S/O: Doula vs. Midwife

[BigDog]

Can someone explain the difference? Don't want to seem dense, but I really have no clue. My birth plan (which has worked in the past) is I simply see my OB for 9mos, then when I'm in labor I head to the hospital to have my kid (with the help of an epidural - which I will beg for). Fill me in on how/if I could benefit from a doula or midwife. Appreciate any feedback!

[SnuggleBuggles]

Totally different. A midwife is an alternative to an OB or MD. There are different levels of midwives, from lay midwives to certified nurse midwives who have been through a good amount of schooling. If you are healthy and low risk then a midwife can handle all of your pregnancy and birth needs. You get your check ups with a midwife, they do all the normal stuff an OB would do and then in labor they deliver the baby. If there are complications or something outside of the normal range than most midwives will have a back up care provider, like an OB.

A doula is not a medical provider. They are more of a labor support coach. They can answer your questions, keep you informed, and provide physical and emotional comfort before, during and after labor.

Beth

[BigDog]

Totally different. A midwife is an alternative to an OB or MD. There are different levels of midwives, from lay midwives to certified nurse midwives who have been through a good amount of schooling. If you are healthy and low risk then a midwife can handle all of your pregnancy and birth needs. You get your check ups with a midwife, they do all the normal stuff an OB would do and then in labor they deliver the baby. If there are complications or something outside of the normal range than most midwives will have a back up care provider, like an OB.

What's the benefit of using a midwife over an OB then?

[bostonsmama]

What's the benefit of using a midwife over an OB then?

With a midwife, there might be less risk of interventions, but since you are planning on getting an epidural, it will medically necessitate certain inventions anyways, such as an IV, fetal monitoring, a catheter, staying in bed, etc.

I'll be delivering with a doula, but not a MW, unless one of the staff nurses happens to also be a CNM (certified nurse midwife). My OB, or whomever is on-call, will do the actual delivery part (well, catching the baby if all goes to plan). Our doula will provide me with knowledge of the birth process, layman's explanation of any medical options I am provided, massage (or, "rubbing" as our state says "massage" is a licensable term), and can help me advocate for myself if she or I believe what the doctor is proposing isn't in my best interest or that there's another way to approach it.

It always surprises me when doctors tell you they think X should happen, but it's not until you ask for other options that they pull out their bag of tricks. For instance, I was watching an episode of Deliver Me (OB practice), and after lengthy contractions, fetal distress and already ruptured bag of waters, the OB recommended a C-section. When the laboring mother asked if anything else could be done, the OB said yes. They inserted a catheter into her uterus, filled it with some water to "recushion" the baby, and within an hour the productive contractions brought her to a safe pushing stage, and then her baby was born healthy & vaginally. See, the fact that it was even an option blew my mind, and it's irritating that the OB didn't come out and say, "Hey, we can refill your uterus w/ some water, although it's only a temporary fix and may not help, or we we can do a C-section." I'm hiring a doula so that I have someone on hand who might know what those options are!

[daisymommy]

Usually people who want a more natural delivery without a bunch of interventions and drugs will use a midwife.

All 3 of my babies were born with midwife, and 2 of them were drug-free, no interventions (one in a birthing center, one at home). I had a doula as well with each one (she assisted the midwife).

[SnuggleBuggles]

A different approach to things, often. There isn't a perfect way to describe the differences because you can find midwives that are more medically minded than average and OBs that are more focused on the whole woman than general. But, as generalizations...

An OB tends to view pregnancy and birth as a risky thing where the typical midwife views them as normal and healthy. Midwives prefer to avoid using interventions in labor unless they really have to but OBs use them more. During pregnancy OBs tend to focus on the baby and pregnancy but midwives take in the whole picture a bit more. Midwife appointments tend to be longer and more inclusive. There is also a mindset that with a midwife that the mom is a partner in her health while with an OB the mom might not be encouraged to really be actively involved and informed.

With ds1 I had a CNM but she practiced with 4 OBs. Ds1 was a hospital birth with no IV, hep lock, interventions, pain meds... It was a low risk pregnancy and birth. With ds2 I went to a CNM only practice. One thing that was immediately different was how much they wanted you to be part of the process. When you arrived you were given your chart. You went to the bathroom and did the dip strips and weighed yourself (they taught you all this). They encouraged you to read your chart and ask questions. Every trimester there was a 45 minute appointment covering relevant issues like nutrition and birth plans. Every other appointment was 20 minutes and they did an exam (whatever normal like check bp and baby's heart) and then talked with you about any concerns or questions. I never felt rushed with any CNM I saw. The best part of the CNM practice was that your CNM got you from the waiting room and the appt started immediately vs leaving the waiting room only to wait in another room. The practice encouraged siblings to come and were well equipped for them to be there. The whole chart thing was my favorite thing though- they felt that by knowing this rather than your chart being a big secret that mom would feel more empowered and interested in being active and involved in the pregnancy and birth.

With both births it is very common for the midwife to be with you the whole time rather than an OB who may pop in 1 time during labor and once to deliver baby.

I started out at a traditional OB practice and felt like a # that they just wanted to get through the pg and birth. I didn't feel like they wanted or expected me to know more about pg and birth than what was included in the pg handbook they gave me. I know that is all generalization and not all OB practices are one way or that all CNM practices are a different way. But, I felt more respected and included by using a midwife vs an OB. I had one great OB at the practice but there was no guarantee he'd attend the birth.

It's a personal choice. Some women do just want to get through it all, have the baby and be done. Some want to really be in the process and know every nook and cranny of it. The whole pain meds thing is another issue but having a midwife doesn't mean you have to go med free if you have a CNM that delivers in a hospital. They won't tell you you can't have them (some women believe that). It's your birth experience. They want you to make an informed choice that is right for you.

Beth

[SnuggleBuggles]

It always surprises me when doctors tell you they think X should happen, but it's not until you ask for other options that they pull out their bag of tricks. For instance, I was watching an episode of Deliver Me (OB practice), and after lengthy contractions, fetal distress and already ruptured bag of waters, the OB recommended a C-section. When the laboring mother asked if anything else could be done, the OB said yes. They inserted a catheter into her uterus, filled it with some water to "recushion" the baby, and within an hour the productive contractions brought her to a safe pushing stage, and then her baby was born healthy & vaginally. See, the fact that it was even an option blew my mind, and it's irritating that the OB didn't come out and say, "Hey, we can refill your uterus w/ some water, although it's only a temporary fix and may not help, or we we can do a C-section." I'm hiring a doula so that I have someone on hand who might know what those options are!

The worst is when you are watching the shows and know there are alternatives that aren't being shared. It boils my blood. Or when they start a cascade of unnecessary looking inteverntions (breaking the water at 2cm, continuous monitoring in bed...) and all of a sudden things are snowballing towards more interventions. All the while you can see that if the mom had had a different care provider things could have been so much different, or if she simply had a doula to explain things to her along the way.

When you arrive at the hospital you are signing papers that say you will give your informed consent. But, they don't always actively solicit that informed consent. To truly give it they should tell you the benefits, risks and alternatives (and the risks and benefits of those).

Beth

[wellyes]

I had a hospital birth with pain meds. I have a great OB but both times I delivered with a midwife (CNM) and it was a very good experience.

My OB recommended that I, or anyone with a low-risk pregnancy, get a midwife for delivery. OBs focus on anticipating problems and solving them. During labor they will only check in on you occasionally. A midwives focus on creating a positive patient experience and, if she can, will stay with you as long as you want her there.

Another way to think of it: OBs are surgeons who specialize in pregnancy and labor. Midwives are medical professional who specialize in non-surgical births. You will want and need an OB if you end up requiring surgery, of course, but if you have a vaginal delivery (always preferable if possible from a health standpoint) then a midwife is the way to go.

[essnce629]

Here's a good 1 1/2 minute video on the difference between a midwife and a doula:
http://www.youtube.com/watch?v=X-aeTr86y4w

[sste]

For doula, I would think about it as "support" and "labor coach" and educator. Doulas typically don't do any physical exams, they don't deliver babies . . . they are there to "attend to" you in labor and support you.

For midwife, I would be a little careful. Our midwife-trained doula explained her scope of midwifery practice this way, "I am an expert in normal childbirth." I agree with pps that midwives *tend* to be less intervention focused. But, ask around about your midwife and ask your midwife lots of questions about her c-section rate, tearing rate, pitocin rate, etc. Some midwives are very medical-minded and intervention-oriented. With at least one friend I am virtually 100% sure her midwife put her on unneeded bedrest for three months - - the midwife was out of her scope of practice and unsure what to do and reacted with extreme conservatism.

Personally, when dh and I started looking what mattered to us was not so much title/training but:
1) physical skill - - my ob has golden hands when it comes to exam, delivery, surgery, etc. Her practice is disproportionately doctors and nurses who have seen her in action (and their spouses);

2) knowledge base and eagerness to learn more. Both my ob and my midwife-turned-doula are fascinated by all things birth. Actually, the doula/midwife is smarter than me, dh, and my ob and reads everything she can get her hands on.

3) bedside manner - - and this is probably even more important than #1 or #2! My OB's general approach is that half the battle is making sure the mom isn't stressed out, feels supported, and is happy and healthy globally.

4) intervention - - I wanted someone who would use interventions only when truly needed and who was a proponent of vaginal birth.

Personally, I am someone that trends a little toward a holistically-oriented OB because I began having babies in my mid-thirties, had a few medical complications/issues, etc. But, if I was a younger mom, had no risk factors, or was comparing so-so/intervention-happy OB with top-rate midwife, I would be drawn to midwives. Also, if licensure changes in my state and my midwive-certified doula can practice here, I would go to her in a heartbeat for a possible baby #3 and I would identify in advance a high-risk OB who would be my back-up/consultant for any abnormal issues that may arise.