What's the difference between a midwife and a doula?
Whats the difference between a midwife and a doula?
At some point labour contractions become longer, stronger and closer together. Around this time a midwife provides care to see if mother and baby are both well. My job remains essentially the same, helping with the non-medical needs of a labouring person. Midwives are often busy ensuring safety is maintained while a doula will be assisting with position changes, setting up the environment to be soothing, helping the labouring parent stay hydrated and focused on taking one contraction at a time.
As a doula I do not interfere in any way with the care provided by midwife or doctor. As birth is a dynamic process, parents may be faced with an change in their care or a medical intervention. In these situations, I remain as always non-biased and assist with gathering information on the options available to my clients. My highest concern is that the labouring person is listened to and can make a choice they are happy with.
I often find midwives are cautious when meeting a doula in labour but once they see the positive effect it is having on the women, they are very supportive of her choices. Its also interesting to look at the evidence around doulas. Numerous studies have shown an added benefit to continuous support in labour. These include shorter labours, less requests for pain medication and less likely to have a caesarean or a instrumental birth (Hodnett et al. 2013). This was most effective when the continuous support was provided by someone who was neither part of the hospital staff nor the woman's social network, such as a doula.
What does my hospital one birth partner policy mean for doulas?
Waterford University Hospital, Wexford General Hospital and St. Lukes in Kilkenny have a policy of one birth partner in the delivery ward. What this means in working terms is women need to make their wishes known in advance of labour if they wish to bring a doula in addition to their partner
In fact, only one hospital in Ireland, the Coombe, has a position statement on doulas, acknowledging their role to provide for women's continuous support needs. Outside of Covid-19 restriction or an emergency event in labour, Irish hospitals do facilitate a woman’s request to have both her partner and her doula present during her labour and birth whilst on delivery suite.
I recommended writing to the Director of Midwifery in your hospital with your birth preference to have a doula as your second birth partner. Then add their email/ written response noting this birth preference or in your notes/ file before 37 weeks. While not always required to have this written agreement it may clear up any confusion arriving in labour with your partner and your hired doula.
How does a doula work alongside my partner?
In my experience partners are much more relaxed with a doula present at the birth. I am someone they have come to know during antenatal visits. This is a bonus as frequently your midwife or doctor at the birth would not be known to them. I am very aware of taking time to build a rapport between myself, the partner and the care providers in labour.
Health care or infant care is not typically an area of expertise for partners and that can feel scary. Some dad's worry they wont be able speak up or if they do they will sound confrontational. I can help with those difficult conversations and offer partners tools so they can be hands-on if they wish.
I can never replace a partners/ dads special role in bonding with the woman and newborn. What I do offer is support at times when it feels overwhelming and give some ideas of ways to manage the normal anticipated moments of labour. Knowing that the mother will not be alone if partners need to step out for breaks is very welcome too!
What does a doula service entail? And cost?
Initially, I offer a complementary -1 hour- meet over Zoom, WhatsApp or in-person to discuss my service, associated fees and your needs. Please get in touch with Germaine for the price list.
Once we decide we are both are happy to proceed the doula package consists of:
2 - 3 antenatal visits in the 2nd-3rd trimesters
on-call from 37/38 weeks (day and night) for labour support
Birth attendance to approximately 2 hours post-birth.
1 postnatal visit
Can a doula help me if I am having an epidural or caesarean?
Yes! Doulas have a range of skills that wonderfully support mothers with all sorts of birth experiences. We are all unique and have our own path from conception to birth and beyond.
Once an epidural is placed its true that the birth becomes more medically managed by the midwife and doctor team. Parents are often pleased they tried all the comfort measures I can help with such as massage, showers or position changes before requesting an epidural. Specific ways I help with epidurals include, the use of a peanut ball, guiding breathing techniques to conserving energy for birthing, hands-on skills of reflexology to support progress in labour.
Whether a caesarean birth is planned or unplanned, doula support can help the birthing parent stay calm, centred and prepared.
How long will my doula spend with me in labour?
I often meet parents at their home in the early stages of labour for a support visit. I can remain nearby if it makes the mother feel more comfortable. Most labouring people advised to stay home as long as possible. This is is easier to achieve with support while waiting for labour is becoming more established, even just phone support. The labouring mother will contact me when she wishes I join her in labour. I will remain until the baby is born. In the case of a very long labour, we might discuss the option of a back-up doula to step-in for a time (after 16-24+ hrs) to have a rested companion at your side.