Need your help!

[CarolynnMarilynn]

I am presenting at a doula conference speaking on midwives and doulas working together. I am soliciting help and feedback. If you wouldn't mind could you answer my questions and provide any other feedback/experiences that come to mind?

1) Are you a doula, midwife, or a consumer who has used both a doula and a midwife (at the same birth)?

2) What are the advantages/positive things about a doula and a midwife providing care together (with the doula doing her role and the midwife doing her role)?

3) What are the disadvantages of a doula and a midwife providing care together?

4) What things can be done to optimize the care of a woman in this situation?

5) What roles do you see the doula playing, and the midwife playing? Where do they intersect, and where do they meet?

6) What experiences do you have with midwives and doulas working together?

7) In what ways would midwives and doulas working together be ideal? How can birth workers support each other?

Thank you so much. You can reply here, or by PM.

Carolynn

[CarolynnMarilynn]

Please?

[DallasCPM]

1) Are you a doula, midwife, or a consumer who has used both a doula and a midwife (at the same birth)?
All of the above! I've been the doula at a midwife-attended birth, the primary student midwife at a birth with my preceptor and a doula, and I've been the mom who has had both a doula and a midwife at my birth.

2) What are the advantages/positive things about a doula and a midwife providing care together (with the doula doing her role and the midwife doing her role)?
My doula took tons of pictures for me (which my midwife couldn't do when she was busy doing FHTs/catching/etc.) which was a wonderful plus. She ran and got drinks. She made sure my husband was eating (he tends to forget in the moment). She did a bunch of errend stuff. She gave me back rubs. As a student midwife, I love when a doula can do those things, so I can concentrate on learning with my preceptor. At one birth, where my preceptor and I were trying to get a baby going, the doula quietly and quickly explained to mom and dad what was happening and provided emotional support while us midwife's were busy doing what we had to do. There was no time for us to talk in the moment. The doula took that role beautifully and provided a calming spirit. The parents stayed calm, and everything resolved quickly and calmly.

3) What are the disadvantages of a doula and a midwife providing care together?
Too many people in the room which can inhibit labor. I've seen that at some births I've attended. My doula for River's birth was perfectly "invisable" to me. She let my hubby do most of the labor support, and honestly, I hardly remember her being there. I remember we had tons of picutres afterwards. I remember my glass was always full. I remember when transition hit, I looked for her eyes and she told me I was doing great. But other than that it was if she wasn't there. (I've always said, a good doula for me is like a good waitress - they do their job, make sure everyone is taken care of, but they don't interrupt the conversation between the husband and wife at the table)

4) What things can be done to optimize the care of a woman in this situation?
Let the woman labor as she wishes. And don't constantly have too many eyes "watching" her as she does her thing.

5) What roles do you see the doula playing, and the midwife playing? Where do they intersect, and where do they meet?
6) What experiences do you have with midwives and doulas working together?
7) In what ways would midwives and doulas working together be ideal? How can birth workers support each other?

I think the last three questions, I answered above in previous responses.

Here's what my husband and I had to say about having a doula at a midwife-attended homebirth.
http://www.dallasdoula.com/testimonials_cori.htm

HTH. LMK if you need more.

[CarolynnMarilynn]

Thank you Cori for taking the time to answer my questions and for sharing. Lovely pics by the way!

Carolynn

[Altair]

1) Are you a doula, midwife, or a consumer who has used both a doula and a midwife (at the same birth)?

I'm a doula who has attended midwife births.

2) What are the advantages/positive things about a doula and a midwife providing care together (with the doula doing her role and the midwife doing her role)?

Each person in the labor team has a role. The midwife is there for making sure the birth process is safe, using her knowledge of what a "normal" birth looks like and knowing the signs of unusual things happening that require more attention. The partner (if there is one) takes whatever role s/he wants-- physical support, emotional support, spiritual support, etc. The doula fills in any gaps and supports the partner to make it happen. The doula can do whatever is needed at that particular birth to make the mother as empowered as possible. She does not have to be as much of an "advocate" as in hospital births (IMO, it's not an appropriate role for a doula regardless, but that's another story).


3) What are the disadvantages of a doula and a midwife providing care together?

Depending on the particular doula, I've seen what the PP talks about too-- too many cooks in the kitchen. A doula who thinks she must be "doing something" at all times might be too aggressive. It's ok to know when to take a background role, it's ok to take a break and give the mother and partner some breathing room.

Of course, there's always the chance of a personality clash, which has no place in a birth, but unfortunately DOES happen if either doula/midwife or both are just too strong willed. The birth shouldn't be about either of them, of course, it should be about the family, so a GOOD doula or midwife won't have this issue.

A doula can still be put in an awkward position if a midwife who claimed to be hands off during prenatal visits now wants to take a very hands-on approach, despite the family's wishes.

4) What things can be done to optimize the care of a woman in this situation?

make sure the needs of the entire family/household are met.

5) What roles do you see the doula playing, and the midwife playing?
Where do they intersect, and where do they meet?

I somewhat answered this-- I think they have very distinct roles, but both can be there for physical/emotional support. Sometimes one particular personality just clicks more for a mother in labor.


6) What experiences do you have with midwives and doulas working together?

All positive. The only negative birth teams I have encountered with doulas/midwives are when there are too many midwife assistants involved as well, esp those who want a really active part in the birth. The mom just might not want all of those people around her, esp if she's never met the students before. The problems have always quickly solved themselves though (mothers in transition have a way of making their needs known!!)


7) In what ways would midwives and doulas working together be ideal? How can birth workers support each other?


Giving each other space to fufill their own roles, while supporting each other. There's no reason why a doula can't "help" the midwife and the midwife can't "help" the doula at different times in labor. When there are lots of women around the mother, everyone needs to remember the father's needs and remember that his participation in the birthing process is a heck of a lot more important than yours!

[CarolynnMarilynn]

Thanks Altair. You have both made excellent points. I appreciate your responses!

[Zoo Loo Naturals]

I've always said, a good doula for me is like a good waitress - they do their job, make sure everyone is taken care of, but they don't interrupt the conversation between the husband and wife at the table.-livelybaby

Cori~
This just cracks me up! I'm very happy you said this as I know this sort of thinking very well. No wonder I have done both! lol



I will be thrilled when we have more natural care providers working together. We Doulas and Midwives have alot to offer our clients and each other, I like to think I can fill many roles as I travel down my path and Doulas and Midwives to me have a lot in common. We also work very happily with chiropractors, homeopaths, herbalists, massage, therapists, lactation consultants...the list is long. And I'm always very pleased to work with the doting grandmothers, they make things so nice and I have had the best conversations. They seem to really appreciate what I do and they make great food! lol

[Mamajamz]

Just my .02 and I will probably ramble a bit...

I work now as an assistant and sometimes alter my role between doula and midwife assistant. I have found that we work together very well. I'm speaking of the midwife and I. I also have the advantage that she is my mom, so we know each other very well, and have mutual respect and care. I think that spills over to the client as there is a seamless continuity of care always flowing in the room. We each "read" the situation and let the energy in the room dictate, unless there is need for more direct help. I also work with other midwives on occasion and again it is the same, we become extensions of each other for the sake of the birthing mom. I, being the assistant, am providing more of that "extending" role, which I think brings up an important point. I may split hairs here, but please hear me out to the end of my thought. I think it is very important for the doula to defer to the midwife and to support any directives the midwife gives BECAUSE, that midwife is the provider that the mother has chosen. I have seen doulas undermine the suggestions that the midwife has given, which causes mom to doubt the person that she had put in that role to do. Then not only does mom have to be in labor and make decisions based on her state of being at that point, but she has to decide all over again if she can trust this person she has appointed as the keeper of the birth space, the midwife. It ends up putting more of a burden on the mother than helping her. I personally do not believe that doulas need to take on the role of advocate within the model of midwifery. If that is happening, then mom needs to find another provider that she feels more at ease with. IN a good midwife-mother relationship, there is no need for an advocate because mother is being heard, understood, cared for and there is trust. A doula who comes into that setting, who may be accustomed to being an advocate (because there *is* a need for that in other settings, for sure) takes on a role that disrupts the flow of trust and communication. It's funny sometimes to see a conversation happen where the midwife will ask mom a question or give some options that are available to her and doula will jump in between them to make sure that Mom is comfortable with that, or is that what she really wants, when there is no need because the choice has never been taken away from the mom in the first place.

I have now officially forgotten what the other questions were, and have rambled off my own initial thought, so it's time for night-night. I'll re-visit this again. :wink

[Mamajamz]

Just blabbing some more here. ( I love this topic)
#5 In my work, and often what I see as well, they definitely intersect. No, I should say they CAN intersect. I think it depends on the midwife's approach. If she is very hands-on, loving and supportive (which I think is probably ideally what she should be) then the midwife and doula share in the care for the moms. Everyone has a job, as someone has already said. I find that a lot of times I will stay with Mom as MW has to attend to paperwork or whatever is needed, or even just a potty break. Then, as Mom begins to push I'll usually go make sure the O2 tank is ready in case, and other birth supplies for when baby comes out and MW stays right by her. Then I return and we're both there along with partner for the rest of pushing. There is always one of us either with Mom in support, or nearby. We find it works beautifully this way. It's true, I am technically considered the midwife's assistant rather than the doula, but so many times I find that "doula" is the embodiment of a concept of care and support more than it is a specific person. The care we give really depends on the mother and who she has with her. [I might add here, that possibly it can be a disadvantage if the mother has hired a doula but finds that in labor she just really needs her space. It's easy for me to give her that because I have to be there any way, and have other duties to attend to if she doesn't need my presence. The doula, however, sometimes may have a hard time becoming invisible if need be because after all, they are paying her to do her "doula thing". It's hard to just sit back and sit on your hands in those cases. I have seen moms get angry at their doula (rarely, but it happens) because doula wants to *do* something, when mom just needs space. ] There have been births where there was no professional "doula" but rather a mother and best friend who provided such wonderful support that MW and I pretty much just backed up out of the way. Other times there has been a hired doula, but it was evident by the looks on mom's face and her complaints and requests that the doula was not really tuned in, so I added a little help and a group of us helped mom through labor. I think it is so significant to realize that the doula was a concept that has evolved in recent years only because the medical community took over childbirth. The only times, in our practice, that it seems the professional doula has been really really necessary (or would have been, had she been there) is when there is some kind of crisis, and both MW and I are having to tend to the crisis at hand. Dad is usually sitting dumbfounded, not sure what to do or say. In those instances we are moving so quickly that comforting becomes secondary. How wonderful to have a doula present who can put the situation in context, comfort and explain in encouraging ways what is happening in that moment, and can also support Mom in re-framing the situation later. In those times a doula really shines because she maintains the continuity of nurturing care. Otherwise, when birth goes along its normal pathway, the presence of a doula usually just makes our job easier, because if mom doesn't have a doula and needs one, I step into that role. I have to emphasize, however, that if Mom has a special bond with her doula, be it her sister, friend, mother, or even a hired doula that she is really connected with, then in that case the presence of THAT particular person becomes comforting, not just a kind of care or skills that they possess. In that case, I can't step into that role in place of that person, of course. But usually, I find that Mom and I bond through the hours of labor even if I haven't met her through prenatal care, such that my presence becomes comforting, KWIM?

[Paige, CPM]

Mamajamz,

Thanks much for your post...I had what you have described, a doula who really undermined our role as midwives with a couple of clients once. Thank you for putting that into words.

Here's the short story... :o)

They were two young ladies who were friends from the same area due around the same time. They both knew this woman as she had children their age, and was known to have attended some births. She made it known that she would help them, do some CBE and some kind of backup because it could take us over an hour to get there. It sounded like a great community connection to my partner and I.

It became clear at the home visit that she did not think we were doing things the way she would like it. I.e. not teaching CBE classes to them on top of prenatal care, and not giving the kind of information she would. (Mind you we do incorporate CBE stuff into prenatals.) She was asking questions for them at the visit. Yikes, my partner and I left feeling so bad about her behavior. She didn't really know our work and yet she questioned it... And we are homebirth midwives...(not that every homebirth midwife is great, or we are perfect, but, you know what I mean...) I think she had questioned the client about what we did and asked if we had done certain things. Which at least planted a do-not-completely-trust seed, and at most may have even complained to the client that we should be doing these things. Eeks...

We should have pow wowed more with her before the births to straighten these issues out. But, we didn't want controversy for our clients, one in particular, who clearly seemed to defer to her. So we figured it would not be a big deal.

At the first birth she was all over the mom and I had a hard time communicating...it really did feel like it was not the best situation at all for us to be in as far as mom listening to us if she needed to, and most importantly, I could see it was taking the mom's birth power away from her. It was kind of sad that way. Every thing the mom did was directed by this lady. Perhaps it worked for her, as she did not ever complain. But I still have this feeling that it might have been different for her.

And with other client, she thought things were early so she hung back...the mom did more things on her own.... and then there was the head... no time for interference. This was a good birth.

But, never again, I will address these issues if they come up... And I may save your post too....just for that occasion, as it is so eloquently addresses the issue. Thanks!

Warmly, Paige

PS I do Doula work also, I love Doulas...it was just this one story that reminded me of the ways in which it can be more about the doula than the mom... which is rare, I believe...

[muslima0midwife]

I am presenting at a doula conference speaking on midwives and doulas working together.
Carolynn

Hi can u tell me when and where is this conference... i'd like to attend if its not too far! I love a good conference. I plan to attend the Midwifery Today conference 2006... AND i am planning my own for next spring. (also maybe we can stay in touch and i could have u speak at mine??!)
Thanx Muches! :D
:bouncy

[muslima0midwife]

Mamajamz,

Thanks much for your post...I had what you have described, a doula who really undermined our role as midwives with a couple of clients once. Thank you for putting that into words.

Here's the short story... :o)

They were two young ladies who were friends from the same area due around the same time. They both knew this woman as she had children their age, and was known to have attended some births. She made it known that she would help them, do some CBE and some kind of backup because it could take us over an hour to get there. It sounded like a great community connection to my partner and I.

It became clear at the home visit that she did not think we were doing things the way she would like it. I.e. not teaching CBE classes to them on top of prenatal care, and not giving the kind of information she would. (Mind you we do incorporate CBE stuff into prenatals.) She was asking questions for them at the visit. Yikes, my partner and I left feeling so bad about her behavior. She didn't really know our work and yet she questioned it... And we are homebirth midwives...(not that every homebirth midwife is great, or we are perfect, but, you know what I mean...) I think she had questioned the client about what we did and asked if we had done certain things. Which at least planted a do-not-completely-trust seed, and at most may have even complained to the client that we should be doing these things. Eeks...

We should have pow wowed more with her before the births to straighten these issues out. But, we didn't want controversy for our clients, one in particular, who clearly seemed to defer to her. So we figured it would not be a big deal.

At the first birth she was all over the mom and I had a hard time communicating...it really did feel like it was not the best situation at all for us to be in as far as mom listening to us if she needed to, and most importantly, I could see it was taking the mom's birth power away from her. It was kind of sad that way. Every thing the mom did was directed by this lady. Perhaps it worked for her, as she did not ever complain. But I still have this feeling that it might have been different for her.

And with other client, she thought things were early so she hung back...the mom did more things on her own.... and then there was the head... no time for interference. This was a good birth.

But, never again, I will address these issues if they come up... And I may save your post too....just for that occasion, as it is so eloquently addresses the issue. Thanks!

Warmly, Paige

PS I do Doula work also, I love Doulas...it was just this one story that reminded me of the ways in which it can be more about the doula than the mom... which is rare, I believe...
WOW!
it sounds like u were in the room with an Uptight Male (take away womens' Empowerment) OB Doc or something! LOL! Thats usually the way i have seen the OB's Act towards doulas.... NOT Doulas towards midwives. See as a midwife and doula i dont think that i would ever act that because i am on both sides of the fence. I once went to a conference and sat in a Doula workshop and the best advice i had ever been given came from this conference : 'Remember, It is NOT your birth'. That says it all... if ALL doulas, midwives, and OBs saw it that way... many mom's would be well off. Thekey is :to know your Position and where u stand in the birth. If i were attending a birth as a doula with midwives delivering (and me being a midwife too) and i had some extra input, i would (if there was time)pull the catching midwives to the side and make my suggestion, listen to ther feed back and then present it to the client. But this OF COURSE of course of course depends on the situation. But overall when i am the doula - iam the doula. i try Not to but into the Midwives' business (with how she is practicing) because that is not what i was hired for. But when i am Midwife- i am midwife - and i will respect the doula ( although so far i have never had a doula attend one of my births) as long as she brings thesame respect (which i mentioned previously).
:blah :blah :blah
i did not mean to say all that! :blush

[CarolynnMarilynn]

Hi can u tell me when and where is this conference... i'd like to attend if its not too far! I love a good conference. I plan to attend the Midwifery Today conference 2006... AND i am planning my own for next spring. (also maybe we can stay in touch and i could have u speak at mine??!)
Thanx Muches! :D
:bouncy

Heya!

The conference is this weekend in Toronto. It sounds like you may be pretty far away. I have never gone to a Midwifery Today conference before -- are they very good?

Do you have a theme for your conference? I am trying to set one up here for the Association of Ontario Midwives entitled, "Midwives taking a stand" and discussing autonomy of midwives, women and disabilities, sex-positive stuff, genetic screening and midwives, midwifery protocols, etc. Basically around the idea that midwives can and should exert more influence on the obstetrical world than they do now (publishing research-based protocols, protecting normal birth more etc.)

Carolynn

[CarolynnMarilynn]

Thanks for all the great responses. So thoughtful and well-said.

XOXO

Carolynn

[flyjawn]

i didn't know there was a conference here this weekend... how exciting.

good luck with your presentation - sorry i can't help with the questions - i didn't have a doula - just a midwife...