Using a doula RATHER than a midwife?

[rose11]

I just found out I am pregnant, and so excited!! And of course over the last week, all I have been thinking about is how I want to plan this birth.

This is my second chid. With my first, I saw an OB and a midwife for prenatal care, intended on birthing at home initially, switched to a birthing center, and ended up having my daughter on the stairwell of our apartment, with a hospital visit afterward (bc she fell on her head). Not at all how I imagined it would go, but you know . DD was perfect and aside from hating being in the hospital for a day, I can't complain too much - she has a great story after all.

My thoughts currently, due to financial reasons, are that I can see the same OB I saw last time (wonderful, supportive of non invasive methods, supported my desire to home birth) for prenatal care, and hire a doula for additional support through the pregnancy and during the birth at home. There are a couple of midwives near me that offer doula services.

My thoughts here are that I would just be hiring someone as a doula, essentially for the emotional support, but she would still have midwifery experience if something went awry...

What are others thoughts on this? Is this essentially UCing? Is this something midwives/doulas would be open to?

[prone_to_wander]

Would your OB be conducting the home birth? Because I don't think you can ask a midwife to be a doula and then use them as a midwife.

[rose11]

I wouldn't be hiring her for anything other than being a doula. I just like the idea of having a doula that has experience with home birth as a midwife. And I wouldn't be opposed to paying extra if there was an emergency during the birth and she had to switch to "midwife mode"...

It's just that if I see an OB for prenatal care, it wouldn't cost me anything, whereas a midwife would cost thousands. I intend on birthing at home (no, the OB would not be attending), but don't know that I can afford a midwife for the entirety of the pregnancy.

I'm assuming it would just be best to speak with a couple of doulas/midwives and explain the situation and what I am wanting of an attendant, and just see what they have to say...

[CookAMH]

I would consider that UC'ing, yes.

[phathui5]

I think it's reasonable to have a UC and want a doula there for emotional support, but I think it's better to just expect her to be your doula and not look for a midwife to be there at a discount and switch over to midwife mode to take care of you in an emergency.

[katelove]

I think you would need to talk to the midwives/doulas involved. It probably depends on the laws where you are but, in Australia it could get messy for the midwife/doula if they were there as a paid birth attendant, especially if they were the only one. Regardless of the client's request/understanding of their capacity they would be treated as a midwife by our licensing body if something were to go wrong.

This may not be an issue where you are but the midwives will be able to tell you.

[alaskanmomma]

As a doula, if you're hired as a doula regardless if you're also a midwife, nurse, dr., etc. You CAN'T intervene medically, even if you wanted to. I'd be hesitant to take on a client who wanted me as a doula and a "just in case"

[womenswisdom]

I can't see a situation where I would be hired as a doula and be expected to change to midwife mode of something "went wrong". I may not have the knowledge I would need to help the mother/baby in that moment because I would not have the provider/client relationship with them and would not have been monitoring the health of the mom and baby through pregnancy and labor. It would put me in a difficult position of having to basically guess what the best course of action would be, without all of the relevant information. I would also be unlikely to be able to detect a problem as early as I would if I were in "midwife mode" since I'm assuming you would not want to doula to be monitoring the baby and you. And then I might be responsible for trying to resolve a problem that I wasn't aware existed until it was more advanced, likely without the tools I might need to assist in the best way (since I assume I would not be bringing my birth bag with me if I were just coming as a doula).

[momof34me]

Congratulations on your pregnancy!

As far as doula rather than midwife? I think you need to commit to either having an unassisted birth (with or without a doula) or hiring a midwife, but hiring a midwife to only act as a doula unless something goes wrong, seems very wrong. The two roles are very different. If something goes wrong, the midwife, acting as midwife, most likely could have seen it coming, prevented it, or remedied the situation, if she was monitoring you & baby. If she can only act as a doula, then she would not be doing anything medical. It seems like you have plenty of time to work out payment arrangements with a midwife.
I know in my birth circle, homebirth midwives would never do this.
That said, I totally see where you are coming from!! I had a homebirth (with my 3rd) and was very comfortable & confident with going unassisted (I am a childbirth educator & doula) BUT there still was that part of me that thought 'what if.' Because of that, I hired homebirth midwives. They were only with me for 2 hrs during labor birth, but stayed for about 4 hours making sure everything was good~placenta, bleeding etc. Totally worth it!
It would not be fair to say to a midwife, I didn't need you during the labor/birth as a midwife, so I'll stick with our doula fee, but you stitched me up and made sure my bleeding stopped, so bill me for that. That seems weird, doesn't it?

Then again...all doulas, midwives, places are different! Maybe some do it this way!

Interested to see what you go with!

Best wishes for a beautiful homebirth!

[rose11]

I understand where you are coming from and I do agree. I felt kind of weird about the whole idea in the first place which is why I posted it to the board to see what others opinions were. I have a feeling I will probably just interview a couple of the local midwives and see if they're willing to work with me on payment. I think that would be the best option at this point, because I don't want to do anybody wrong or expect more of someone than what their job is supposed to be.

Thanks for all your input!

[MidwifeErika]

I am a midwife who also offers doula/monitrice services. However, I will not act as a doula/monitrice if the family does not have a care provider. Essentially, what the family is hiring me for is to be their midwife, but at the rate of a doula, which is unfair. My peers and licensing board would still hold me to the responsibility of the midwife in a situation like this. I think it is a much better solution, like you mentioned, to interview the local midwives and see if any of them can work with you. 

[Voondrop]

We're UC'ing w/ a doula. We had talked on the phone & she's had 6 UC of her own but this will be the first UC she's attended. We in no way expect her to practice any midwifery skills she might know & it was a kind of cross interview as she wanted to ensure that we would have supplies ready. I joke that she's mostly for Husband so he can attend me or spell him w/ the backrub for a smoke break or something. He wanted a woman w/ natural labor experience but not in labor to bounce his thoughts off of (apparently I act high at birth); we both want a UC so it's a compromise like most things in our marriage.

[PrimalJoy]

A good midwife know how to hang back and leave a woman be until she is needed. If you are looking to birth with little interference but want a professional there just in case, that might be a better route for you. You would just have to ask, "What is the minimal interaction you will have with a woman in an uncomplicated labor and delivery?"

Good luck to you.

[Logan]

I have heard of women negotiating with the midwife for a cheaper rate. Things like less appointments in pregnancy and less follow up visits following the birth (parents take the baby to the regular doctor for check-ups etc instead). So maybe something like that is an option. Also some midwife will barter or let you pay it off slowly.

But if you truly prefer a UC then I would just go with a regular doula for support (if you want support) and not a midwife acting as a doula.

Alaskanmomma- I see what you are saying, but what midwife (or person) would watch a baby die rather than step in and help? I agree it's not fair to ask them to do that if they are hired as a doula. But I am pretty sure "can't" would go out the window if a life was at stake. Definitely puts someone in a difficult position though.