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ChildbirthSolutions: Hello, everyone, and welcome to ChildbirthSolutions' first live discussion! We have midwife Kathleen McClelland and doula Pam Cass in with us today. Please feel free to send any questions or comments! OK -- Pam and Kathleen, What do you feel are the respective roles of the midwife and the doula? Pam Cass: The doula’s role is to provide continuous emotional and physical care and comfort to the birthing woman. Additionally her role encompasses providing support to the birthing woman’s primary support person; in most cases the woman’s husband, mother or sister. Because of her experience with birthing women, the doula is able to reassure the birthing family that all is well when the unfamiliar sights and sounds of birth become intimidating. Also, the doula is able to translate unfamiliar medical terms and protocols that might otherwise create anxiety. Most importantly though, the doula is the one childbirth professional who is there to focus exclusively on this particular birthing woman through every contraction, with no shift changes or other duties to distract her. Kathleen McClelland: The midwife's role is largely to empower, educate, and support her client enabling her to make her own decisions and all the while, providing expert medical assessments and care. To quote Judith Rooks in her book, Midwifery and Childbirth in America while discussing the midwifery model of care, "Midwives are experts in protecting, supporting, and enhancing normal pregnancy and childbirth. large part of the midwife's attention and concern focuses on her client as a person, a unique individual, in the context of her family and her life. The midwife is interested in the woman's expectations and experience of her pregnancy- her perceptions and beliefs;her knowledge, opinions, question, and worries; her feelings, satisfactions and dissatisfactions, comforts and discomforts; her desires, decisions, and action; and the effect of all of these on her pregnancy, her fetus, her labor, delivery, breast-feeding, postpartum recovery, and her development as a mother. Midwives see the pregnant woman as an active partner in her own care." Manhattan: I recently visited a midwife for well-woman care who told me she didn't think doulas were necessary for women being cared for by midwives. What's your take on this? Is this the attitude of most midwives? Pam Cass: A doula's role in supporting a birthing woman is not impacted significantly regardless of whether she gets her care from a midwife or an obstetrician. In either case, though the midwife, in general is more compassionate and considerate of a woman's emotional needs during pregnancy and birth, the bottom line is that she is always going to have other patients to think about and perhaps care for in labor at the same time. The doula is the only one who will be with the birthing woman without distraction for every contraction of her labor. Also, if there should be a medical emergency, the midwife needs to focus all her energy and attention on the situation at hand. This obviously will leave the birthing woman floundering for educated emotional care at a very scary time if there is not a doula there to devote all her energies toward caring for her emotional needs as well as filling her in on what's happening and why. This is something the midwife will not have the time to do as she is handling the situation. Kathleen McClelland: Certainly, the midwife and doula provide similar and complimentary roles. However, the doula is often more able to focus all her attention on the pregnant woman's needs during labor and birth whereas the midwife may have other repsonsibilities that detract from her ability to provide continuous emotional and physical care, such as documentation (writing in the chart), other clients in labor simultaneously, and phone calls from clients with questions or problems. In addition, the doula is more likely to support a client early in labor in her home than a midwife in a busy hospital practice. At a home birth or birth center birth, the midwife and the doula would be able to support each other while extending their emotional and physical energy to provide care for the laboring woman. Culpeper, Virginia: Since the doula seems to have taken over the role of coach, with the midwife responsible for delivering, what's the role for the father, other than taking pictures? Pam Cass: The doula can never take the place of the primary support person because he is the one person there who loves the birthing woman and will be involved in her life for ever after the birth is over. The doula's role is to support the support person. She does this by offering suggestions as to what might be comforting to the birthing woman. She will, if she notices that the laboring woman needs a drink of water, will suggest it to the father, rather than doing it herself. She will look for ways to help the father help the laboring woman... so that in the long run of the labor, the father comes out looking far more useful than he might have done. Keep in mind that for many fathers this is the only birth they will ever experience and having a doula there as the "expert" can free them up to participate in the birth emotionally since they no longer have to be the one to anticipate and watch out for every eventuallity. Kathleen McClelland: The primary role for the father or the support person of the client's choosing is to just BE THERE for her. He or she should not feel any need or pressure to know what to do to ease her labor pain or to facilitate the labor and birth process. That is the role of the doula and the midwife. The midwife has the additional role of having the knowledge and expertise to anticipate any medical problems and to handle them accordingly Crofton, MD: Hi! Sorry I am late! I wanted to ask a question, if I may? ChildbirthSolutions: Send it in! San Francisco, CA: Can I have pain medication during labor if I am cared for by a midwife? Kathleen McClelland: Absolutely, provided that the women is planning to give birth in a hospital. Often, just knowing that pain relief medicine is available if necessary empowers a women to go as far as she can without using medicine. The midwife, during prenatal care, will educate the woman and her partner regarding natural pain relief techniques and encourage the use of massage, baths or showers, position change, heat and cold packs, and mental preparation for labor. Childbirth classes would be encouraged for the client and her support person to more fully prepare her for labor and birth. Pam Cass: Of course you can. Every woman needs to know that she can have whatever she wants in her birth, though if you have specific needs and or desires, it would be important to talk with your care giver about those and switch care providers if you need to. California: What happens if I have to have a C-section. WIll the doula stay with me? Can she help me? Pam Cass: Absolutely. A doula can be a tremendous help before during and after a C-section. I've supported many women who have had sections...both planned sections as well as emergency sections. Not only can the doula provide a running commentary of explanations of what is going on and what to expect next, but there may be specific comfort measure she can use as the woman faces interventions like the insertion of the foley catheter. Also, after the baby is born, typically the father accompanies the baby to the nursery, and the doula remains with the mother as her surgery is finished up. Without the doula there, the mother may feel abandoned and alone, which is a tragedy when you have just given birth and want someone to share it with. Additionally, the birthing couple often have a ton of questions after the birth and the doula, having been there and an eyewitness is able to answer many of them, reassuring the couple of the need for the section and ensuring that they end up with positive memories of their birth. Cleveland: What are some important questions to ask a prospective midwife or doula in order to find out if we are compatible? Kathleen McClelland: I think that first impressions count for alot when trying to determine compatibility. Also, reccomendations of like-minded friends and colleagues. As far as specific questions, you would want to know her experience and expertise with the type of birth you hope to have (home, birth center, or hospital). Also, you would want to know with whom she collaborates medically, in the event of a need to involve a physician in your care. Pam Cass: When you are interviewing a doula it is important to feel a real connection with her. You can achieve this best by having a nice relaxed conversation with her. You may want to ask her about her credentials and how long she has been serving birthing women. But you will really need to find out whether or not she is prepared to support you unconditionally. She should be if she is certified, but it is an important consideration. Boston Ma.: What does a doula cost? Is there any insurance coverage? Pam Cass: Charges for a doula's care will depend on several circumstances. These will include what the going rate is in the area where you live, how much experience the doula has, whether she is in private practice or is part of a larger service. In general...as a very ball park figure... you can expect a newly certified doula to charge around $200 and a very experienced doula to charge upwards of $700. Doula services may charge significantly more. Also, doulas, especially those in private practice tend to charge on a sliding scale and every one I know has done births for free, when they feel that circumstances warrant it. As a matter of fact, most doulas I know would do what they do for nothing, but they understand the need to compensate their families for the time the spend taking care of others. At the moment there are only a few insurance companies that reimburse for doula services, however it is always worth checking your own out. Also, this may be a good time to use your flexible spending account money if you have one through your job. Virginia: Are there certain exercises that I could do in order to better prepare myself (and my partner) for my birth? Pam Cass: I like to encourage my clients to practice relaxation exercises and stretching. These can be very helpful during labor and birth. Kathleen McClelland: I encourage most all women, early in her prenatal care, to remain active through-out her pregnancy. This can be achieved by taking aerobic classes for pregnant women or more simply, by walking daily or every other day briskly for 30 - 45 minutes. The benefits of this include mental and emotional, avoidance of excess weight gain, and imporved carbohydrate metabolism, especially for women with gestational diabetes. Regarding specific exercises, there are stretches to alleviate back ache and leg pain that can be suggested if the need arises. Maryland: I am a local doula. I sometimes feel confused as to whether I should be actively trying to “change” a woman’s mind about her birth preferences (because I understand it might be better for her and baby in the long run), or just let her go into birth with her beliefs intact? I try to mentor, rather than teach or instruct…but it is so HARD in my area to encourage women to view their options, rather than do the “norm”…which is a hospital birth with early epidural. Kathleen McClelland: During the rapport that will come from prenatal visits, the doula will be able to better understand whatever issues, fears, or concerns the woman may have regarding the upcoming birth of her baby. For some women, such as survivors or sexual abuse, having as pain-free labor and birth as possiblem may be the absolute most important thing. It takes time to really know what will matter most to individual women. This is part of the role of the doula (or midwife). Pam Cass: I understand your confusion.
But the bottom line is that you are not going to have to live this
woman's life for her after the baby is born. Your role should be to
support the woman's plan for her birth whatever is might be. But,
at the same time be ready to offer to introduce options that the pregnant
woman may not be aware of and be ready to teach if she responds with
a desire to learn more. ChildbirthSolutions: OK... last question -- ChildbirthSolutions: What's the best part of doing what you do? Kathleen McClelland: I thoroughly enjoy seeing the personal growth of women and families as I am involved in their care during such an important time in their lives. I enjoy the relationships we share throughout their pregnancy and am thrilled to be present at the birth of their babies. Working with women who are not pregnant, I enjoy educating and empowering them to make healthy decisions regarding their bodies. Working in a college health service setting for about 10 years I felt that what young women learned in my office about maintaining their sexual health was of more importance in their lives than much of their college course work. Pam Cass: The best part of being a
doula is to not only be a part of birth, but to provide a service
that is so appreciated by the women I support. I have three children
of my own, they are 23, 18 and 15 and I didn't have the opportunity
to have a doula with any of them. Though they were all unmedicated
hospital births with an OB that I really lilked, with my husband at
my side, I will jokingly tell people that by my third birth I might
have been tempted to sell my first born if it would have gotten me
a doula for the birth. ChildbirthSolutions: Thanks Kathleen and Pam! That's it for today... keep checking back on the site -- we're going to have a lot more of these in the new year! Send us suggestions or feedback about this discussion at discussions@childbirthsolutions.com. Bye! |
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