As you may have noticed, I haven’t had much time for blogging lately. It’s been a busy time for me, with classes and clients, as well as other life-stuff going on (nothing major, just moving to a new town and getting married!), and I haven’t been writing as much as I would like to.
As I don’t see this trend reversing any time soon, I thought I’d try my hand at a short (haha), once-weekly series to keep me honest. Hence, FAQ Fridays! Every week (on Friday, obviously), I will tackle a common (or ‘frequently asked’) question about doulas, birth, babies and what have you. Feel free to drop me a line if you have a question you’d like me to answer!
How is a doula different from a midwife?
This is by far the question I answer most often (unless you count “what’s a doula?”). I should note before delving into this that I will be responding to this question in terms of Ontario’s model of midwifery care, which differs in some ways from midwifery in other places, so if you’re not an Ontarian, keep in mind that some of this info may not apply to the situation where you live.
Many people are aware of midwives, but far fewer know about doulas. When they hear the words “birth support”, they go immediately to the model they know best – midwifery – and they’re not wrong. Midwives, like doulas, do provide their clients with support during labour and birth, but the catch is that that’s not all they do.
While midwives are able to give their clients greater support during labour than an L&D nurse can (for the simple reason that midwives attend to just one labouring client at a time, whereas nurses are typically dealing with several women who are in labour at any given time), they are also required to perform clinical and administrative tasks, in addition to providing support. The research behind doulas, which demonstrates the impacts that we have on obstetrical outcomes and birth satisfaction, shows that these benefits are greatest when women receive continuous, uninterrupted one-to-one support.That means that when your midwife has to go to the nurses’ station to fill out administrative forms, or check into hospital policies regarding a request you’ve made (for example, “can I take off the monitors so as to sit in a warm bath for a little while?”), or insert an IV, she can’t be giving you 100% of her attention, and that means interrupted support. Even in a home birth setting, there are forms to be filled in and clinical tasks to perform. Midwives are amazing, but they’re not superhuman.
Another difference has to do with clinical information and how it’s presented to you as a client. A midwife, like a doctor, is a clinical professional. She has specialized training and a license to provide you with recommendations as to your care and interventions. Doulas do not, in fact we can not, give advice or recommendations of a clinical nature. In addition to the physical and emotional support that we give to our clients, we also typically provide informational support, meaning resources and clarification. When a client asks me about a particular intervention or test, she’s not asking me whether I recommend it or not, she’s asking me to provide her with evidence-based information about the risks and benefits of that intervention or test. I consider informational support to be a major component of my role as a supporter of client self-advocacy. By finding and sharing the most up-to-date, well supported evidence available, I am giving you the tools you need to make your own decisions for your care. I don’t tell my clients what I think they should do, nor do I tell them what I would do if I were in their situation. Your birth is not my birth. Only you can make decisions about your care – my role is to make sure that the information you’re relying on in order to do that is current and supported by strong evidence. Beyond that, my role is to support whatever decision you do make, regardless of whether it is what I would have chosen for myself or not. Keep in mind that, from a legal standpoint, your midwife is responsible for the health and safety of both you and your baby. That means that she is subject to liability. In addition, she is subject to the policies of the hospital in which she is providing your care. A midwife working at one Toronto hospital may recommend an IV and antibiotics or continuous electronic foetal monitoring in a given situation, where a midwife in identical circumstances at a different hospital may not. This may be because of differences in their individual practices and past experiences, or it may be the result of differences in hospital policies, or it may be a combination of factors, but it is not exclusively about you and your preferences for a satisfying and empowering, as well as safe, birth experience. If, after a prenatal appointment when a recommendation has been made, you want to know more about the evidence re the risks and benefits of the recommended procedure, your doula is there to do research for you and ensure that what you’re reading is informative and accurate, without being unnecessarily frightening or stress-inducing. Beyond the fact that our scope of practice does not include the capacity to give medical advice, a doula also has the time to do this kind of research on a client-by-client basis. Midwives and doctors are super busy and don’t have hours to spend digging up the latest studies for you or even talk to you about the information you already have. Again, a prenatal appointment with a midwife is likely to be longer than one with an OB, but their schedules are nonetheless extremely full. My letter of agreement clearly states that I am available to do research for you, the client, on an ‘as-needed’ basis.
Finally, again picking up the thread of continuous support, sometimes with a midwife-attended birth, there is the need for a transfer of care. While many midwives like to stay with their clients even once care has been transferred to an OB, this is not always possible. Sometimes they’ll leave and come back when you’re pushing, or they may get called in to another birth now that they aren’t technically attending yours. A doula stays with you no matter what changes to your plan may arise, including transfers of care. In addition to the possibility of a transfer to a physician, sometimes the attending midwife may have to be replaced by another midwife partway through your labour because of laws regarding number of hours awake for clinical professionals. The midwife who replaces her may be someone you know already (you’ll probably have at least met your second), but she may not be. In fact, it’s entirely possibly that neither your primary nor your secondary midwife will be on-call and you may wind up with a midwife you’ve never met from the start. The chances of being attended by a practitioner you’ve never met are lower with midwives than in cases where the practitioner is an OB, but it still can and does happen. Having a doula means that no matter what happens during your labour there will be at least one person you know and trust with you who is experienced and knowledgeable about birth.
A doula is an important part of your birth team. That means that she works in a professional and complimentary way with your midwife (or doctor/nurse team). Your doula should never act aggressively or confrontationally with your health care practitioners and, in most cases, midwives, doctors and nurses are happy, even relieved, to learn that you have doula support. They feel better knowing that, when they have to be out of the room or performing a clinical task, their client is getting good quality support of a physical and emotional nature. In addition to the fact that support is what we do, full stop, it should also be reassuring to you to have someone on your team who works directly for you and who will remind you of your right to self-advocate and ask questions. Midwives and doctors are licensed by the government and have privileges at specific hospitals. Both of these entities may impose restrictions on them in terms of the recommendations they are able to give. Your doula works only for you, which means that your agenda and her agenda are one. Having her there with you, from whenever you want her to be once labour starts, until you and your baby are comfortable and resting after birth can make all the difference, regardless of whether the rest of your professional team is composed of nurses and doctors, or midwives.
Have another question? Leave it in the comments or email me.
Have a fantastic weekend everyone!