Midwives and Doulas

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If you are seeking a natural, drug-free birth (no matter where you want to give birth), midwives and doulas can help you to achieve your goal by supporting you and attending your birth. Midwives and doulas receive special training in what natural birth should be like, while OBs are trained surgeons. If something's wrong, you want an OB. But if you're a healthy, normal woman seeking a drug-free experience, a midwife and/or doula is the way to go.

First, let's look at the different types of midwives and doulas.

Doula -- A doula is a labor coach or support. They are women (I've never heard of a man being a doula; the idea is that a woman who has a particular interest in birthing and often experience birthing naturally supports another woman) and they are hired to attend a woman's birth. There are actually different types of doulas, and different services that they can provide. They do not replace a husband's role in the birth if the woman has a husband, but can be a sole labor coach/support if a woman does not have a husband or other partner (mother, sister, friend, etc.). Doulas are NOT trained to actually deliver babies and do not have any type of medical training. They function as a support. At a hospital, a doula can function as an advocate for the laboring woman in discussing any interventions with hospital staff and guiding the woman as to what is necessary.

Prenatal doula -- This is a doula who meets with a woman prior to her birth, and may provide supplementary prenatal care (I don't think this is common, but sometimes midwives-in-training will do this; we have the option locally). She will also meet with a woman during her labor and support her then, and may even meet with her once or twice after the baby comes just to make sure everything is going well (breastfeeding, emotional stability, etc.).

Birth doula -- This is the most common. This doula will meet with a woman or couple once or twice before the birth to learn the couple's wishes. Then, the doula will either meet the couple at home or at the hospital (some doulas will come to your home even if you are planning a hospital birth, to support you in early labor) and stay throughout labor. This doula may or may not visit the new mom postpartum.

Postpartum doula -- This doula can help a mom after her baby comes with breastfeeding questions, light housework, watching children (new baby while mom showers, or older children) and generally makes mom's life a bit easier in the early days.

There are doulas which combine the above services. Every doula is different. The least expensive options are usually doulas who meet with you once prior to birth, and meet you in active labor and stay through birth, and don't visit after. The more expansive the doula's services (more prenatal visits, coming earlier in your labor, visiting and providing support after birth), the more expensive she will be. Doulas can range from $200 - $1000 depending on area and services provided.

There are several places to find doulas: asking neighbors/friends, checking with local OBs (not all will be supportive of doulas, but some will have names), asking local midwives (many of whom may also work as doulas), looking on Craig's list, or checking DONA or Childbirth International. There are several other websites, as well, if you search the internet. Make sure that your doula is certified and/or experienced, and don't hesitate to call her references.

There are also several types of midwives out there.

Certified Nurse-Midwife: This can be a man or woman (though more commonly a woman), and it is a person who was first an RN, and then became certified as a midwife. This type of midwife frequently attends hospital births, and in certain areas will also attend home or birth center births (unfortunately there aren't a lot of birth centers). CNMs typically work closely with OBs, seeing patients who are low-risk but can transfer to their OBs if necessary at any point in time. CNMs are a great option for women who want or need a hospital birth but would like a natural approach if at all possible (knowing there's a back-up OB right there if necessary).

Certified Professional Midwife: This type of midwife is also called a direct-entry midwife, because she (and rarely, he) learns midwifery primarily through an apprenticeship. That is, she attends and observes births, then works under trained, experienced midwives. She learns to use a doppler, feel for the baby's position, checking maternal and fetal heart tones (with a fetoscope), check the mother's progress internally, etc. In states where CPMs are legal and monitored, they can attend hospital or home births. In states where they are not legal (including Ohio, where I live), CPMs attend only home births. CPMs tend to be a great option if you are looking for a totally natural, medical-free birth, because their perspective tends to be different than a CNM who works in a hospital and with OBs. Most CPMs, though, do know OBs and have preferred back-up doctors and hospitals. It depends on what you are comfortable with.

For a list of questions to ask when selecting a midwife or a doula, read my post on home birth.

In the U.S., there is sometimes a legal issue surrounding birth. There are states in which home birth is technically illegal. That is, a woman is allowed to birth anywhere she chooses, with anyone she wants in attendance, but midwives can be prosecuted for attending intentional home births, and brought up on charges of "practicing medicine without a license." This doesn't occur in states where midwives are legal and regulated.

The problem with midwives being unregulated is that women who want home births will usually find a midwife anyway, but there is no accountability. This means that midwives who are not certified and may have had negative birth outcomes can continue to practice. It also means that reputable, safe midwives can be arrested and taken to trial simply for helping women give birth. It also, unfortunately, means that in extreme cases, families can be prosecuted even after a SAFE home birth! This seemed impossible even a few months ago, until the Levier family was brought up on charges following their child's safe home birth (the mother was having minor issues after birth and the midwives took her to the hospital to be safe, and she was later prosecuted even though she is now fine and the baby never had issues).

Small aside: It makes me angry, that in a world where alcohol, cigarettes, and other "vices" are legal, and abortion is legal, that women can't choose to birth their babies where they want. Women don't HAVE to choose home birth, obviously, but it should be an option that is free and open to them, and even supported and encouraged! It is so very backwards that a woman can end her pregnancy, and her baby's life, but she cannot give birth to a healthy, normal baby in her own home.

Please support a woman's right to birth where SHE chooses by ensuring that trained support people (midwives and doulas) are available.

More Links:
Mother's Choice
National Association of Certified Professional Midwives
North American Registry of Midwives
Midwives Alliance of North America
Doula Network
Adventures of a Midwifery Advocate
The Big Push for Midwives

Have you ever used a midwife or doula? Is this issue important to you? Please share your thoughts!

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