Mothering Forum banner
1 - 20 of 22 Posts

· Registered
Joined
·
447 Posts
Discussion Starter · #1 ·
Does anyone have an opinion on this?

Mamas who homebirth with a midwife who felt they did or did not need a doula?

Midwives?

Doulas?
----------------------------------------------------
I have some questions and concerns regarding the practice of doulas at midwife attended homebirths.

Recently I have started a local birth doula certification program, run by a certified home midwife. I love the class and she is a phenomenal instructor. During our first day we talked a lot about homebirths and the teacher mentioned most often doulas do not attend homebirths with midwives. That primarily they attend hospital births.

Ok, so this slightly makes sense, certainly a midwife will provide an amazing amount of care to her clients. And certainly they will be hands on and very supportive during the whole process. Not to mention many doulas do there work because they want woman to have the best birth experience they can, even if the woman has a hospital birth.

But I wonder why do doulas and midwives work so far apart? It seems this would be an amazingly synergetic dynamic for all parties involved.

I thought more about this and remembered a friend of mine who had a midwife attended homebirth for her first child. She told me during her interview or one of her prenatal visits she asked her midwife if she should hire a doula, to which the midwife replied "no, that's why you have a midwife."

It seems the midwife probably should have said something along the lines of "If you want to and feel comfortable having another support person there, I don't see where it could hurt."

My friend is happy with her birth memory but often feels as though the addition of a doula would have indeed made her experience easier. Her reasons run from wanting to have had someone there who was there for just her needs (opposed to also there for the baby) and someone who could have helped with the endless pots of hot water for the tub or just someone there to take care of the things she needed so dad could fully enjoy the day and be there emotionally for her.

I wonder if this is the normal attitude of midwives in general, considering the frequency a doula is invited to a homebirth. Or an isolated case?

I love birth and I think women are entitled to the support they need (and I think most of us reading this believe the same thing, which is why many consider sliding scale fees and payment plans.)

Thoughts?

Sorry if the thought process isn't 100% complete. I kind of ran out of time LOL

Thank you for your thoughts on this.
 

· Registered
Joined
·
3,328 Posts
Doula's are there to do what midwives are no longer able to do due to time constraints and hospital rules. Midwives ideally work one to one with a woman, and two to one at delivery (so the baby gets their own midwife too). In hospitals it is usually at least 4 women to each midwife until the moments of birth. Midwives who are not overloaded with cases can usually show up, hang out, help out, catch the baby, settle them all in and then leave. There is no gap for the doula to fill.

In short there is nothing a doula does that a good midwife in an ideal setting cannot do, and it is usually better for the midwife to be doing it (because that is true one-to-one care), but modern birthing has obliterated the role of the midwife to such an extent that she is no longer able to perform much of what she is there for. So a doula steps in.

I homebirth. I would not want a doula. If i needed a doula i'd know i had picked the wrong midwife.

ETA - people who fill the tub and fetch the tea are not doula's or midwives, they are friends, mothers, older children or sisters. I would be very dubious about paying a doula to be there only to have her do domestic chores, since most of them are well versed in all the non-medical aspects of labour and birth (emotions, massage, positions etc.)
 

· Registered
Joined
·
4,103 Posts
I think a midwife should certainly be open to the mother choosing to have a doula in her home if she wants one, but personally I have ZERO desire for one. My midwife did act in the role of doula the two times I had to birth at the hospital (she has no privileges there, so care was turned over to on-call staff) and that was great. I am comfortable with her and appreciated her opinion on how things were going and also having someone with me when dh accompanied dd2 to NICU right after birth.

But as far as paying for one more person to come into my home? No thanks. As it is I have my husband, midwife, and her assistant, all of who are focused solely on my needs and have no one else to attend to.
 

· Registered
Joined
·
50 Posts
There are a lot of factors to consider here. First, there is the relationship the mother has with the midwife. In a solo or dual midwife practice, doula's are probably less frequent as midwife and mother usually develop quite a close relationship and these midwives usually take less patients/month so usually can come to the labor when the mother needs assistance, even if early in the labor.

The other support the mother will have during the labor will also make a difference. If her partner is very anxious about watching the mother labor or has any reservations about seeing the birth, that is a different scenario than a couple in which the partner is relaxed and excited to attend the birth.

Having a doula for an out of hospital birth can help the couple maneuver through the earlier part of the labor process more comfortably and confidently so the midwife can get more rest, eat, etc. before heading out to the birth, which is a big plus, and many of them are good at knowing just when to call the midwife in to be there for the final stages.

I have heard it said that the midwife's job at a normally progressing birth is from the pushing stage on, for that's when you need to have an alert, medically trained person there, just in case. Most everything before that, is emotional support, sometimes positioning recommendation, reminding mom to eat and drink, etc. which doula's are great at!
 

· Registered
Joined
·
774 Posts
Generally speaking I don't think my midwives suggest a doula unless it is a 1st birth, especially if they are planning a hospital birth.
 

· Registered
Joined
·
2,847 Posts
I think doulas can fit in very nicely at homebirths. If I have a client who wants a doula, then more power to her!

If you consider much of what a doula's role involves for a hospital birth then it really isn't that surprising that some midwives would feel uncomfortable with the idea that a woman could want or feel a need to hire a doula. In the hospitals, doulas are often trying to help women dissect everything their dr says, judging actions, and helping the woman to fight back against the whole system. In a homebirth, much of this is not needed and no one wants to feel judged. However, I think doulas are often free to do what they are really best at during a homebirth and that is simply meeting the emotional and physical needs of their clients without worrying about politics and games.
 

· Registered
Joined
·
3,357 Posts
I am a doula and would KILL to go to a HB, but there is no real need for me there. The midwife plays the role of doula until time to catch, that is when she becomes a midwife. Yes she does more monitoring then I would had home before transfering for a HB and she is MUCH more trained than I, but that is the wonderful thing about having a homebirth, she is your doula/ med prof. all in one at your house!
 

· Registered
Joined
·
211 Posts
We have hired a doula to help out with our kids during our planned homebirth. Honestly, I was skeptical that it would be appropriate to even ask a doula to do this type of clearly domestic work. We had instead been considering trying to hire a post partum doula. But, we had a serious gap in our needs (no support for the girls), and our midwife suggested a doula friend of hers who normally only gets to do hospital births but loves to attend homebirths. I think it is fabulous for the girls -- they get to have someone who understands enough about what's going on to explain things to them age appropriately. It's great for me. If the girls are sleeping or otherwise doing okay, then their support person will not be "in the way" of our experience, but will be able to participate in and support it. And if my husband needs a break, there is somebody who can step in. But I would never have considered asking this of her if it wasn't something my midwife had suggested. Besides that, I don't think I really need a doula because I don't see the gap. We will already have a midwife and an apprentice. I don't see how we could possibly need a third person.
 

· Registered
Joined
·
1,125 Posts
I'm a doula, and have attended ahospital birth with midwives and a homebirth with midwives. I felt that I was very important at both births. At the hospital birth, the midwife was very busy doing medical stuff--charting took a lot of time. I was 100% focused on mom and hardly had time to pee or eat. At the homebirth mom was in the birth tub and midwife sat on the couch. I felt that she was more comfortable with me and let her true feelings show for me.

I think it depends on the individual. I wouldn't automatically discount the need for a doula just because there'l be a midwife there. In my (small) experience, the midwives are busy with mom's body and the doula's are busy with her head. Also, it may be very different where you are from--in Ontario, midwives are part of the medical system and must work by their guidelines. This includes a lot of medical stuff that some midwives may not be obligated to do.

Another huge plus for having a doula no matter who your care provider is--here, anyway, the midwife won't go to your house until you are in active labour--contractions 5 minutes apart, lasting a minute or so for at least an hour. I've had a few moms who needed me WAY before that time.
 

· Registered
Joined
·
35 Posts
I did not hire a doula for my home birth - but that was because my midwife brought two other women two assist - a midwife and a midwifery student. A good amount of my labor I was supported by these two women, much like a doula would have supported me. My labor was REALLY long, so I imagine one midwife would have been exhausted supporting me along. I think a doula can be very valuable at a home birth IF the midwife delivering doesn't provide additional assistants and/or you don't have others to help (supportive husband/mom/etc).

I think comfort with the person may cause a woman to decide on a doula as well. While you may trust and love the midwife you select, you might feel more comfortable with a doula that is a similar personality to you, or what have you.

I don't think a doula is necessary, but I can see the value at some home births. Just depends on the person and the circumstance.
 

· Premium Member
Joined
·
877 Posts
I disagree with some pps who said that a doula is unnecessary at a homebirth. A midwife can act as a doula during labor, but what if it's a 48 hour marathon? I wouldn't want my midwife so sleep deprived when it "counted" at the end. I'd expect her to be able to be alert enough to perform NRP or resolve a shoulder dystocia or whatever. If she's been awake 24 hours or more doing counterpressure because I've had gnarly back labor, I would think that would be less likely. There is room for a doula and a midwife at a homebirth. In fact, I think it is more common historically to have more than one woman supporting the mom through her labor for just that reason.
 

· Registered
Joined
·
35 Posts
Quote:

Originally Posted by womenswisdom View Post
I... but what if it's a 48 hour marathon? I wouldn't want my midwife so sleep deprived when it "counted" at the end. I'd expect her to be able to be alert enough to perform NRP or resolve a shoulder dystocia or whatever. If she's been awake 24 hours or more doing counterpressure because I've had gnarly back labor, I would think that would be less likely. There is room for a doula and a midwife at a homebirth. In fact, I think it is more common historically to have more than one woman supporting the mom through her labor for just that reason.
Exactly. My labor was several days (the "active labor" was 26 hours by itself). If my midwife didn't have the two support midwives along with her, I would have really wished I had a doula. My midwife was able to get some rest - she took a nap at one point - while the others took turns assisting me through contractions.
 

· Registered
Joined
·
2,420 Posts
Quote:

Originally Posted by NamastePlatypus View Post
I am a doula and would KILL to go to a HB, but there is no real need for me there. The midwife plays the role of doula until time to catch, that is when she becomes a midwife. Yes she does more monitoring then I would had home before transfering for a HB and she is MUCH more trained than I, but that is the wonderful thing about having a homebirth, she is your doula/ med prof. all in one at your house!
My previous midwives didn't do that kind of thing. They really offered no support at home and even less when we transferred to the hospital.

My doula is my labor coach and cheerleader, I wouldn't labor without her.
 

· Registered
Joined
·
3,286 Posts
I like having LOTS of support especially when things get rough. I had 2 midwives + apprentice, and 2 doulas. One was a student who I wanted along just in case dd needed extra attention, I didn't want to lose a support person. As for mothers/sisters/friends/etc being the ones who should be helping fill the birth tub and fetching drinks.. thats not necessarily practical for some. What if all your family/friends think you're a psycho for home birthing? Even though my mom was supportive and lived close enough to come, she doesn't "get" birth. she doesn't doubt my decisions or think i'm being reckless, but she doesn't GET it. I didn't want anyone at my birth who didn't 1000% think that home birth and vbac were the awesomest things in the world. I think my mom really wanted to come over and watch dd while I labored, but hiring a doula for that job (which turned into only needing to put her to bed) instead of my mom was my way of protecting my birth space.

I really think that, by pushing, everyone there had something to do. The midwives were busy making sure we were both ok and getting equipment ready. I had signs that SD was about to occur so they were preparing for that. The apprentice took pics (and I LOVE the pics!) I really don't know who all was doing what but at various times there would be someone helping hold a leg, or massage where I was cramping up, holding a hand, getting me more juice. dh really didn't know what to do with himself besides be encouraging. Yeah, I'll definitely be having a doula at my next birth! Some of my favorite pics after the birth (taken by dh) are minutes after ds was born, my holding him sitting on the floor, and a semi circle of amazing supportive women all around. They give me the chills.There's also a picture (look up the youtube video about "what is ican" and its in there!) that has a bunch of differen't hands in it on me and baby. love it!
 

· Registered
Joined
·
3,460 Posts
Quote:

Originally Posted by womenswisdom View Post
I disagree with some pps who said that a doula is unnecessary at a homebirth. A midwife can act as a doula during labor, but what if it's a 48 hour marathon? I wouldn't want my midwife so sleep deprived when it "counted" at the end. I'd expect her to be able to be alert enough to perform NRP or resolve a shoulder dystocia or whatever. If she's been awake 24 hours or more doing counterpressure because I've had gnarly back labor, I would think that would be less likely. There is room for a doula and a midwife at a homebirth. In fact, I think it is more common historically to have more than one woman supporting the mom through her labor for just that reason.
Exactly--well put. I tell my hb clients that while I'm a great doula, they just can't count on me 100% for doula services throughout labor. I may need to sleep. I may need to leave to do other client visits that are scheduled (if labor is slow and other clients are fairly nearby!). So I tell clients that they don't have to hire a doula, but they do have to have some people either onhand, or at least oncall, to come help with various aspects of labor support (including boiling more water, fetching food, care for other kids--all stuff I'm willing to do, just not going to commit to doing all of it for the full duration of labor). That said, I've had a fair amt of births where it was just mom, dad and me....only comfy for me because there were indeed people oncall if needed....and the other kids had been sent off for the duration.

On the other hand, though I do support people hiring a doula, I have found in a few cases that there can be some confusion about roles. Meaning that maybe the doula rec'd calls and info but I didn't--mom/dad kind of thought of us as 'interchangeable parts of a single care unit'. No one intended harm--just that assumptions were made, doula assuming I'd rec'd similar calls info as herself, parents assuming all info going to doula was also reaching me (or all coming to me was also reaching doula). So when people hire a doula, I try to make sure that our respective roles are clear amongst us all, and that comm lines and expectations are clear. No, me and your doula are not 'one unit', yes, our roles/responsibilities are different
.
 

· Registered
Joined
·
1,745 Posts
I am glad that I had a doula at my home birth. I labored overnight and my MW slept through a good portion of it. Her apprentice was awake, but was doing other stuff so she couldn't have performed the doula role. Also, when my MW was awake and my doula had stepped away to use the bathroom, my MW looked at me and said that I could do that contraction on my own and sat and looked at me. Totally not what I wanted and was not helpful. I didn't expect the MW to be there every single moment, but I didn't think that rubbing my back or applying counter pressure during one contraction was too much to ask. Apparently it was for her. I am still waffling about having that same MW at my birth in April, but I know I want the same doula there. Also, having a doula there helped put my DH at ease.
 

· Registered
Joined
·
44 Posts
When I told her my plans to have a doula, my homebirth midwife told me her clients didn't usually hire one. A good friend of mine is a doula, though, and I wanted her there. (They actually knew each other already- midwife had delivered friend's 2nd baby) My midwife said she'd love the extra help, and I figured my husband and I would, too. I think the general idea was for her to be 1/2 midwife assistant, 1/2 "me assistant". But I'm so glad we had a doula- my daughter was born surprisingly quickly, into her waiting arms! My midwife arrived shortly afterward
 

· Registered
Joined
·
1,697 Posts
Some of the HB mw around here also work with a "Birth Assistant". People taking my classes ask me how all those roles work, and here is what I say:

The midwife's job is to take care of the medical aspects of your birth. If the medical needs are slight, she may have time to do physical, emotional, or other support. But, if the going gets tough, she won't.

The midwife's assistant's job is to help the midwife. She is more likely to have time to do physical, emotional, or other support, but may not. She's also there to be the 2nd trained medical person in case there are problems for you AND the baby after birth.

A doula's job is to be there for you and your birth partner, as needed.

You may feel you need that kind of guaranteed support, or not. But it's not fair to expect that support from your midwife or birth assistant and get upset that it wasn't there, since that's not their bottom-line role.

That said, I've only doula'd at 2 homebirths, both for good friends/family members.
 

· Registered
Joined
·
896 Posts
My midwife and doula brought very different energies to my birth.
They both fulfilled my needs that were imminent at the moment of labor and birth.
My doula also helped my family (DH and DS) process the birth with me while my midwife concentrated on attending to me.
I would recommend a doula in whatever birth setting.
 

· Registered
Joined
·
6,616 Posts
Quote:

Originally Posted by MsBlack View Post
I tell my hb clients that while I'm a great doula, they just can't count on me 100% for doula services throughout labor. I may need to sleep...
Well put. My first priority is the health and well being of mother and baby. I like to provide emotional and physical support for the family, but I have to drop that sometimes to do a good job in my primary role. It's also not fair to the mother to be her number one support, getting her through each contraction, and then "disappear" when it's sometimes the hardest part - the actual birth minutes.
We all know how sometimes holding a hand or shoulder gets you through it - I just can't promise I'm not going to take my hand away at a bad time. Hospital birth as a doula? I'm not going anywhere, and I can promise that with a willing heart. Homebirth? I just can't promise.
I also have to sleep at long labors to make sure I'm ready if needed.
A doula is a luxury, but it's one that mothers deserve if desired. If you can't be queen for a day when you're birthing, when can you be queen?

To answer a question from the OP, most births are hospital births. About 3% are out of the hospital, at birth center or home (in my area). There are just a ton more hospital birthers to hire doulas out there. I do encourage my clients to strongly consider a doula, including well experienced doulas and doulas-in-training. I've never had a client regret hiring one.

I also say that I'm a midwife, and I'd hire a doula for my own birth. Sometimes that helps clarify the support you can expect from a doula, that it's a benefit no matter your education level about birth or the relationship you have with your midwife, or how comfortable your husband is with birth.
 
1 - 20 of 22 Posts
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.
Top