Midwives and Doulas

I received a call yesterday from a first time mom who had hired a midwifery group for her birth. There had been several changes during her pregnancy in the practice and she had begun to question if she needed to stay or find a new practice. I assured her that it is more than just about the midwife- it is about the location for the birth- the mindset of the staff at the hospital and about her preparation and support. But for some reason she had thought that the midwifery approach meant they would “labor sit” with her – being with her the whole labor.

Ronnie Falco discusses the roles of the support people in your labor on her site http://www.gentlebirth.org/archives/doulacar.html and I think it enlightens a person on the differences of each role. Most nurse midwives in a hospital setting will need to be taking care of several women in labor- some may also be seeing patients in the office- and others may be sleeping or eating as they can be on call for entire weekends. For those who select homebirth as an option, most homebirth midwives will come to your home once labor is established or may send an apprentice midwife to you earlier. But they usually believe that the less interference the better. So they will read a book in another room and wait for the mom to truly need her before entering into her space. But the idea of a midwife being able to labor sit with a mom during her entire active labor is a misnomer for the most part.

The midwifery model does lend itself to longer prenatal visits. The average is twice as long as the doctor visit. So she lends herself to a more gentle paced visit where more questions can be asked and answered. She looks at birth as a natural process, not an emergency about to happen. She tends to see things as normal rather than a problem that needs to be fixed.

But the history of midwifery does not show midwives as labor sitters per se. In a village there may have been one midwife. Since birth control was not common in the early villages, often there were many women who were pregnant at the same time. She would be offering prenatal care of sorts to each of those women and would be present at the birth of most of those women. So in the history what we see are five women present during a labor and birth.

These five women include the mom herself, her mother- giving her confidence as the woman who birthed her and offering confidence in her lineage, her maiden- a younger sister or friend who had never seen birth- it is her time to serve and learn by doing so in preparation for her birth, the crone- this was the wise older woman in the village that was there to guide the new mom- this is the modern day doula, and then as birth was more imminent the maiden or the partner retrieved the midwife for the birth. She may have just gotten home from a prenatal or a birth of another mother.

So the question arises all of the time, “If I have a midwife, do I need a doula?” The answer is yes. Many midwives will agree. There are a few who will say you do not need one, that they will be with you. But I have to say in 17 years of doulaing I can count on one hand the times a midwife was with the mom the whole labor. Those situations occurred in either fast labors or where the midwife made a special concession and came in for that mom specifically. So don’t count on it.

But if you are looking for a low interventive birth- one where you have the most options and most consideration- see a midwife for your prenatal care and use her for the birth of your baby. On rare occasions you will find a doctor who offers care that is similar in some ways to a midwife… but it is very rare.

If you are looking for continuous physical, emotional and information support during labor then hire a doula. She will meet you at your home if you are laboring there and want her- she will remain with you throughout your labor and stay for an hour or two afterward to help you get settled. She will not do the clinical or medical things that a nurse, midwife or doctor does… but she offers a skill set that is different and provides that emotional support they often would like to give but are unable to do in a hospital setting. At a home birth a doula provides the same services to help you along your journey.