doula vs. midwife

[javamoma]

Which do you prefer and why? What is the difference between the two?

I will give birth in a hospital and my MD has worked with both well but did not have a recommendation of one over the other.

 

[fussymonkey]

Hi Javamom,
I haven't worked with either (I WISH!) but I thought that doulas and midwives had different purposes. I believe, at least in my state, the midwife replaces the doctor, and actually monitors yours and baby's health during the pregnany and delivery. Doulas, around here, do birth support to coach you through labor and assist you in dealing with the pain.

Both my kids were born via c/s but I'd hoped to have a vbac with #2, and interviewd doulas. One that I really liked was massage therapist that was also a doula, talk about comforting! Anyway, good luck as you make your choice.

 

[emh1129]

They have completely different jobs.
I had an OB with my first baby (ended up being c-section).
Switched to a certified nurse-midwife with my second baby (vbac).
Used a certified nurse-midwife and also planned to use a doula (ended up not using her, though) with my 3rd.
You can use one, both, or neither.
I think doulas and midwives are awesome! (the vast majority of them , that is )

From the website:
http://www.dona.org/mothers/index.php

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.

A Birth Doula

* Recognizes birth as a key experience the mother will remember all her life
* Understands the physiology of birth and the emotional needs of a woman in labor
* Assists the woman in preparing for and carrying out her plans for birth
* Stays with the woman throughout the labor
* Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision
* Facilitates communication between the laboring woman, her partner and her clinical care providers
* Perceives her role as nurturing and protecting the woman's memory of the birth experience
* Allows the woman's partner to participate at his/her comfort level

 

[NotUrsula]

Doulas don't actually delivery babies. They are there for Mom, to help keep her as comfortable as possible during labor. You can use their services no matter what kind of professional delivers your child, and personally, I recommend it. They know the delivery process well, which your DH/partner probably does not, and will be able to calmly clue you both in on what everything means, which the nurses generally don't have time to do.

If you live in a state where midwife delivery is legal, the question will be midwife or OB? Midwife delivery is NOT legal in the state where I delivered my children, so I can't advise you on that.

 

[emh1129]

NotUrsula- just curious, which state would that be? And are you talking CPM or CNM?

 

[robinb]

I had both, although I wasn't too impressed with my doula. She really didn't do a whole lot for me. My midwives, OTOH, were *great*.

 

[hoosiergirl7]

Agree with PP's. Doulas are coaches that can be hired to help a mom during labor - relaxing, meditation, massage, etc. Midwives are similar to OB's in the sense they can monitor the pregnancy and deliver babies. My SIL had all 3 of her kids at home using a midwife and a nurse at her side.

I know that the use of doulas is really on the rise, but they cannot deliver babies.

What you are looking for is a doula. I don't have the slightest idea how to search for them. You might try to find a good pregnancy message board and ask questions about recommendations in your area. Good luck with the new baby whenever he/she arrives!!!

 

[NotUrsula]

NotUrsula- just curious, which state would that be? And are you talking CPM or CNM?

Missouri, and either one. Technically, it is now legal as of about 11 months ago, but they are still unregulated, so the hospitals won't touch them for insurance reasons unless they are working under the direct supervision of a licensed physician.

 

[TinaLala]

I had a doulah in my first delivery and she was very helpful. Honestly it's all about the nurse = the doctor is there the last few seconds to catch the baby. Have supportive people who will keep you active during labor and then have someone who can pull and catch for the delivery. LOL

 

[javamoma]

Thanks for all the replies. This is helping.

So doulas just aid the mother in birth where as the midwife delivers the baby right?

My sister gave birth with the aid of a midwife in a hospital so they must be able to do the doula's job (as in helping the momma) as well. Correct? My OB said he had worked with both in the delivery room and I am assuming they helped the mom while he attended the baby on the other end.

My OB is an all natural kind of guy (he has a low c section rate) and gave me recommendations but before I called them I wanted some background information on the different jobs the doulas and midwifes do.

Last time I worked with the same OB and a message therapist that specialized in deliveries (she was also working at the time to become a doula). However, my labor went so fast (which is a good thing!) that the message therapist couldn't make it to the hospital in time. My daughter was breech and my labor went so quick the contractions were too strong to try to turn her. I ended up having an emergency c-section.

So, I am the perfect candidate for a VBAC and would like the experince of birth with a midwife or doula. Heck I would like the experience of a home birth but as you can tell, that's really not an option! Sounds like a doula is more of what I am looking for.

Both my husband and I are laid back and both have medical careers. I'm sure we would do fine again on our own. But, I like the idea of having a liason with the staff and someone who will cater to our needs. Does that make sense?

I am thinking doula fits that description more.

Wow, that was a long post. Sorry

 

[~Kristina~]

I had a doula (labor support person) for 2 of my hospital births. She was awesome!!!

I had/have a homebirth midwife my last pregnancy and this pregnancy and my midwife and homebirth were out of this world fabulous!

Many states it's illegal for CPM's to practice, but there are many lay midwives that DO practice in those states.

In Michigan, CPM's are unregulated but it's not illegal to practice outside of hospitals.

 

[Colinsmom]

A midwife would replace your OB. She would care for you during your pregnancy and be there to deliver the baby. My last midwife "labor-sits" starting at 4cm, which means that she is in the room or very close by starting at 4cm, helping mom through the labor. She was awesome as both a labor coach and as the person medically responsible for the delivery. That birth was in a hospital. If the birth turned into a c-section, I would have been handed back to her back-up OB as midwives do not perform surgery. She did, however, stitch me back up after some mild perineal tearing.

Not all midwives can or will attend a vbac for various reasons (here in IL, it usually relates to hospital policy or their back-up OB).

A doula is a labor coach only. They do not make medical decisions, but can answer questions and help explain things so that you can make your own decision. I had a doula at the same birth as the midwife, and she was okay, but the midwife was definitely a bigger factor in how the delivery went.

If I had to go with an OB, I'd definitely bring in a doula. When you birth with an OB, you are really playing L&D nurse roulette - you get a great one or you don't - who can make or break your birth, esp your vbac. The doula can help you deal with a less than stellar L&D nurse. Yes, you need an OB supportive of your vbac, but there are so many things that the L&D nurse can do to screw up your chances before the OB shows up... You sound like you need/want a doula.

 

[laluna]

Wow! Finding this thread fascinating! I am a midwife in the UK and we carry out all care for women in pregnancy, labour, delivery and the post partum period, only referring to an OB if there is a problem. We are very autonomous and largely work alone. Doulas are not common here as we tend to take their role too. I didn't realise that it was illegal for midwives to practice in some states. What about Florida?

 

[Anonomom]

FWIW, I used a doula when I attempted a VBAC for my second daughter, and she was wonderful. She asked me to call her as soon as I went into labor, so we could spend time at home before going to the hospital. She was invaluable when the doctor started making noises about my "lack of progress" and my "very large baby." She reminded me how far I'd come and how well I was doing, reassured me that the baby was doing fine, and gave me coping strategies when the contractions started lasting 30-45 minutes at a time with no break (that's not normal, btw).

I did ultimately have the c-section, and the "huge" baby came out weighing exactly 8 lbs. But I'm very glad I had my doula, and I'd recommend one to anyone giving birth in a hospital, where even the best doctors seem to become scalpel happy once you've been in labor for more than 8 hours.

 

[robinb]

Wow! Finding this thread fascinating! I am a midwife in the UK and we carry out all care for women in pregnancy, labour, delivery and the post partum period, only referring to an OB if there is a problem. We are very autonomous and largely work alone. Doulas are not common here as we tend to take their role too. I didn't realise that it was illegal for midwives to practice in some states. What about Florida?

Here in the US Midwives are usually practitioners that support a more natural birth experience. Babies are also delivered by primary care physicians and OBs. While some of them certainly encourage natural births, the standard operating procedure for births in America would make your hair curl. Between routine induction of labor, routine drugs for pain, routine epidurals, routine fetal monitoring, routine episomities and a high percentage of c-sections it's no wonder that some women choose a midwife.

Don't get me wrong! I would have used any and all of those procedures/medications/ect *if* I needed it. I'm not dumb or stubborn or a "hero". In fact, I was attached to a fetal monitor because my DD showed some distress and they needed to monitor her heart rate. It's just the routine aspect of all those medical interventions that bugs me about the way we Americans birth babies. The sad fact is that since it is the SOP many women don't even question it.

 

[DisOrBust]

Tina thanks for your kind words. I'm glad someone notices....


Now to defend my profession. As an L&D RN I have seen my share of "bad" doulas. They are for the most part unregulated there are organizations that certify but with varying degrees of requirements. IF you decide on a doula make sure she is REALLY experienced, not just fudging the numbers and get at least three recommendations by Moms that really have used her as well as any MDs she has worked with.

Can you get a bad L&D RN, of course. But if you are not "connecting" with her then ask for someone else. It is our privilege to be able to participate in your birth and if your not happy with your nurse by all means ask for a switch. Most hospitals will accommodate.

IMHO its not the Doula or RN or MD that makes or breaks your birth experience but your partner. LEt them know you your wants and needs, tell them how to help, take classes and really PRACTICE! It goes so much better when they don't look like a deer caught in the headlights.

 

[Anonomom]

Don't get me wrong! I would have used any and all of those procedures/medications/ect *if* I needed it. I'm not dumb or stubborn or a "hero". In fact, I was attached to a fetal monitor because my DD showed some distress and they needed to monitor her heart rate. It's just the routine aspect of all those medical interventions that bugs me about the way we Americans birth babies. The sad fact is that since it is the SOP many women don't even question it.

Now, I'm veering off topic, but I have to say I agree with you 100%! But it's not just that women don't question -- those who do question it are treated to an array of scare tactics and caveats that are pretty much designed to make them shut up and do as they're told (usually, to submit to an induction and possibly a c-section).

The reference I made to my "huge" baby is a case in point -- when I was 37 weeks, my doctor, who had previously told me she supported a VBAC, started listing all of the conditions I'd have to meet before I'd be "allowed" to labor (I was to come directly to the hospital as soon as I had my first contraction, agree to be hooked up to a monitor that would keep me motionless in bed, and agree to an epidural just in case an emergency c-section was needed). Then they told me I had to get an ultrasound to determine the size of my baby. At 37 weeks, they measured her at 8 lbs. 12 oz and told me she'd probably weigh over 10 pounds at birth. Then, of course, I was told I "needed" a c-section because my baby was so large.

I switched doctors and hospitals, and ended up in a more supportive atmosphere. But even there, the doctor couldn't resist telling me the stories of all of the ruptures and stillbirths he'd seen, all the while telling me it was safer just to have the c-section.

It's hugely frustrating.

Oh, and Disorbust, I should also mention that the L&D nurse I had with my daughter was AMAZING! She was super-excited that I was trying to labor without an epidural and was very helpful and supportive. She and my doula worked well together and did a great job of talking me down when the doctor started freaking me out.

 

[emh1129]

Tina thanks for your kind words. I'm glad someone notices....


Now to defend my profession. As an L&D RN I have seen my share of "bad" doulas. They are for the most part unregulated there are organizations that certify but with varying degrees of requirements. IF you decide on a doula make sure she is REALLY experienced, not just fudging the numbers and get at least three recommendations by Moms that really have used her as well as any MDs she has worked with.

Can you get a bad L&D RN, of course. But if you are not "connecting" with her then ask for someone else. It is our privilege to be able to participate in your birth and if your not happy with your nurse by all means ask for a switch. Most hospitals will accommodate.

IMHO its not the Doula or RN or MD that makes or breaks your birth experience but your partner. LEt them know you your wants and needs, tell them how to help, take classes and really PRACTICE! It goes so much better when they don't look like a deer caught in the headlights.

There are some truly amazing L&D nurses out there.
I had the most amazing experience with my VBAC birth- the nurses were so supportive and respectful (to both me & DH). They really have such an important role!

It was then that I decided to become a nurse and will be graduating this coming May I plan to work L&D and then when my kids are older I will go for my master's degree to become a CNM.

 

[K and K's Mommy]

I might have gotten lucky, but I had all three of mine naturally with just the nurse and my wonderful DH! Number two was definitely the hardest, but the nurse got me through. She was an older lady and definitely knew what she was doing.

I am not a natural type person in most regards, but for some reason, epidurals scared me!

 

[Gretchen3ajoshmom]

I LOVE my midwives! I went with OB's for my first two, and switched for my last two. The difference is unbelievable! My midwives were concerned about me and my family as a whole, not just medically. I gave birth in a hospital and I had epiderals all 4 times... What can I say, I'm a wimp! I was much more relaxed and had easier times with the last two... CNM are allowed to practice in hospitals in PA- they just have to be "under an OB" - I never had to meet/see/ or go to the OBs office though.... One weird thing here in PA - CNM cannot prescribe anything- not even prenatal vitamins!!! They have it called in through the OBs office- crazy- huh?