. I’d like to go see that.” You might go to a dealer then to test-drive it. You might want to know some things about it. So you go to the website for more details. But your website has a specific challenge of really introducing you because, you know, is she nice? Is she gruff? Is she this? Is she that? You know. And, and trying to evoke a personality through a website is really hard. Your old website did a good job of that. I do think the new one does a better job of that, and you’ve had feedback from your clients that that’s been very effective.
Enza: I have had, I think, almost every single one of my clients has said to me, “I knew you from the moment I met you on your website.” They said, “Your website just brings out your personality.”
Paul: Well, you have a big personality, a delightful personality. So it’s a lot easier to show that though when it’s truly there, than trying to take somebody that’s a curmudgeon. Who would it be? Who would be a good example without… I’m thinking of the Grinch maybe. If you put that face on there, you know, it’s not going to come across warm and fuzzy. And so I think just your whole personality, just your whole demeanor comes through on the website. And then you have a lot of good testimonials and comments from other people which are really helpful. And, you know, as we advise people who are building websites, you really want to think about that. No matter what business you’re in… I mean, this is an incredibly personal business. It’s a very personal decision to have somebody there while you’re giving birth and after that.
Paul: So we’ve been talking with Enza Lilley of A Mommy’s Friend doula…What’s the actual title? A Mommy’s Friend, period?
Enza: Mommy’s Friend Doula Service.
Paul: Doula service. Okay. And, she’s headquartered, or really, works geographically out of the North Shore, Massachusetts into Boston. And she helps moms bring new people into the world.
Enza: Thank you for having me.
Paul: Absolutely. It’s been a pleasure!