Guest Post by Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE, FACCE

Editor's Note: Tech issues as we updated the MANA site meant this post couldn't run during the month of May. However, this content remains relevant year round, not just during International Doula Month! 

International Doula Month, celebrated every year in May, is a great time to examine the issue of doulas and midwives working together to support birthing families. While the roles of both birth doulas and home birth midwives are clearly defined, it is not hard to imagine that along with the desire to offer the best professional service to a family, the professionals serving in these capacities might find themselves feeling a bit awkward with each other. There even may be some "jockeying" for position as the midwife and the doula strive to best serve the client and the client's family. Remember that not all home births have a doula presence, so the doula's presence may require some adaptations.

According to DONA International, birth doulas are trained to provide emotional, physical and informational support during labor, birth and the immediate postpartum period. The word "doula" comes from the Greek language and means "woman who serves," though there are both men and women serving in the doula role today. The typical birth doula will meet with his/her client once or twice prenatally to understand their preferences for labor and birth and how the doula can best support them and their family. They also explore any worries or concerns that the pregnant person may have. The doula will attend the birth and then close the professional relationship with a final postpartum meeting or two. The doula is a source of information for the family from the time of hire through the first weeks postpartum. (Postpartum doulas can be hired to provide services after the birth, including newborn care, meal preparation, light housekeeping, and family support.)

The midwife is a trained health care professional who provides clinical care along with information and emotional support during the pregnancy through six weeks postpartum. The term "midwife" means "with woman." Over the course of the pregnancy, a person will see their midwife 15-20 times for pre- and postnatal appointments, where the midwife will assess the client and baby and share information, along with benefits, risks and alternative of procedures, tests and assessments.

Here are nine tips for making the most of what doulas and midwives have to offer while working together:

1. Midwives support healthy, low risk birth and doulas help improve birth outcomes

Midwives are appropriate health care providers for healthy, low risk pregnancy. They are well suited to providing a safe and satisfying birth experience for their clients. Evidence shows that outcomes are good and families are very satisfied with the care they receive.

There is ample research on the benefits of doulas at births. (Hodnett, 2013) When the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released their groundbreaking "Safe Prevention of the Primary Cesarean Delivery" Obstetric Care Consensus Statement in February 2014, one of their key recommendations to reduce the primary cesarean rate in the USA was the continuous presence of a doula at a birth. (Caughey, 2014)

By working with a midwife/doula team, families reap the benefits of both models of care.

2. Doulas work within their scope of practice

When doulas stay within the scope of their practice, they best serve their clients and are more likely to be a welcomed member of the birth team. Many doulas may be pursuing the path to midwifery. Some doulas may also be a trained midwife or birth assistant, working in that capacity with other clients. But in the doula role, emotional support, physical support and helping a client and the family to find their voice is key.

3. Respect pre-existing relationships

The midwife has an emotional relationship with the client, developed over time. The midwife has also been trained in providing physical support and promoting a normal labor. The midwife is the only one responsible for providing clinical assessments and providing medical advice. The client can make optimal use of both their doula and their midwife. Everyone at the birth has the same goal - healthy family and a healthy birth.

The midwife shares the responsibility of emotionally supporting the client with the birth doula, and recognizes the value of the doula-client relationship. Having a birth doula in attendance allows the midwife to take care of clinical tasks and documentation, and also rest to conserve her energy for the actual birth, when s/he needs to be on the top of their game and ready to respond to unexpected situations. The client views the two professionals differently, but relies on support from both of them. Midwives and doulas are both experts in providing emotional support and physical comfort measures at births.

4. Support in early labor

Often times, a doula will support a client prior to the arrival of the midwife. This early labor support helps the client to gain confidence in their coping abilities, feel supported and promote normal, physiological birth staying hydrated, nourished and changing into positions that promote progress. Sometimes, they arrive together and the midwife can feel confident that the client is supported emotionally while the midwife clinically assesses the situation and sets up birth equipment.

5. Two heads are better than one to promote progress

Having a doula present at a home birth often means that two heads are better than one when it comes to suggesting coping strategies and offering comfort techniques that allow the labor to progress. I always learn something from every midwife I work with; a new position, a different coping strategy. Frequently, the midwife may learn something from me. As a birth doula, I have the chance to work with a wide variety of midwives (and doctors and nurses) and I bring those diverse experiences to all my births.

6. Transfer support

One of the midwife's responsibilities is to provide medical information and assessments and make recommendations for care, prenatally, intrapartum and after birth. The midwife and client make the decision when it becomes necessary to transfer. The doula can help the client to receive all the information that is needed in order for the client to feel comfortable with their choices. The client may choose to transfer and the doula can help the client's voice to be heard.

If a transfer becomes necessary, the doula will stay with the client at the hospital until after the baby is born. Some midwives stay as well, after transferring care to the hospital health care provider. If the midwife leaves, the client will still have continuous support from the doula.

7. Twice as many postpartum visits

Both doulas and midwives have scheduled postpartum visits with the new family. Having separate visits from both professionals means more support for the family on breastfeeding and adapting to caring for and parenting a newborn.

8. Celebrate the different roles

Midwives and doulas serve different but valuable roles during the pregnancy, labor, birth and postpartum period. Working with a midwife should not preclude the benefits of working with a doula and having a doula attend the birth should not interfere with or minimize the trusting working relationship that the midwife has with his/her clients.

9. Collaboration is key

Working together, midwives and doulas are able to create a win-win situation that clearly supports healthy births, healthy parents and healthy babies. When doulas and midwives collaborate, the families reap the benefits. Unfortunately though, subtle (or not so subtle?) areas of conflict can arise, between midwives and doulas, as both strive to serve their clients in the best way possible. When all the professionals attending a birth work together and avoid conflict, the end result is exponentially more positive for all.

Summary

Doulas and midwives should recognize that each professional brings different skills to the birth, along with some overlapping, but not competing abilities. Working together, respectful of the boundaries of the other, will benefit the client and their experience, create a collaborative situation that builds on everyone's strengths and supports the best outcomes for parents and baby. There is no reason to feel territorial or defensive. Open communication between midwives and doulas, mutual respect and a clear definition of each other's scopes of practice create the optimum circumstances to welcome a new human being into the world.

Photo credit: ©2014 Patti Ramos Photography
www.pattiramos.com

References

• Caughey, A. B., Cahill, A. G., Guise, J. M., & Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology, 210(3), 179-193.
• Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub5.