Aren’t doulas and midwives the same? And other misconceptions.

Every time I tell someone I am in school to become a midwife, I get something like “My friend is a doula too!” Well, I’m here to share a little secret – midwives are not doulas. Although some midwives are also trained as doulas, they are distinct professions.

Both are an important part of the birth team, but midwives and doulas have very different roles during pregnancy and births. One is a trained medical professional and the other is a trained labor support professional. For the purpose of this post, I will be focusing exclusively on birth doulas, but folks also train to be postpartum doulas, abortion doulas, and bereavement/end-of-life doulas.

Doulas

Photo of doula, Efe Osaren. Photo credit Janet Upadhye.

First of all, let’s get this straight, I am not a doula. I’ve had the pleasure of working with many doulas in the hospital setting, so I’ve witnessed firsthand some of their tremendous impact in the birthing person’s world. This is a list of my observations about the work of a birth doula:

  • Offers professional birth support, and often continuous care during labor.
  • Does NOT catch babies or medically assess the client in any way.
  • Does not give medical advice or speak on behalf of the client to medical personnel.
  • Offers resources and information during pregnancy to help prepare the birthing person and their support team for labor, birth, and the postpartum period.
  • Helps the birthing person identify preferences and priorities for their birth experience.
  • Helps the birthing person cope with the pain of unmedicated labor.
  • Helps the birthing person cope with positioning while getting an epidural.
  • Ensures that the family is involved in the birthing person’s care.
  • Educates the birthing family on comfort measures during labor.
  • Encourages everyone in the family to get adequate rest and nutrition during labor.
  • Works with clients regardless of their preferred birth setting (e.g., home, hospital, birth center, etc.).
  • Generally stays for a couple of hours after the birth of the baby, or until family is settled and nursing.
  • Usually follows up with the birthing family after birth. Follow-ups occur once or twice in the birthing person’s home or by phone.

Midwives

Midwife, Asasiya Muhammad, LM, CPM.

Midwives are the medical caregivers during the childbearing process. There are different types of midwives (I’ll post more on this later). Midwives can be community-based midwives, certified professional midwives, certified midwives, and certified nurse-midwives. For the record, I will mention that the scope of practice for midwives varies based on the type of midwife you are (and the state you practice in). For example, Certified Nurse-Midwives (CNMs) care for clients from the onset of menses through the menopausal years. This is one of the huge differences between CNMs and Certified Professional Midwives (CPMs), as CPMs care for clients during the childbearing year only. For the purpose of this post, I will highlight some of the ways in which CNMs care for people.

  • CNMs are licensed medical professionals trained to focus on the wellness and safety of the birthing person and the baby (in utero and newborn)..
  • They can catch babies at home, in the hospital, or at a birth center. They also perform medical assessments during pregnancy, labor, and the postpartum period.
  • They may have multiple clients in labor depending on the birth setting, so often are not available to provide continuous labor support.
  • Can do all prenatal, birth, and postpartum care for normal, healthy pregnancies (meaning you will not have to see an Ob/Gyn unless you have certain risk factors or complications).
  • Can give medical advice.
  • Can prescribe medications.
  • Can do yearly well-person check ups.
  • Can do pap smears and other types of gynecological care.
  • Can insert IUDs, place Nexplanons, and prescribe birth control.

As you can see, the roles of doulas and midwives are distinct. However, their ways of supporting the birthing person can sometimes overlap and they commonly work together at some point in order to give their mutual client the best birth experience possible. People often ask me, “should I get a doula?” and my response is always a resounding “YES!” Doulas are an integral part of any the birth team alongside a midwife or Ob/Gyn.

This post was cowritten by Crystal Hawkins, RN, SNM (Jamii Midwife) and Mari-Carmen Farmer, CNM. The list is not meant to be exhaustive, but rather to show some of the major differences between doulas and midwives.

Empowering Your Hospital Birth.

Image used with permission – Ina Boteva

There’s a lot of talk circulating about hospital policies and Ob/Gyn’s who disempower birthing people rather than empower them. Let’s face it, this is sometimes true. However, home or birth center birth is not an option for everyone, and as a labor and delivery nurse, I know firsthand that beautiful and empowering hospital births are possible. Below are a few simple tips on empowering your hospital birth.

Interview your provider.

You do not have to choose the first Ob/Gyn or Midwife you meet. If possible, I highly recommend researching birth care providers in your area before becoming pregnant. However, I know this isn’t realistic for everyone. So tap into your resources. Ask your friends, family, neighbors, community facebook groups, etc. for suggestions. Unless you live in an OB dead zone, you have options!

Make a birth preferences list.

Birth plans can be tricky. I can’t tell you how many people I’ve taken care of who have had their births not go as planned and how deeply disappointed they felt. I suggest you make a birth preferences list that can be amended, if necessary. There are hospital policies that nurses, midwives, and doctors must adhere to. Therefore, it can be hard in the hospital to abide by strict birth plans. For example, writing “I do not want a c-section” on your birth plan does not mean you won’t have a c-section. But writing out preferences that may help to prevent the cascade of interventions that can sometimes lead to a c-section might be more beneficial.

Consider going into labor naturally.

Inductions are great if they are medically necessary. Sometimes, in the case of uncontrolled maternal illness (e.g., diabetes or high blood pressure), delivering the baby sooner than later is the safest thing to do. However, if you can let your body get to the point where you go into labor on your own, you may just avoid the additional medications and interventions that occur during routine inductions, and, therefore, not require as much monitoring as someone not having physiologic labor and birth.

If you are considering an induction, check out this article for tips on what to ask before scheduling your induction.

Carefully curate your birth team.

In addition to choosing a provider who will support and empower you, think about who else you want to be in the delivery room. And, for the love of god, hire a doula! We know that people who birth with doula assistance statistically have lower rates of pre-term delivery, low birth weight, very low birth weight, c-sections, and a higher initiation of breastfeeding than people who birth without doulas.

I fully understand that doula support isn’t always financially feasible. Some doulas may consider bartering or trading services with you. But if you cannot find that, consider other people in your life who you may want to invite to your birth. Do you have a cousin who is passionate about birth who would be a good birth coach? Do you have a friend with a calming presence? Does your partner give really good massages? Does your mom know how to calm you down and distract you in a good way? Being empowered not only means being able to speak up for yourself in the presence of healthcare providers, it also means speaking up to friends and family members, too. No one feels more entitled to attend a birth than grandparents of the baby.

If your empowered birth just looks like you and your partner in the delivery room, that’s ok, too!

This information should not be used in place of medical advice. 

Black Maternal Health Fair – Meet the Team

Click here to donate to the Black Maternal Health Fair.

Now in her second year of organizing the Black Maternal Health Fair, Crystal is excited to bring Philadelphia a bigger and more empowering event. Crystal is a mother, a labor and delivery nurse, and a student midwife.

Crystal Hawkins, BSN, BA, RN

Candace is a creative individual who strives to make her community a safe and expressive environment where individuals do not feel inadequate or stigmatized to the societal norms. She brings 7 plus intensive years in mental health and numerous years  with birth work. After having her baby at the of 18, she found her passion in becoming a doula and helping black women and teens find their voice and create their own birth story. Her mission is bring forth a community where people can advocate for themselves with effective and sustainable interventions, resources, and evidence based research that is going to uplift the community. 

Candace Shillingford, MSW

Dr. Peterson is a women’s health advocate with a focus in perinatal mental health issues and support services provided by community health workers, doulas and breastfeeding peer counselors. She is a member of the Birth Equity Leadership Academy (BELA) through HealthConnect One and a board member of The National Association to Advance Black Birth. Dr. Peterson is the founder of the Philadelphia Birth Equity Project, an organization developed to address disparities in maternal and child health in the city of Philadelphia. She also volunteers with the Maternity Care Coalition and is a member of the Breastfeeding Task Force here in the city.

Faith Peterson, MD, CLC

What to ask before scheduling an induction.

In 2018, the study that started the 39 week induction craze was published and it has become a routine part of pregnancy care in America. As a labor and delivery nurse, I meet expectant parents all the time who schedule their inductions religiously at 39 weeks and zero days because it was offered to them. The thought of meeting your baby sooner usually appeals to people. As does getting rid of the constant lower back pain, the swollen feet, and the urge to pee every five minutes.

But most people come in with unrealistic ideas of how the induction is going to go – get some meds, have a baby later on today!

Their facial expressions usually go from excited to “what did you just say?” once I begin to discuss the length of scheduled inductions and my particular hospital’s policies regarding them.

The truth is inductions take time! They can take a few days, to be honest. Days of being tethered to an electronic fetal monitor and maybe even an IV pole depending on the facility you choose to give birth in. I can only attribute everyone’s confusion about the length and protocols surrounding inductions to a lack of education during prenatal visits.

Because all birthing facilities have their own policies, here are some questions to ask your healthcare provider (midwife, Ob/Gyn, etc) when you are given the option to schedule your induction. I highly recommend asking these questions during your prenatal office visits so that you have time to think them over before making a decision, or find another provider if you do not like the answers you get.

What are the benefits and risks of inducing labor?

Asking this question will hopefully equip you with the tools needed to make an informed decision on whether or not you even want to be induced. There are risks and benefits to everything, and inductions are no different. For some people, inductions are absolutely necessary, and for others, it is not. Find out which one you are.

What medications are used to induce labor?

Common drugs used to induce or augment labor include misoprostol (cytotec), dinoprostone (cervidil), and oxytocin (pitocin). I have seen these drugs cause fetal distress more times than I can count. This is not something I believe parents are educated on early enough. I do not say this to dissuade you, but to prepare you for what could possibly happen. Again, there are risks and benefits to everything. Discuss them with your provider.

What about mechanical dilation?

Some providers will use different methods to dilate (or open) your cervix. Mechanical dilation consists of placing a balloon or catheter into your cervix and using tension or pressure to open it up. Ask your provider what type, if any, they prefer to use. Also ask what the procedure looks like, e.g., how long does it take, is it painful, etc.

Do I have to be continuously monitored?

Usually you will be monitored if you are given any of the drugs I mentioned above to induce your labor. Some drugs will require you to be monitored only for a few hours, and others will require you to be monitored continuously. Find out from your provider what your hospital’s policies are on intermittent versus continuous monitoring.

Click here for a great review of the evidence on continuous fetal monitoring.

What factors could affect the length of my induction?

While there’s no crystal ball that will tell providers exactly when your baby will be born, they can speculate. There’s no harm in asking if there are any factors that might make your induction very short or very long.

Can I eat while I’m in labor?

From my personal experience, if you are being given certain medications or have an epidural, you can only ingest clear liquids. Clear liquids are anything you can see through at room temperature, e.g. water, apple juice, cranberry juice, ginger ale, jello, broth, water ice, and popsicles. However, I do believe that some places keep birthing people NPO (nothing by mouth) during labor. This Evidence Based Birth article discusses why some hospitals do not allow birthing people to eat in labor and what current research says about this practice.

How long does your practice allow people to stay pregnant?

Every birth care provider will be comfortable with keeping you pregnant until a maximum amount time. The longest I’ve personally heard of was 42 weeks and zero days. But this is something very important to discuss with your provider, especially if you opt not to schedule an induction. According to ACOG, the risks of “postterm pregnancy” is stillbirth, macrosomia (large baby), meconium, and decreased amniotic fluid. Again, discuss these risks with your provider to come up with a plan that works for your body and your baby.

This information should not be used in place of medical advice. Everyone’s situation is different and inductions are medically necessary for some people. This information is meant to be a tool to help you ask your healthcare provider important questions so that you may make an informed choice.

CNM 189

Two days ago I received this email from Frontier letting me know that I was accepted into their CNM program. It doesn’t really feel real yet. And while I can’t wait to get started, I’m looking forward to enjoying the rest of my summer off.

I was able to log into the portal and get started on all of the “pre-bound activities” that are required of us before attending bound. I’ve been able to complete:

  • Frontier bound fee of $675.
  • Castlebranch (the company they use to track immunizations, verify your nursing license, do your background check, and verify your physical exam) fee of $61.
  • Sign up for bound.

I still have so many questions about how this program is going to go. I guess they will be answered at bound.

I’m planning on driving to bound. I hate flying so much, so I’m taking the ten hour drive from Philly by myself. I’m actually looking forward to the alone time. 🙂