What's the difference between a doula and a midwife?
A midwife's most important role is as the medical guardian for your birth.
She monitors your health and your baby's health, and she usually catches
your little one. A doula is a non-medical professional who offers physical
support, emotional support, informational resources and advocacy skills.
As doulas, we are trained in supporting normal birth, and our goal is to
make it the smoothest, most comfortable and centered process for the new
family. Your doula's most important goal is to help you have the best possible
birth.
I'm seeing a wonderful midwife that I really like. Do I still need
a doula?
We love the midwifery model of care, and work often with great midwives
all around Southwest Michigan. As noted above, your midwife is your medical
guardian. Your doula is an expert in supporting the whole family through
labor. At various points in every labor, your midwife's attention has to
turn toward your safety and your baby's safety; your doula will be focused
on your physical and emotional comfort.
Consider too, that some midwives have excellent labor support skills and really enjoy sitting quietly with women for hours on end, and others do not. Often your doula can be with you during your nighttime labor so that the midwife can sleep for a few hours—and it's helpful if your midwife is well-rested and alert at the most critical moments of birth. Even the best hospital-based midwife will not be able to meet you at home and labor with you there, and she may have more than one patient in labor when you arrive at the hospital (we've seen even small practices with three or more women in labor at the same time). Your doula is your expert sounding board and resource both during pregnancy and birth. You can call us at 7 p.m. to ask us about heartburn or swollen feet, or just to talk through any worries. Also, it's important to consider that your doula works only for you, and is not bound by hospital policy or other political considerations, so she may have suggestions that you wouldn't hear elsewhere.
Your midwife and your doula complement each other during labor, and we often find ourselves brainstorming on the best way to support the mother or help the labor progress. One midwife told us recently that it's like each mom needs a basket of support cards during her labor. Sometimes you need the midwife card, sometimes you need the partner card, and sometimes you need the doula card to get you through. The labor unfolds as it should and the cards are there as you need them.
Do you work with Doctors?
Absolutely! Most physicians spend very little time with the mother during
her labor, so a doula can be especially helpful for labor support. We've
developed positive relationships with a number of family doctors and obstetricians
in the region.
So what exactly will you do at my birth?
It's hard to say ahead of time! We bring an entire toolbox of ideas, tricks
and techniques. Sometimes we might rub your back for 16 hours, or trade
off with your partner in that role when his hands are aching and he needs
to eat and rest. We might be the quiet, calm, reassuring voice whispering
in your ear, or the firm, anchored voice that will help you get back on
track when labor starts to feel intense and overwhelming. Your doula could
be focusing on natural ways to help your labor progress, or how to straighten
out a baby that's slightly malpositioned. Perhaps we'll give you ideas on
how to negotiate with the staff to achieve some important elements of your
birth plan. Sometimes we are offering a lot of support to your husband or
partner, showing him and other loved ones how they can best help you, and
reassuring them about what's normal. Maybe we'll offer a hand massage to
help you rest and relax, or we'll explain your options and help you brainstorm
questions when you're facing medical interventions for you or your baby.
On occasion, our help and reassurance after the birth might be key to establishing
your nursing relationship.
Every labor unfolds in its own unique way. Our job is to bring our expertise in birth to the table and stay fully present and supportive, whatever your needs.
I'd love to have a doula but my husband or partner really wants
to be my support person.
Dads are sometimes nervous that a doula might take over their role, and
they'll be "shut out" of the labor process. That is not the case
at all! Dads and doulas actually complement each other in labor. A doula
is kind of like a tour guide in a foreign country. Your tour guide doesn't
take away from your trip, she enhances it for both of you. The same is true
of your doula. She can help you both navigate the health care system and
understand the process of labor and birth. We often find ourselves reassuring
dads about the normal sights and sounds of labor, which can be disconcerting
to even the best prepared support person.
Doulas can show dads particular techniques to help the laboring woman, based on exactly what is happening in her body at that moment. Experiencing back labor? "We might try this counterpressure technique, let me show you exactly where to put your hands." Relaxing in the bath? "How about gently pouring water over her belly with each contraction, like this. Yes, that's it, just like that!" Mom is laboring in the bathroom? "Here, let me get the birth ball so she can lean forward into your chest to rest between contractions."
During labor, moms usually retreat into their own private "laborland." As doulas, we often find ourselves bonding closely with the dad during the birth, as we work together to figure out the best way to support her. Dads are generally so happy to have another "birth partner" with them for the journey!
But my mom/friend/aunt is going to be with me for the birth. Do
I still need a doula?
Friends and family members can make wonderful labor support people, but
their role is distinctly different than a doula. Your doula brings specialized
training in birth and labor support. In most cases, she has seen many births
in various settings, and she can help familiarize you with what to expect
at each stage. We don't have the same emotional attachments as your family,
so it's easier for us to separate ourselves from your choices—we're there
to support you in whatever kind of birth you want, whatever that looks like
for you. You don't have to worry about what we might say or do in any given
situation, we're there for your unconditional support. And we can support
your friends and family, too, just as we support dads and partners in the
birth space.
Isn't all of this what nurses are supposed to do?
In the past, labor support was a big part of a labor and delivery nurse's
job. Today, however, nurses have many other responsibilities, including
medical monitoring, detailed charting and caring for numerous other patients.
And as you might expect, even if they had time, some nurses enjoy and are
very skilled at labor support, while for others that is not their strength.
By having a doula, you're ensuring that you have someone at your birth who
will meet you at home and help with the transition to the hospital, is devoted
only to you, whose personality is a good fit with your own, and who has
specific training in attending to mothers' (and fathers') physical and emotional
needs.
I'm planning a hospital birth, and I want to stay home as long
as possible once labor begins. Will you come to my house?
Yes, of course! This is one of the big benefits of having a doula. We're
usually in touch with clients by phone in very early labor, and then if
you'd like, we can meet you at your home as things pick up. We're not medical
providers so of course we are not monitoring the baby or doing vaginal exams.
But for those who want to stay at home until hard, active labor, we can
help you move your labor forward until that point, help you recognize those
signposts, and then help with the transition to the hospital.
I know I want to use pain medication, will a doula try to talk
me out of it? (Or, I think I want a natural birth, but what if I change
my mind?)
Your doula comes into your birth space with an open mind and an open heart.
We're not there to carry out some agenda, we're there to help you have the
best birth possible, whatever that looks like for you. We'll talk in-depth
during our prenatal meetings to learn more about what kind of birth you
envision, and we'll put all our energy toward helping you get there. And
if you get into labor and for whatever reason plans change, we can actually
help you cope with the unexpected turn of events. There is a lot a doula
can do if you opt for pain medication, including position changes and other
tricks to help your baby descend. We can also help you cope with the physical
side effects of medication, to continue making your journey as comfortable
as possible. Sometimes pain medication doesn't work as expected, but mom's
movements and coping tools are suddenly limited—your doula will get you
through.
What if I need a c-section?
There are so many things a doula can do to help make a cesarean birth the
most loving, family-centered experience possible. For example, your doula
will be with you before the surgery, to help with relaxation and assist
you in brainstorming questions for your health care team. We can help advocate
for some of the things you might want during the surgery. For example, we've
had great success recently in working with surgeons and anesthesiologists
to allow skin-to-skin contact on the operating table, while the surgeon
is finishing the operation. This is so much more family-centered than taking
the baby to the nursery or to the recovery room to wait for you, and we
have found that it significantly decreases birth trauma for the mother.
But it's often something that requires some advocacy with the staff—your
doula can help with those negotiations.
In Southwest Michigan, we are usually allowed to stay with you and your partner in the operating room during the surgery, although this is always a case-by-case decision by your surgeon and anesthesiologist. If we are in the OR, we can help explain what is happening during the surgery and show your husband or partner some physical comfort measures that may help you deal with the sensations of surgery. Sometimes a baby needs to go to the nursery or the NICU after a cesarean birth, in which case the dad or partner generally goes with the baby, and your doula will stay by your side. This helps mothers to not feel so alone as the surgery is finished and recovery begins, and helps partners to not feel so torn between mom and baby. In most cases, though, the baby will go with the mom to a recovery area, where we can help you establish nursing and skin-to-skin bonding.
And finally, if the cesarean was unexpected, your doula will offer a compassionate, listening ear to help you process the birth. She can also connect you with resources such as Birth Kalamazoo's Cesarean and VBAC Support Group.
Do you have back-up in case you can't attend my birth?
Because we work in a group of doulas, we have automatic, built-in back-up.
As the owner of Birth Kalamazoo, Jessica English has been careful to choose
doulas with excellent training and professionalism. Generally, if a client
connects with one doula, she will connect with any of our doulas. We all
have very similar birth philosophies. It's very unusual for one of our doulas
to miss a birth, but if your doula is sick, at another birth or otherwise
unexpectedly tied up, she will send one of her partner doulas to be with
you for your birth.
I'm planning a home birth, do I need a doula?
Not every home birth mom wants a doula, but many find the extra support
invaluable. In fact, there is a local home birth midwife who often recommends
our services, especially for first-time mothers, those planning a VBAC,
or women who have been through a previous traumatic birth. Although the
advocacy part of our job may be less with a home birth, your doula still
helps with all the same issues at home as in the hospital—your physical
and emotional comfort, your partner's well-being, and informational support
about your options and what's happening with your labor. Many times your
doula will labor with you for a significant stretch of time before your
midwife comes to the birth. When she arrives, we work together as a cohesive
team to help you have the best experience possible.
How is it that doulas contribute to better outcomes for moms and
babies?
There's definitely something unique about what a doula brings to a birth.
The physical assistance and information we offer can help couples avoid
unnecessary interventions—better outcomes. When interventions are medically
necessary, we can help mitigate the side effects—better outcomes. Doulas
can help women feel safer and more comfortable during their birth, which
allows their hormones to function optimally—better outcomes. We have breastfeeding
expertise and can offer encouragement and insights based on helping scores
of other women nurse their babies—better outcomes. It would be impossible
to list all of the ways a good doula can help improve a couple's odds of
a normal birth, but this gives you an idea of how our support impacts outcomes
for moms and babies. Your doula brings skills and knowledge to the birth
team that no one else can offer.
Are doulas covered by insurance?
In most cases, insurance does not cover doula services. However, the national
organization that governs insurance billing codes recently added a code
for doula services. Many see this as an indicator that insurance coverage
for our services may be on the horizon. Until that time, couples are encouraged
to submit a claim to their insurance company. Typically, it will be rejected
at first glance, but if you appeal that ruling you will receive a review,
at which time you may make a case for the benefit of a doula. The more consumers
ask for this service (directly to the insurance company and through your
human resources office), the greater likelihood doula services will eventually
be covered. In our experience, most medical savings accounts do cover doula
services, which is a nice opportunity to pay with pre-tax money. We also
offer payment plans and gift certificates, so grandparents, aunts and other
loved ones can help pay for your doula. For those who qualify, we also sometimes
work on a sliding scale, or we may be able to connect you with a new doula
in training—please ask if you cannot afford a doula, we want to help.
When is the best time to hire a doula?
You can hire a doula any time you're ready—we've had clients contact us
when they're just six weeks pregnant, or the day before they go into labor.
With our group set-up, we can usually accommodate all requests, whatever
the timing. The best time to hire a doula, though, seems to be in the second
trimester. This is when most mothers' thoughts turn to birth, and it gives
us a good chunk of time to get to know one another before your little one
arrives. Call us or send an e-mail when you're ready to talk, it's never
too early or too late!
Kind words:
“For my VBAC birth, Andrea walked us through all of our concerns, allowing
my husband and I to make the decisions that were right for us; she was available
for anything at any time, going above and beyond her job description; and
most of all, she was excited about the new life entering the world. After
the birth, I said I couldn't have had the natural VBAC I wanted without
Andrea by my side (or my husband as well, but this isn't about him). Maybe
I could have done it with less support, but I know I wouldn't have had the
peace of mind she lent. I also know I wouldn't want to do it any other way,
and that's a sign of a successful birth.”
- Kelly, mom to big brother Aidan
and Holly, born at Bronson Hospital
“The doulas at Birth Kalamazoo are honestly some
of the most passionate women I have met regarding all that surrounds the
birth experience. I learned that how I think and what I do has a direct
correlation to the kind of birth we would have. "Kind of birth"...not
just "showing up"... we have options?! That knowledge propelled
us to take ownership of our decisions. In addition to the great advice and
warm encouragement throughout the pregnancy, our doula Val spent over 30
hours with us in labor. Specifically, she helped me breathe more effectively
during contractions; knew better positioning to facilitate the baby's movement;
comforted me while my husband took short breaks; and believed in me so I
that I could believe that my body was working. I am convinced her tireless
support ensured us a natural birth. Our son arrived on the scene very alert,
extremely healthy, and happy. We couldn't be more pleased with our journey!”
- Joy Wiegand, mom to Lance, born at Pennock Hospital
