What's the difference between a doula and a midwife?
A midwife's most important role is as the medical guardian for your birth. She monitors your health and your baby's health, and she usually catches your little one. A doula is a non-medical professional who offers physical support, emotional support, informational resources and advocacy skills. As doulas, we are trained in supporting normal birth, and our goal is to make it the smoothest, most comfortable and centered process for the new family. Your doula's most important goal is to help you have the best possible birth.
I'm seeing a wonderful midwife that I really like. Do I still need a doula?
We love the midwifery model of care, and work often with great midwives all around Southwest Michigan. As noted above, your midwife is your medical guardian. Your doula is an expert in supporting the whole family through labor. At various points in every labor, your midwife's attention has to turn toward your safety and your baby's safety; your doula will be focused on your physical and emotional comfort.
Consider too, that some midwives have excellent labor support skills and really enjoy sitting quietly with women for hours on end, and others do not. Often your doula can be with you during your nighttime labor so that the midwife can sleep for a few hours—and it's helpful if your midwife is well-rested and alert at the most critical moments of birth. Even the best hospital-based midwife will not be able to meet you at home and labor with you there, and she may have more than one patient in labor when you arrive at the hospital (we've seen even small practices with three or more women in labor at the same time). Your doula is your expert sounding board and resource both during pregnancy and birth. You can call us at 7 p.m. to ask us about heartburn or swollen feet, or just to talk through any worries. Also, it's important to consider that your doula works only for you, and is not bound by hospital policy or other political considerations, so she may have suggestions that you wouldn't hear elsewhere.
Your midwife and your doula complement each other during labor, and we often find ourselves brainstorming on the best way to support the mother or help the labor progress. One midwife told us that it's like each mom needs a basket of support cards during her labor. Sometimes you need the midwife card, sometimes you need the partner card, and sometimes you need the doula card to get you through. The cards are available as you need them!
Do you work with Doctors?
Absolutely! Most physicians spend very little time with the mother during her labor, so a doula can be especially helpful for labor support. We've developed positive relationships with a number of family doctors and obstetricians in the region.
So what exactly will you do at my birth?
It's hard to say ahead of time! We bring an entire toolbox of ideas, tricks and techniques. Sometimes we might rub your back for 16 hours, or trade off with your partner in that role when his hands are aching and he needs to eat and rest. We might be the quiet, calm, reassuring voice whispering in your ear, or the firm, anchored voice that will help you get back on track when labor starts to feel intense and overwhelming. Your doula could be focusing on natural ways to help your labor progress, or how to straighten out a baby in a wonky position. Perhaps we'll give you ideas on how to negotiate with the staff to achieve some important elements of your birth plan. Sometimes we are offering a lot of support to your husband or partner, showing him and other loved ones how they can best help you, and reassuring them about what's normal. Maybe we'll offer a hand massage to help you rest and relax, or we'll explain your options and help you brainstorm questions when you're facing medical interventions for you or your baby. On occasion, our help and reassurance after the birth might be key to establishing your nursing relationship.
Every labor unfolds in its own unique way. Our job is to bring our expertise in birth to the table and stay fully present and supportive, whatever your needs.
I'd love to have a doula but my husband or partner really wants to be my support person.
Dads are sometimes nervous that a doula might take over their role, and they'll be "shut out" of the labor process. That is not the case at all! Dads and doulas actually complement each other in labor. A doula is kind of like a tour guide in a foreign country. Your tour guide doesn't take away from your trip, she enhances it for both of you. The same is true of your doula. She can help you both navigate the health care system and understand the process of labor and birth. We often find ourselves reassuring dads about the normal sights and sounds of labor, which can be disconcerting to even the best prepared support person.
Doulas can show dads particular techniques to help the laboring woman, based on exactly what is happening in her body at that moment. Experiencing back labor? "We might try this counterpressure technique, let me show you exactly where to put your hands." Relaxing in the bath? "How about gently pouring water over her belly with each contraction, like this. Yes, that's it, just like that!" Mom is laboring in the bathroom? "Here, let me get the birth ball so you can sit on the ball and she can lean on your to rest between contractions."
During labor, moms usually retreat into their own private "laborland." As doulas, we often find ourselves bonding closely with the dad during the birth, as we work together to figure out the best way to support her. Dads are generally so happy to have another "birth partner" with them for the journey!
But my mom/friend/aunt is going to be with me for the birth. Do I still need a doula?
Friends and family members can make wonderful labor support people, but their role is distinctly different than a doula. Your doula brings specialized training in birth and labor support. In most cases, she has seen many births in various settings, and she can help familiarize you with what to expect at each stage. We don't have the same emotional attachments as your family, so it's easier for us to separate ourselves from your choices—we're there to support you in whatever kind of birth you want, whatever that looks like for you. You don't have to worry about what we might say or do in any given situation, your doula is there for your unconditional support. And we can support your friends and family, too, just as we support dads and partners in the birth space.
Isn't all of this what nurses are supposed to do?
In the past, labor support was a big part of a labor and delivery nurse's job. Today, however, nurses have many other responsibilities, including medical monitoring, detailed charting and caring for other patients. And as you might expect, even if they had time, some nurses enjoy and are very skilled at labor support, while for others that is not their strength. When you hire a doula, you'll know that you have someone at your birth who will meet you at home and help with the transition to the hospital, is devoted only to you, whose personality is a good fit with yours, and who has specific training in attending to mothers' (and fathers') physical and emotional needs.
I'm planning a hospital birth, and I want to stay home as long as possible once labor begins. Will you come to my house?
Yes, of course! This is one of the big benefits of having a Birth Kalamazoo doula. We're usually in touch with clients by phone in very early labor, and then if you'd like, we can meet you at your home as things pick up. We're not medical providers so of course we are not monitoring the baby or doing vaginal exams. But for those who want to stay at home until hard, active labor, we can help you move your labor forward until that point, help you recognize those signposts, and then help with the transition to the hospital.
I know I want to use pain medication, will a doula try to talk me out of it? (Or, I think I want a natural birth, but what if I change my mind?)
Your doula comes into your birth space with an open mind and an open heart. We're not there to carry out some agenda, we're there to help you have the best birth possible, whatever that looks like for you. We'll talk in-depth during our prenatal meetings to learn more about what kind of birth you envision, and we'll put all our energy toward helping you get there. And if you get into labor and for whatever reason plans change, we can actually help you cope with the unexpected turn of events. There is a lot a doula can do if you opt for pain medication, including position changes, use of the peanut ball and other tricks to help your baby descend. We can also help you cope with the physical side effects of medication, to continue making your journey as comfortable as possible. Sometimes pain medication doesn't work as expected, but mom's movements and coping tools are suddenly limited—your doula will get you through.
What if I need a c-section?
There are so many things a doula can do to help make a cesarean birth the most loving, family-centered experience possible. For example, your doula will be with you before the surgery, to help with relaxation and assist you in brainstorming questions for your health care team. We can support you in advocating for some of the things you might want during the surgery. For example, we've had great success recently in working with surgeons and anesthesiologists to allow skin-to-skin contact on the operating table, while the surgeon is finishing the operation. This is so much more family-centered than taking the baby to the nursery or to the recovery room to wait for you, and we have found that it significantly decreases birth trauma for the mother. But it's often something that requires some advocacy with the staff—your doula can help be a bridge in those communications.
In Southwest Michigan, we are often allowed to stay with you and your partner in the operating room during the surgery, although this is always a case-by-case decision by your surgeon and anesthesiologist. If we are in the OR, we can help explain what is happening during the surgery and show your husband or partner some physical comfort measures that may help you deal with the sensations of surgery. Sometimes a baby needs to go to the nursery or the NICU after a cesarean birth, in which case the dad or partner generally goes with the baby, and your doula will stay by your side. This helps mothers to not feel so alone as the surgery is finished and recovery begins, and helps partners to not feel so torn between mom and baby. In most cases, though, the baby will go with the mom to a recovery area, where we can help you establish nursing and skin-to-skin bonding.
And finally, if the cesarean was unexpected, your doula will offer a compassionate, listening ear to help you process the birth. She can also connect you with resources such as Birth Kalamazoo's Cesarean and VBAC Support Group.
Do you have back-up in case you can't attend my birth?
Because we work in a group of doulas, we have automatic, built-in back-up. As the owner of Birth Kalamazoo, Jessica English has been careful to choose doulas with excellent training and professionalism. Generally, if a client connects with one doula, she will connect with any of our doulas. We all have very similar birth philosophies. It's very unusual for one of our doulas to miss a birth, but if your doula is sick, at another birth or otherwise unexpectedly tied up, she will send one of her partner doulas to be with you for your birth.
I'm planning a home birth, do I need a doula?
Doulas can be so helpful at home births! In fact, there is a local home birth midwife who often recommends our services, especially for first-time moms, those planning a VBAC, or women who have been through a previous traumatic birth. Although the advocacy part of our job may be less with a home birth, your doula still helps with all the same issues at home as in the hospital—your physical and emotional comfort, your partner's well-being, and informational support about your options and what's happening with your labor. Many times your doula will labor with you for a significant stretch of time before your midwife comes to the birth. When she arrives, we work together as a cohesive team to help you have the best experience possible.
Sometimes women are told they don't need a doula because their home birth midwife will bring an assistant or apprentice midwife to the birth. The roles of an assistant/apprentice and a doula are actually quite different! The assistant or apprentice works for the midwife, and has clinical responsibilities such as listening to heart tones and doing vaginal exams. Her job is to assist the midwife (setting up, cleaning up, charting) and learn the clinical aspects of birth. She may be able to serve as an extra set of hands to support the birthing mother, but that is not her primary role. A doula is specifically trained in the physical and emotional support of childbirth, training that is distinct from the clinical aspects of birth. She often arrives to support the mother long before a home birth midwife and her assistant. The doula is also available to the mother during her pregnancy and the strong relationship they develop prenatally helps to set the stage for support during the birth. If complex situations arise during the birth, the doula's role is to support the mother in her autonomous decision-making process. All of this is possible because the doula works for the family. We value the role of an assistant or apprentice at a birth, but that role is very different from the role of a doula.
How is it that doulas contribute to better outcomes for moms and babies?
There's definitely something unique about what a doula brings to a birth. The physical assistance and information we offer can help couples avoid unnecessary interventions—better outcomes. When interventions are medically necessary, we can help mitigate the side effects—better outcomes. Doulas can help women feel safer and more comfortable during their birth, which allows the hormones of labor to work as they should—better outcomes. We have breastfeeding expertise and can offer encouragement and insights based on helping scores of other women nurse their babies—better outcomes. It would be impossible to list all of the ways a good doula can help improve a couple's odds of a normal birth, but this gives you an idea of how our support impacts outcomes for moms and babies. Your doula brings skills and knowledge to the birth team that no one else can offer.
Are doulas covered by insurance?
In most cases, insurance does not cover doula services. However, your flex account or medical savings account may cover doula services, which is a nice opportunity to pay with pre-tax money. We also offer payment plans and gift certificates, so grandparents, aunts and other loved ones can help pay for your doula. For low-income families who qualify for WIC, we have partial funding available through our Fund for All. We may also be able to connect you with a new doula working at a lower rate—please ask, we want to help.
When is the best time to hire a doula?
You can hire a doula any time you're ready! Some clients contact us the minute they know they're pregnant (it's pretty fun when a past client texts a photo of her positive pregnancy test), and our doulas have even been hired by women in labor. With our group set-up, we can usually accommodate all requests, whatever the timing. The best time to hire a doula, though, seems to be in the second trimester. This is when most mothers' thoughts turn to birth, and it gives us a good chunk of time to get to know one another before your little one arrives. Call us or send an e-mail when you're ready to talk, it's never too early or too late!
“For my VBAC birth, our doula walked us through all of our concerns, allowing my husband and I to make the decisions that were right for us; she was available for anything at any time, going above and beyond her job description; and most of all, she was excited about the new life entering the world. After the birth, I said I couldn't have had the natural VBAC I wanted without Andrea by my side (or my husband as well, but this isn't about him). Maybe I could have done it with less support, but I know I wouldn't have had the peace of mind she lent. I also know I wouldn't want to do it any other way, and that's a sign of a successful birth.”
- Kelly, mom to big brother Aidan and Holly, born at Bronson Hospital
“The doulas at Birth Kalamazoo are honestly some of the most passionate women I have met regarding all that surrounds the birth experience. I learned that how I think and what I do has a direct correlation to the kind of birth we would have. "Kind of birth"...not just "showing up"... we have options?! That knowledge propelled us to take ownership of our decisions. In addition to the great advice and warm encouragement throughout the pregnancy, our doula Val spent over 30 hours with us in labor. Specifically, she helped me breathe more effectively during contractions; knew better positioning to facilitate the baby's movement; comforted me while my husband took short breaks; and believed in me so I that I could believe that my body was working. I am convinced her tireless support ensured us a natural birth. Our son arrived on the scene very alert, extremely healthy, and happy. We couldn't be more pleased with our journey!”
- Joy Wiegand, mom to Lance, born at Pennock Hospital