Midwife and Doula?

[Charmie981]

I'm starting to see some advantages to working as a doula as well as a midwife, especially given our local birth climate (I think we're under hurricane warning ).

So, does anyone here do this? How does it work? I was thinking of reserving two "slots" (out of five) per month as doula slots and including in my contract that a midwifery obligation comes first (because there are NO midwifery backups in this area!) and making sure that I have a trusted backup for my doula clients, and that my clients know the backup "just in case."

Are there any other things I should think about that maybe I'm not??

[mwherbs]

while you have time and you are working on building a practice, or gaps in doing home births it can help you to serve women and get to know the nurses and docs- after a while it can drive you crazy--- I have done my share of doula work -- but at some point when you see the lies or unnecessary stuff being done it gets urksome-- my old midwifery partner had more of an ability to deal with the hosptial- she would coach the whole room- she just had this disarming ability and people listen to her so she would say things talking to a mom ok now we can see that everything is fine the baby is doing well just take your time and go very slow so this doctor can help you give birth without you tearing- and the doctor poised with the scissors in hand would put them down and wait some more-- it was like she hypnotized the whole room
any how maybe it is a good place to give birth and the hospital has decent care and it will be fine to go regularly--- as for scheduling do you have someone else to refer to if you are already enguaged?

[DoomaYula]

I know a few apprentice mws in Phoenix who work as doulas and they do NOT like it -- as compared to working as a mw.

Do you want to deal with snarky nurses? Listen to docs treat your clients like imbeciles? Work in the midst of CYA-based practices, as opposed to evidenced-based?

(Okay I'm sure there are some nice hospitals and birth centers where these things don't take place, but that is life here in Yuma.)

And the thing is, I don't even have that much knowledge/experience and sometimes it REALLY bothers me, ya know? So having all the experience and knowledge that you have, it might drive you really nuts.

[Charmie981]

Okay, I should have prefaced this with a disclaimer. I understand that doula work is NOT midwifery. Until this week, I would never have considered it. I have done it in the past and truly HATED it. But I've come to a different place over the last week or so and realized a few things: 1.I need to be recognized in my local birth community as a doula AND midwife, not just a midwife, because that's too "out there" for many of the birth professionals, even the ones who are "open" to natural birth and 2.there are women in this town who will only choose hospital or birth center, not home, not even if it were an option (which right now it's really not, because I'm not licensed in Louisiana yet and I'm the only midwife here). Until I can have a birth center, there will be people who want a birth center experience from the hospital and many times they will be sorely disappointed, but who better to help them get that than someone who has actually ATTENDED an out-of-hospital birth?

So I've already done all of that. I know that it's not going to be all rosy and wonderful and that the doula births will really make me appreciate the care that my homebirth clients get from us. But at this point, it's take doula clients or go to nursing school and become part of the system, which I just CANNOT do!!

[MamaRabbit]

:

[mwherbs]

yes there are some things that you have to tread lightly with supporting choices without fighting the battles.. are there any birth centers there already? because they can be easier to work with than the hospital. you certainly get the lay of the land if you are in there for a while.

[DoomaYula]

Well being a doula is definitely a way to get your name out there as a women's advocate, and not just some crazy homebirth midwife :

I used to think being a L/D nurse wouldn't be too bad... til I had a client who got a shot of Hemabate and I watched the nurse change client's diahrrea-filled bedsheets, oh, like 6 times in a row, in the space of an hour. BLECH. (The nurse was very kind and understanding and everything but, good grief!)

[1stimestar]

I recommend that you take an actual doula training before doing this. That way you can be more assured of the scope of practice etc. to help you keep the two separate jobs, well, separate. If you are able to support women's choices even when THEY are not evidence based then go for it. It was hard for me at first (as it is for most doulas at first) to realize that information alone does not a decision make. Clients will choose to go along with what the doctor says just because he is the doctor or just because they are tired of being pregnant or just because this is what their friend told them or just because they mom is having to fly back home and she STILL hasn't had the baby, etc. There certainly is a learning curve as to how to teach more effectively. Can you support those women without judgment? Good luck. Let me know if I can be of any help.

[Jane]

I don't think I could work here like that. There are tons of midwives, 3 freestanding birthcenters within driving distance, and a homebirth rate 3-5 times the national average. And several midwives are working to get hospital privledges for non-cnm midwives. There isn't a middle group of women who want natural birth but HAVE to go to the hosptial, in my opinion.

[Charmie981]

Yeah, and if I lived in WA, I wouldn't be thinking about this. But I live in a place where I have the only freestanding birth center and I can't operate it because my license has been held up by paperwork since FEBRUARY. The choices women have here are: homebirth with an illegal midwife (not me, but another midwife who is actually 1.5 hours away, so mom would have to go there for prenatal care). Homebirth with me attending at a friend's house in Texas (if they happen to know someone who lives over the border), unassisted homebirth, drive 1.5 hours to one of two midwife attended birth centers in Texas, or hospital birth with an OB (there are very few OBs in this town who are even willing to be supportive of natural birth, not to mention the L&D nurses). There are doulas and there are two Bradley instructors, but many (all?) of the doulas are maxing out their client load, which varies from 4 per year to 2 per month, depending on the doula.

Like I said, a couple of weeks ago I wouldn't have even thought of taking doula clients, but I'm seeing the advantages for me professionally, as well as for the women who are trying to fight for respectful treatment in childbirth.

[Jane]

I think there's a place for you. Why not do it for 4 births and see how you like it? That way you don't fill up your schedule 8 months into the future with births you don't want to do if it turns out that way?

From a business standpoint, I think it's great marketing. Get them into talk about doula stuff, and get the midwifery client...or not and do the doula role.

[Defenestrator]

I do doula work and I like it. I guess I just take satisfaction in helping women in the hospital to have a better birth experience than they would have otherwise. I also feel absolutely zero stress about my doula work -- I show up, I do my job, I go home. With midwifery, I am thinking about my clients constantly and put a lot of mental energy into their births. Doing doula work has enabled me to stay a lot busier without taking on the emotional burden of feeling responsible for 4-5 women per month.

The money is good relative to the work that I do. When I started I asked that the doula clients understand that the midwifery clients came first when there were two people in labor at the same time but now I have better midwifery backup. I haven't found it necessary to "reserve" a few of my spots for doula client -- the midwifery clients tend to reserve me at the beginning of their pregnancies and the doula clients at around week 32-34 or so.

My doula clients often labor for a long time at home with me and then when we go in there are often fewer interventions because their labors are cooking along nicely. I also work most often with midwives and they have come to respect me. That is one of the best benefits of doing doula work -- it has made my relationships in the hospital much better. When I go in for a transport I almost always encounter people I have worked with before and there is no substitute for spending hours and hours with someone.

I guess there is a time when I won't want to do this anymore, but for right now it is just fine.

[Charmie981]

I haven't found it necessary to "reserve" a few of my spots for doula client -- the midwifery clients tend to reserve me at the beginning of their pregnancies and the doula clients at around week 32-34 or so.

That's a very good point...

...they have come to respect me. That is one of the best benefits of doing doula work -- it has made my relationships in the hospital much better. When I go in for a transport I almost always encounter people I have worked with before and there is no substitute for spending hours and hours with someone.

This a great way to word what I've been trying to say. It's not the only reason that I want to doula, but it is an advantage to being a doula/midwife that I hadn't thought of before now.

Do you ever have doula clients who decide they want a homebirth? What is your protocol for that? I've heard of doula/midwives who let their clients decide *in labor* if they're going to the hospital or not, but I really think I'd need more notice than that, for all of the reasons you mentioned .

[onlyboys]

Originally Posted by Charmie981

Do you ever have doula clients who decide they want a homebirth? What is your protocol for that? I've heard of doula/midwives who let their clients decide *in labor* if they're going to the hospital or not, but I really think I'd need more notice than that, for all of the reasons you mentioned .

I just recently talked myself out of my doula fees (nice one, eh?) because a very naturally minded woman wanted basically the impossible at our local women's hospital. I gently told her so, and she decided to transfer (at 37 weeks) to the licensed midwives. I am still going to attend her birth, but I can't charge in good conscience because I attend births free at the center all the time.

[Charmie981]

Originally Posted by onlyboys

I am still going to attend her birth, but I can't charge in good conscience because I attend births free at the center all the time.

, yep, I'd do that for sure, too. I'm glad she heeded your advice and hopefully she'll get a good birth out of it. Good for you, mama!!

[Defenestrator]

I just had someone change her mind at 38 weeks. That is ok, but changing your mind in labor won't fly with me unless I really know and trust you. I just don't spend enough time trying to flesh out a good medical history with my doula clients and I would hate to run into trouble with an allergy, a serious condition, etc.

I can think of a few people I would have stayed home with, though. It probably would do some damage to my relationships with their care providers (doula talks laboring woman out of going to hospital -- I can see the rumor now). That alone wouldn't be enough for me to say no to someone I knew very well if she were laboring well and asked for my support.

Now . . . if someone has an accidental homebirth, I am also probably not going to call the ambulance and encourage them to transport, either.

[mwherbs]

oh no I don't play that game-- if we are going somewhere we are going -- I am not getting roped into a quazi midwifery job while being a doula.-- just bad form all the way around- the doc and nurses will think I was just trying to take a client from them and as someone else said I don't do a "provider" work-up - is she Rh-? does she have GBS or a clotting disorder, does she have hepatitis and the baby needs a shot ASAP
and I agree that I am not going to panic if it happens but I am going to support getting them in to be stitched and what ever else they may need including a birth certificate-- if they want a midwife it is a different job-

[beautifulbirth]

Hey from Baton Rouge

I am definitely encouraging you to support moms whereever you can, even in the dreaded hospital as healthcare providers down here need as much exposure to the idea of supporting mothers and their decisions in their care as we gave give them. We need good birth stories and need to get the word out...as so many moms down here are unaware that HB is even a LEGAL option, well, at least for the time being.

I agree that switching a doula client to a MW client at the last minute is not a good idea for soooo many reasons.

Besides, Emmy, the MW down here gets a pretty penny to doula moms.

Best Wishes on your paperwork being completed soon (that could be yrs. though in this state).

[conniebonnie]

this is really intersting for me, a brand new doula-aspiring one day to become a midwife.. i hope this will be something i am discussing in the future- so im glad to have stumbled across it.
just one question (probably silly) but, how is it you schedual 5 births a month into your calendar? i feel nervous with more than three, and thats just as a doula...