What would you choose: homebirth at home with midwife but no doula or midwife birth at hospital with doula? - Mothering Forums

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#1 of 26 Old 12-29-2010, 08:22 AM - Thread Starter
 
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I really would like to have a home birth with this pregnancy (first pregnancy was uncomplicated) however my insurance does not cover midwives for home births.  I can't afford both a midwife and a doula for a home birth. I love my midwife at my local hospital but after my last birth I decided that the hospital was a huge hassle that I did not want to do again. If I gave birth at the hospital with a midwife then I could afford a doula. But if I pay out of pocket for a midwife for a home birth then I won't have the doula.

So my options are a home birth without a doula or a hospital birth with a midwife and doula. Which would you choose?

Thanks for the advice!

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#2 of 26 Old 12-29-2010, 08:41 AM
 
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I would go with homebirth with midwife and no doula. In fact, I am going with that option although the alternative for me is hospital birth with an OB. I feel/hope that my midwife will be enough labor support that I won't need a doula. The assistant she expects for my birth is a student midwife and a doula so there will likely be someone here with doula training.


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#3 of 26 Old 12-29-2010, 09:05 AM
 
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Best of both worlds: HB midwife with a student doula?  I knew a student doula in my area who did her contact hours for free, but you should definitely be able to find one with significantly lower rates than an already-certified doula.  In your shoes, I would investigate this option first.

 

Also, does your HB MW work with an apprentice?  A doula with an HB is very useful in that she frees up the MW to focus on catching the baby.  But if there is an apprentice on board, she can provide a lot of the support and encouragement that a doula would.  Granted, that's not technically her role. She probably won't be free to run and microwave a rice-sock or provide pressure-point massage, but she could work with you on your breathing, remind you of good coping mechanisms, and--working with the CPM or CNM, advocate for you and your birth plan in the event of a hospital transfer.  In other words, between two MWs and your DP/SO, you may have all of your bases covered for a home birth.

 

Out of curiosity, what made your hospital birth a "hassle?"  Did you feel invaded or disrespected in anyway, or were you mostly bothered by the whole rigamarole of getting in the car and dealing with triage, hospital protocols, etc?  Or both?  If the hassle is more minor but you have implicit trust in your hospital CNM (and you know for sure that she will attend your labor and not some on-call stranger), I wouldn't totally rule out the hospital-doula option.

 

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#4 of 26 Old 12-29-2010, 10:11 AM
 
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HB, no question! First, I personally wanted a doula in my hospital birth mostly to act as "body guard" because, even though it really was a great hospital with great CNMs, I still had my anxieties. I also wanted her help in deciding when to go to the hospital. & it was also helpful having someone else who knew my birth wishes, wasn't a stranger, & would be there constantly for me (whereas the CNM might have other patients in labor & might not stay with me.)

Well, NONE of that is an issue with an HB! :D

 

Besides, I believe most HB MWs always have an assistant with them - so you'll already have 2 women who you know well dedicated exclusively to supporting you. At least with my MW & her apprentice, they're more than willing to help with position changes, counter-pressure, etc - the sorta physical & emotional support a doula would provide.

 

I'm not saying a doula is always completely unnecessary at a HB - generally they show up earlier in labor than a MW does, but on the whole, I feel like the doula is less necessary at HB relative to hospital birth & I would absolutely chose HB over hospital + doula. There's no replacement for being at home.

 

Plus, if you end up having to transfer, most HB MWs will go with you to act as your doula in hospital.

 

& finally, are you certain your insurance won't provide any coverage? I'm using a CPM and she's totally illegal here in MD, but yet I got an exception to have her covered at the full in-network rate! Ha! I'll still have to pay some out of pocket, but not tons. We could afford a doula if I wanted one, but I'm not getting one because the 2 birth attendants is plenty & I prefer privacy & solitude in labor anyway.

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#5 of 26 Old 12-29-2010, 01:14 PM
 
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I am doing a HB with midwife and a student doula.  I could not have afforded a doula otherwise.  With DH being an airline pilot and totally gone when he is gone, I really wanted the comfort of knowing that I will have at least one support person available when I go into labor.  DH has also been so busy with recent training, that he has not had a chance to do any reading or learning about how to be an effective labor partner, so I will be relying heavily on my doula to help him help me.


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#6 of 26 Old 12-29-2010, 01:24 PM
 
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i had 2 hbs, and neither one i used i doula.  i could have used one for the first birth. and if this was a first birth, i would say, homebith/mw/student doula.  mainly because they will come earlier than a mw and they can reassure you and help both you and dp with logistical stuff - get more water, get clean towels ready, etc.  but, after my first birth i know that i birth better if everyone leaves. me. alone.    i may need someone to turn the water on in the shower or get me a towel, or give me water, but i dont need "support"  i need to be left in a room by myself.  so, i would always go hb w/mw. 

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#7 of 26 Old 12-29-2010, 01:27 PM
 
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I would go with the homebirth.  However, as someone else mentioned student doulas often do their work for free or low cost.  You have to be a doula a certain amount of times to get certification with most organizations, this work is usually done for free.  I am having a HB with a student doula.  I would have been alright if I hadn't found a doula though, homebirths are so much less intense than hospital births. 


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#8 of 26 Old 12-29-2010, 01:31 PM
 
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Homebirth with midwife. I don't think doulas are as necessary in the home because a midwife should be doing the same thing. In hospitals, the doctor or midwife often have other patients and aren't with you all the time. At home, the midwife is there for you 100%. I planned a homebirth and we had to transfer (exhaustion- 60 hours of labor and I needed help) and the midwife came with me and acted as my doula there


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#9 of 26 Old 12-29-2010, 01:35 PM
 
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Homebirth with midwife, no doula. Hopefully you can find a supportive family member or student doula to help, but as pp said, mw's are able to be more "present" at a homebirth than in the hospital. Also, your birth partner can take a much more active role at home than in the hospital---my husband was the best doula I could've asked for! Though I know he would have been relegated to a much more passive role had we been in the hossy.


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#10 of 26 Old 12-29-2010, 01:48 PM
 
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HB HB HB!!

 

I am so glad that doulas are out there, offering their support and services to mamas that need them.  I can't imagine a hospital birth without one!

 

DS was born in a freestanding birthcenter, so not exactly the same as a homebirth, but I have to say, a doula would have been pretty bored at DS's birth.  Between my partner, my midwife, and her apprentice, I felt like I had PLENTY of support.  My midwife did a lot of what a doula would do in the hospital: she rubbed my back, got me water, helped my stay relaxed and focused, mopped up the buckets of sweat from my back while I pushed love.gif...  A hospital midwife won't have the time to do those things, most likley, but I think it's pretty much par for course that homebirth midwives do more than just monitor you and the baby.  Homebirth midwives are really the full package, and I'd choose a homebirth with a midwife in a millisecond over a hospital birth with a hospital midwife + doula, ANY DAY!!

 

Not to in any way discount the really important work doulas do.  Y'all support women in situations that are so intense...


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#11 of 26 Old 12-29-2010, 04:54 PM
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I'd definitely chose the HB with no doula. I've had 6 homebirths and never had a doula. I found I really don't need one and honestly my labors have always gone so smoothly and quickly I didn't see the need for one. If for some reason a hospital birth was needed I would absolutely get a doula though. But at home I feel just fine with just DH and my midwife.


 
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#12 of 26 Old 12-29-2010, 07:50 PM
 
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While I understand the need for a doula at a homebirth, for the most part an HB midwife takes over much of the role a doula would hold at a hospital birth.  The HB midwife guides the energy of the birth, makes pain management suggestions, and most importantly knows and advocates for you to have an interventon free unmedicated birth.


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#13 of 26 Old 12-30-2010, 06:31 AM
 
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I guess I'm in the minority.  I think it's good to get an affordable doula at home if at all possible. My MW and apprentice were SWAMPED with all-things-birth.  They offered helpful suggestions from time to time, but the full-time doula support that I received was irreplaceable to me and freed them up to attend the birth.


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#14 of 26 Old 12-30-2010, 07:26 AM
 
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I say a homebirth without a doula if that's your only option. A student doula is a good idea. The doula I had at my homebirth was free because she was not certified yet. I ended up not really needing her even though she was my only dedicated labor support person. My dh was deployed. My mother was there but to take care of my 3yo, not me. My MW and her assistant were busy dealing with birth stuff. Once I was in serious labor I didn't want anyone touching me or telling me what to do. I had to go into my own place by myself and do my own thing. Because of that I don't think doulas are as necessary at home as they are in a hospital. In a hospital, not only do you need someone who's really going to support your choices for no meds or interventions but you also need someone to remind the hospital staff of that. I'd want a doula in the hospital more to run interference with the staff than to give me massages and ideas about changing positions. That's just my personal experience, though.


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#15 of 26 Old 12-30-2010, 01:28 PM
 
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HB!


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#16 of 26 Old 12-30-2010, 01:45 PM
 
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Quote:
Originally Posted by Turquesa View Post

Best of both worlds: HB midwife with a student doula?  I knew a student doula in my area who did her contact hours for free, but you should definitely be able to find one with significantly lower rates than an already-certified doula.  In your shoes, I would investigate this option first.

 

Also, does your HB MW work with an apprentice?  A doula with an HB is very useful in that she frees up the MW to focus on catching the baby.  But if there is an apprentice on board, she can provide a lot of the support and encouragement that a doula would.  Granted, that's not technically her role. She probably won't be free to run and microwave a rice-sock or provide pressure-point massage, but she could work with you on your breathing, remind you of good coping mechanisms, and--working with the CPM or CNM, advocate for you and your birth plan in the event of a hospital transfer.  In other words, between two MWs and your DP/SO, you may have all of your bases covered for a home birth.

 


Took the words right out of my mouth! 

 

My MW had an apprentice for our homebirth.  I remember during appointments thinking I didn't want her at our birth... didn't want more than myself, DH and MW.  Turns out, she was a fantastic presence at our birth and I am forever grateful. 

For me, I'd pay out of pocket just to stay home. 


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#17 of 26 Old 12-30-2010, 02:08 PM
 
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HB.

 

I had a midwife at my homebirth, no doula, no apprentice, and the second midwife didn't arrive until moments after the baby was born (she was coming from pretty far away, not anyone's fault except possibly mine for waiting so long to till the primary midwife to come on over).  I don't feel like I missed out on any necessary support, really.  I'm planning on having a friend doula for my coming homebirth, but it's more of an awesome bonus than a necessity. 

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#18 of 26 Old 12-31-2010, 11:06 PM
 
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Definitely a HB!  I've had 3 Hb's with no doula present.  I think that doulas are awesome and amazing, but I had no need for one with my MW and her assistant present and caring for me.  They suggested position changes as necessary, provided comfort measures, helped Dh support me --  I didn't need anyone to help me advocate for myself because I was in my space with birth attendants who were fully on board with my birth plan/philosophy.


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#19 of 26 Old 01-01-2011, 11:45 AM
 
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I would/did choose homebirth with a midwife without a doula... although my midwife brought an apprentice both times so there were always extra hands if I needed them.  I had a family friend who was a doula in training at one of my homebirths but not the other.

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#20 of 26 Old 01-01-2011, 11:47 AM
 
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HB!  If I had to have another hospital birth though, doula all the way.


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#21 of 26 Old 01-01-2011, 02:39 PM
 
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I'd go HB for sure, though I never really got into the whole doula thing.  It's probably one of those "you don't know what you're missing until you try it" type of things but I (personally) don't feel a doula is necessary for HB.  


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#22 of 26 Old 01-03-2011, 02:15 PM
 
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Most doulas have never even seen a hb because most hb mothers just don't need them.  I would, without a second thought, go with the hb.  I have had 6 and never hired a doula. 


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#23 of 26 Old 01-03-2011, 03:22 PM
 
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I would choose a homebirth over a hospital birth w/doula. You could also ask the midwife if she knows of any doulas that you would be able to afford.


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#24 of 26 Old 01-04-2011, 01:02 PM
 
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Homebirth sans doula is my vote without a doubt! I've done it once and plan to again in a couple months- it was an amazing experience.


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#25 of 26 Old 01-04-2011, 02:00 PM
 
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HB with no doula, for sure!  You lose control of a ton of things in the hospital simply by being there and being forced/coerced to abide by their rules and protocols.  even with a doula, you are much more likely to have interventions and other things that may not be in your birth plan.

 

Your midwife will give you a lot of support at home while she's there.  I had a HB with no doula and that was fine.  DH was my support person anyway, but the MW and the birth assistant both provided labor support at different times also.


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#26 of 26 Old 01-05-2011, 04:14 PM
 
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Home birth.  I'm an apprentice midwife and we provide a lot of labor support when it seems wanted/needed.  Occasionally our clients also have doulas, but I often think that having a doula at the birth makes *our* job easier, but probably has little impact on the laboring woman, ultimately (not because her doula isn't helpful, but because we would have done much of the same labor support she did, if she hadn't been there).  

 

So I say hire a midwife you love and skip the doula or invite a friend to attend your home birth.  Most of what a doula does, in my opinion (and speaking as a doula) has less to do with knowing a lot about birth and more to do with being a sensitive and aware person who is committed to helping a woman through her labor.  Without a doubt, I've learned some "tricks" or whatever--that is, I've noticed certain things that are more often than not helpful/comforting to a laboring woman.  But, for the most part, it's about giving a person your full attention, and doing what you can to help them, and you don't have to be a "doula" to do that.

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