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Support in Childbirth: Doulas and Midwives

We’ve all heard that it takes a village to raise a child, and giving birth is not meant to be a solitary experience either. Women have always supported each other physically and emotionally as they prepare for childbirth, go through the birthing process, and welcome their children into the world. Today this role is usually entrusted to midwives and doulas.

Regardless of where you choose to have your baby—in a hospital, at home, or in a birthing centre—you will need help through the process and should not shy away from asking for it. There are several kinds of birth-support professionals whose training and experience focuses on different aspects of care. Who is present at the birth of your child will depend on your health care needs and the options available at the facility you choose.


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All parents want their children to be healthy and happy and have the best possible start in life. Becoming a parent opens the door to a whole new world of knowledge and responsibility. Having someone guide you through the various stages can be invaluable. A birth assistant can familiarize you with the details of the birth process, help you make informed choices, provide support based on your specific needs and health concerns, evaluate when extra medical intervention is necessary, help you create a birth plan, actively participate in the birth in a certain well-defined capacity, and provide other fertility-related support.

Prenatal care

The birthing journey begins from the moment you discover you are pregnant. As the baby develops in your uterus, your body will go through many changes. If you suspect you are pregnant, schedule a visit with your doctor to confirm and find a prenatal healthcare provider. Most commonly this will be an OB/GYN (obstetrician/gynaecologist), but your family doctor, a nurse practitioner, or a certified midwife may also provide these services.

At regular prenatal exams the health of mother and child is monitored through tracking weight gain, blood and urine tests, ultrasonography, and other procedures to make sure development is on track. Your OB/GYN can advise you on exercise, nutrition and prenatal supplements, and other things to consider as your due date approaches. If some risk factor is detected, they can refer you to a specialist to ensure the best possible outcome.

Deciding where to have your baby and who will be present go hand in hand. Procedures and resources will vary from place to place. If you aren’t sure where to start, your OB/GYN will likely be able to provide you with contacts and resources.

Who will be present at the birth of your baby?

Which specialists are present for your labour and delivery will depend on where you are, your health needs, and your personal preferences. The birthing team usually consists of an obstetrician or certified midwife assisted by an obstetric nurse, sometimes called a labour & delivery nurse. They may also work together with an anaesthesiologist, who is trained to administer the epidural and other forms of pain relief, and/or a doula, who specializes in emotional support and more wholistic forms of birth support.

Women who have low-risk pregnancies often choose to have their babies delivered by a certified midwife or nurse-midwife instead of a doctor or obstetrician. Women with higher risk pregnancies—due to health problems or pregnancy complications—will usually be advised to work with an obstetrician who is also a perinatologist, a specialist in maternal-foetal medicine.

While both midwives and doulas are trained to assist throughout the arc of pregnancy, childbirth, and postpartum care, only midwives are certified and insured to deliver babies. Simply put, midwives are medically trained healthcare professionals whereas doulas fill a more emotionally supporting role and are not required to have medical education.


Midwives 

Certified midwives are trained medical professionals who specialize in childbirth and fertility. Any midwife you choose should be certified by a credible institution (such as the American College of Nurse-Midwives or the Royal College of Nurses in the UK) and be included in your country’s official registry of midwives.

In the US, the training and continuing education required of a certified nurse-midwife (CNM) is similar to that required of a registered nurse, but CNMs can diagnose and treat within the scope of their specialty and have the knowledge and credentials necessary to deliver a baby independently. A certified midwife (CM) learns the same midwifery skills and takes the same exams as a CNM but has an initial health care education other than nursing.

CNMs and CMs can work in private practice but will often be found working as part of a team at a hospital or a birthing centre. Midwives are extensively trained in the physiological processes of childbirth. They actively participate in the childbirth process, monitor the health of both mother and foetus, determine various risk factors, and perform minor obstetric procedures such as the episiotomy.

If there are no complications, the midwife will often be the person leading your birth process from start to finish.

What is the difference between doulas and midwives?

Doulas

A doula is also a professional birth assistant whose job is to support mothers before, during, and after childbirth. While not required to have a medical education, they do go through a training and certification process to learn how best to support mothers in navigating the emotional aspects of the birthing journey, and to provide other, not strictly medical, services.

The presence of a skilled doula during childbirth reduces the labouring mother’s stress and the risk of complications. Studies show such support correlates with less time spent in labour, fewer unplanned caesarean births, and a higher rate of successful outcomes. It has taken time for the medical establishment to acknowledge their value, and advocacy groups have been compiling evidence for many years to show that childbirth outcomes improve for a wide range of measurable indicators when a doula is present. The evidence is so compelling that in some places insurance companies are now willing to finance doula services and many doctors and midwives report that doulas play an important supportive role that complements their responsibilities.

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Experienced doulas are knowledgeable about the various stages of pregnancy and childbirth. If everything is going well, they focus primarily on the comfort and emotional wellbeing of the birthing person. Doulas will also track certain aspects of a pregnancy and refer expectant mothers for specialist care when needed. Cultural practices in native and indigenous communities can differ, but, as a rule, a doula does not assist with the actual delivery unless acting in a “good Samaritan” capacity when no medical professional is on hand.


A doula is a knowledgeable companion throughout the childbirth experience who provides support for the mother’s emotional needs, can expand her repertoire of coping skills, and is able to advocate for her with both medical staff and family if necessary.

The support a doula can provide includes:

  • information and resources about pregnancy, childbirth, and postpartum care
  • help designing a birthing plan
  • a more in-depth understanding of what’s happening and what to expect
  • sharing breathing exercises, visualization techniques, and helpful birthing positions
  • help with preparing the environment—birthing equipment, sensory comfort 
  • comfort touch, encouragement, and help with practical tasks during childbirth
  • advocating for the birthing person with medical staff and family
  • emotional support for the partner and other family members
  • ensuring the most positive possible birthing experience

Partners and other family members can be very different when it comes to their ability to support the birthing person though labour. Professional doulas will do their best to provide information and work with families as they are so everyone feels included and comfortable. They can help a willing partner understand what feels supportive for the mother and can also run interference with a difficult family member if the birthing person finds their “help” to be counterproductive.

Doulas also sometimes specialize in a particular religious or spiritual tradition or work with a particular community. In addition to their practical knowledge, doulas can provide cultural sensitivity and attention to interpersonal communication that a doctor or midwife simply does not have time to address on top of their other responsibilities.

Summary

Anyone preparing for childbirth needs the support and encouragement of people with greater knowledge and experience, especially first-time parents.

Both midwives and doulas choose their professions because they care deeply about providing a positive experience for mothers and their babies. If you are expecting, find out what resources are available to you. Make some phone and calls and visit some potential birthing centres so that you can find a birth assistant who understands your concerns and provides the support and safety you need.

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