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Friday, March 13, 2015

Midwife? Doula? What's the Difference & Why You'll Love Them

Baby #2 is weeks away from making it's debut and as the big day approaches I've been reflecting on my two pregnancies and the importance of having a support system before, during, and after giving birth. I have to give Will his credit, he was amazing during labour with Ari and was with me for the entire 23 hours (keeping my fingers crossed #2 doesn't take nearly as long!!!). But for some ladies having support beyond family and/ or a close friend is important.

I've had a midwife for both pregnancies and have been very happy with their methods and attention to both myself and the bumps. One of my closest friends enlisted the help of a midwife and doula for her pregnancy and delivery since she suspected her hubby would be a little squeamish in the delivery room and credits her doula for being everything she hoped for (for the record, I know her hubby was grateful for the doula as well ;) ). While I was familiar with both while chatting with my friend, I thought this would be a good opportunity to share some more information on the topic with TPB readers. Even if you're like me and this isn't your first rodeo, knowing what your options are- especially with 1 or more kids already at home awaiting your return from the hospital- can help your experience go smoother and reduce stress when the time comes. 

To help me with this post, I asked Sarah Thibault of TBO's Doula Services to collaborate. See below for her in- depth look at the role of doulas and the difference between them and midwives.

What is the difference between a midwife and a doula?
This is a question I get asked often. It is sometimes perceived that you will either choose a midwife or a doula, or that there is no value in hiring a doula if you already have a midwife. The fact is that midwives and doulas have completely separate roles when it comes to caring for you and supporting you in your birth.

More on midwives
You can choose between having a midwife or a doctor/OB under MSP. Midwives in Canada are licensed medical professionals. They have the ability to attend both hospital births and home births. If you choose to have a midwife you will be under their care only.  This means that your midwife will be responsible for the health of you and your child prenatally and during your labour and delivery.  Often, expecting parents choose to have a midwife if they crave a more intimate care, as she will work with them closely to make sure their vision of their birth turns into a reality.

Here’s a glimpse of the role of a Midwife:
-Performs gynecological exams (prenatally, during labour, and postpartum)
-Suggests and prescribes health related medications or supplements
-Runs prenatal tests
-Teaches you about health during pregnancy, birth, and postpartum
-Monitors you and your baby during labour and birth
-Consults with an OB if a medical complication arises that is outside their scope of practice
-Helps make your birth a peaceful and calm experience
-Delivers your child
-Provides family planning, infant care, and women’s health care

There are two types of doulas; a birth doula and a postpartum doula.

A doula is a non-medical professional who provides emotional support and physical assistance.
A birth doula will usually meet with you during your pregnancy, around your 30 week mark.
Her main role is to be there for you, your partner and your baby. She will help you envision what your birth will look like and help you understand the birthing process. She can also teach you techniques for relaxation and how to get in the right headspace for a healthy pregnancy.  During labor, your doula can use a variety of techniques to help with pain management.Examples include acupressure, hypnobirthing, rebozo, massage, and different labor positions.

During your postpartum stage, your postpartum doula can help you to take care of your baby by helping out in areas such as breastfeeding, mother-baby bonding, basic newborn care, emotional support, and sleeping. She can also help you in your physical recovery after childbirth. Your postpartum doula is there to help you and your family in the first few weeks after bringing home your baby.

Here’s a glimpse of the role of a Doula:
-Establishes a prenatal relationship with you
-Helps you create a birth plan
-Guides you to useful resources in your community for your prenatal and postpartum stage
-Helps you to learn and acquire a deep understanding of the birthing process so you can be more prepared and confident
-Uses tools and techniques which help aid in pain management and relaxation
-Encourages and teaches the partners ways to be involved in the birthing process (as much or as little as desired)
-Acts as an advocate for the mother
-Helps to guide you in birthing positions and your labouring
-Ensures that you feel safe and confident when communicating what you need
-Acts as a liaison with medical staff
-Provides postpartum at home care for you and your baby   

Is a doula covered by MSP and/ or extended medical?
Doulas are not covered under MSP. However, most doulas believe that every expecting mother should have the right to have one. The difference a doula makes to the entire birthing process is so substantial that having doulas covered under MSP is in the works. It won’t be happening anytime soon, but hopefully will be approved within the next decade.

Doulas are also not usually covered under extended medical. Sun Life insurance, however, has recently approved the use of doulas as a reimbursable service to clients. You must be covered through a Health Spending Account with Sun Life and your doula must be DONA certified. Although the number of insurance companies that cover doulas under extended medical is slim to none, it’s a good start. We are very hopeful and are excited to see what positive changes are made in the near future!

What is the cost of hiring a doula?
The cost of hiring a doula varies, and the cost can even vary a great amount just from city to city. Although many doulas believe in providing a birth free of charge every once in a while (once or twice per year), it is not the norm. You can find doulas that are willing to work for as low as $200, and these doulas are often associated with a company that provides doula services for lower income families. On the other side of the scale, you can find doulas that will charge around $3,000 for their services. Depending on what you’re looking for and who you are wanting to hire, the price can fluctuate.
In 2015 in the Lower Mainland, the average cost of hiring a doula ranges within $650-$1,000. Considering all of the services a doula provides for her clients and that this is usually her livelihood, this is a realistic and fair rate to pay.

Why do people hire a doula?
Having a doula by your side every step of the way during your birthing process brings feelings of security, calmness, confidence, excitement, and peace of mind. The stories I have personally heard from women who have had a doula attend their births have been very positive. I haven’t met a person yet who has had a negative experience with a doula!

There’s no arguing the difference they make to your entire experience, starting prenatally and ending postpartum. Here’s why people will hire a doula. 

A doula’s attendance at a hospital birth reduces:
·       Episiotomies
·       Cesareans by 50 percent
·       Labor time by 25 percent
·       Epidural requests by 60 percent
·       Use of synthetic oxytocin (Pitocin) by 40 percent
·       Use of analgesia by 30 percent
·       Use of forceps by 40 percent

Benefits of a doula’s support to the mother:
·       Increases positive feelings about labor
·       Decreases interventions
·       Decreases need for medication
·       Increases acceptance of the baby
·       Enhances maternal/infant bonding
·       Decreases neonatal complications
·       Decreases anxiety and tension
·       Shortens labor
·       Increases feelings of self-esteem
·       Increases feelings of control
·       Increases mother’s cooperation and participation
·       Decreases postpartum depression

What's your favourite part about being a doula?
Watching my clients and their partners realize the potential they have in their birthing process: Helping them learn what birth can actually be like and watching them discover the power and freedom they now have with this information is the most incredible feeling. I get to empower them! I get to encourage them and positively influence one of the biggest days of their lives!

To be able to be part of the miracle that birth is and to witness the difference I made is exhilarating. Knowing that I aided in turning a baby to the right position so the mama didn’t have to have a c-section, knowing that I helped in the process of encouraging baby to drop down further in order for the mamas cervix to dilate more, using counter pressure, massage, and rebozo techniques to help in managing pain and keep mama focused are all incredibly rewarding things to see. The greatest feelings for me is when each of my clients tell me, “I couldn’t have done it without you, Sarah”.

How did you decide to become a doula?
A few years ago I found myself glued to Google. I was researching anything and everything regarding pregnancy, labour, birth, and postpartum care. I was researching for my own personal desires and finding it exciting, dreaming about how one day I might become a momma too. I was infatuated with everything birth related! I did so much research that I found my friends starting to ask me questions, or coming to me to find out the latest information on this and that. After a full year of realizing that this was not just something I “liked” but that I was deeply passionate about, I decided to go for it and book my DONA* doula training program. 

Within the week of deciding this, one of my best friends asked me to be her doula, and attend the birth of their first baby. I couldn’t believe this and asked her if I had ever shared with her my desire of becoming professionally trained. She was pleasantly surprised and explained that I had never told her my dream of becoming a DONA Doula, but that she was confident of my ability to be everything her and her husband needed for the birth of their baby. Both her and I were excited in the uncovering of this gift I have. It was at that moment that I was confident in my decision to pursue being a doula, and it was at this birth that confirmed I was born to do this!

*Learn what this means here

Do you find anything in common with the births you attend?
I have never really witnessed a totally, stereotypical, Hollywood kind of birth. You know the kind where there’s uncontrollable screaming, yelling, freaking out…oh and blood and guts! I’m not saying I have never witnessed any of these things before, but I definitely don’t experience birth as the terrifying and out of control experience that our society seems to believe it to be. Birth can be an incredibly beautiful process.

You know those moments when you just want to burst out laughing, but really you have to keep it together? That’s me in about 95% of the births I attend. There’s a moment, usually occurring at the beginning of active labour, when my client grabs at my shirt or shoulder and just stares at me, looking directly in my eyes and says “I’m sorry if I yell at you, or get mad at you, or even hit you. I’m just sorry!” I giggle. The look of uncertainty on their face and not knowing how they are going to handle themselves obviously brings them to apologize in advance for anything they might do or say to me at some point during their labour and delivery. That is when I just smile at them and give a little laugh, assuring them that I will never be offended or upset with them. I confidently encourage them that they have full control during their labour and that I will be there with them every step of the way. 

When I share with my client- that almost every single one of the women I work with says this to me around the same time, apologizing in advance- they can hardly believe it! Reassuring them that they aren’t the only one who has ever gone through what they are experiencing is big… it can change their whole outlook and mind frame of whether or not they’re going to make it through this massive goal they’re trying to achieve. In these funny moments I know it can be good to just laugh out loud, easing the tension they are feeling. In these moments it is when I realize that all labouring mothers can relate to each other in some way or another.

I hope this post has helped you understand more about the options you have when it comes to giving birth and how hands- on & dedicated these ladies are to what they do. I encourage you to explore these options for yourself. Whether you opt for a midwife, a doula, or both as part of your support during pregnancy, labour, and postpartum care, know that you and your baby will be in good hands.

A HUGE thank you to Sarah for contributing such an in- depth post!

If you would like to learn more about hiring a doula or would like to get in touch with Sarah, you can visit her website & email her at sarahtbo@hotmail.com. You can also find her on Facebook, Twitter, & Instagram.

Image Sources:
Friends screenshots: Buzzfeed
Women's humor image: Women Employed
Sarah headshots by Bethany J. Menzel 

March posts sponsored by Little Dreamers Consulting