Doulas and Midwives - The Dream Team
When clients ask me the number one thing they should do to try to ensure they have the birth experience they want, I often think they are expecting me to say, “Hire a doula”. Hiring a doula actually comes in second for me. I tell them that the most important thing they can do is find a provider that aligns with and celebrates the type of birth that they want. I tell them that supporting them while they work with a provider who is collaborative rather than combative is really the key to having a magical experience. Oftentimes, that provider is a midwife rather than an obstetrician.
So, why a midwife?
Midwives are the experts in physiological vaginal birth and often the best choice for low-risk pregnancies, while obstetricians are highly skilled surgeons who also have training in the medical management of vaginal births in high- to low-risk pregnancies. While not true for every client we support, most come to us with the goal of a non-surgical, vaginal birth. We want clients with providers who are experts in supporting their goals and who prioritize those goals alongside patient-centered care. Obstetricians serve a vital purpose in maternity care. They are absolutely integral to those who need a surgical birth or who are having complications that put them at risk for certain emergencies and health conditions. They have the knowledge and tools to provide life-saving care when things don’t go as planned. Because of their training and expertise in managing surgical births and complex situations, they are often not afforded the time and resources to provide whole-person care or prioritize physiological birth even in populations where it would be appropriate.
But I want a hospital birth!
You may be thinking a midwife sounds like a great option, but you want a hospital birth and possibly the option of medicated pain management like an epidural. You can still have those options and a midwife! While it is true that some midwives practice only in out-of-hospital settings, such as at home, many practice in hospitals and fully support their patients in choosing epidurals or other forms of pain management. Most midwives are trained to provide the full range of obstetrical care, excluding surgery, including all the same office visits, ultrasounds, lab work, and delivery care that we have come to expect as part of modern obstetrical care. They also have the resources and training to provide life-saving care in the event you experience a medical emergency during your birth, including stabilizing a postpartum hemorrhage, shoulder dystocia, and neonatal resuscitation, both in hospital and out-of-hospital settings.
Midwifery has a different philosophy of care.
Midwives often believe birth is a natural life event that can sometimes also be a medical event that needs medical management. But oftentimes, it is a natural process that, when not interfered with, leads to a healthy and uncomplicated delivery. Midwives prioritize autonomy and family-centered care with a team approach to decision-making. You are going to be presented with options, given the risks and benefits, and then have a discussion about which interventions feel right for your family rather than being told you must do something because of policy. Midwives usually spend significantly more time with their patients and truly enjoy educating and getting to know the “whole person” rather than focusing solely on the clinical tasks at hand. Births tend to be less “instructed” and rigid and more focused on what the mother is feeling in labor, how she wants to move her body, and what position she prefers to deliver in. The relationship a family builds with their midwife is often special and cherished, and it complements the relationship you will build with your doula. Everyone in harmony, working together to support the birth experience that feels right for your family.
At the end of the day, we want families to pick the care provider that feels best for them. But an astounding number of people have either never heard of midwifery-led care or do not understand what modern midwifery care is. We want families to know it is a viable and often underutilized option and often the best chance at having an uncomplicated vaginal birth for low-risk people. Personally, I think every family deserves a midwife, and some families also need an obstetrician to manage more complex issues, with each serving their own purpose and supporting in their own way.
