Over nine wild months of body changes and emotional highs and lows, expectant mamas don’t often feel in control of their pregnancies. But when it comes time to deliver, more and more women are taking back the reins and not only coming up with detailed birth plans, but also going so far as to handpick the players they want on their D-day team.
While most moms-to-be in the U.S. still choose doctors to handle their deliveries, the number of women electing to have midwife-attended births is rising. From 1989 to 2002, the number of midwife-attended births doubled; and as of 2009, midwives now attend around 8 percent of births nationwide. While still a small percentage, it’s on a steady upswing, and it shows a shift in the ways mothers are choosing to deliver. They’re not stopping at midwives, either. Doulas are becoming an increasingly integral player on the labor and delivery team. If you’re interested in making a midwife or doula a part of your big day, read on to learn about the kind of support they can provide.
The term “midwife” comes from the Middle English mid meaning “with” and wif meaning “woman.” So, a midwife is someone who is literally with the birthing mother. Although the etymology may sound simple, midwives are well-versed in the practice of medicine and are able to provide prenatal care to expectant mothers and deliver their babies when the time comes. They offer a holistic approach to birth, empowering the mother to trust her body to do what it needs to do.
There are three types of midwives, and where you plan to deliver (hospital, birthing center or home) will influence which kind you choose.
A certified nurse midwife (CNM) is a midwife who comes from a nursing background and a masters or doctorate degree in her speciality.
A certified midwife (CM) generally doesn’t come from a nursing background but has gone to school to practice midwifery. Both CNMs and CMs are able to deliver in a hospital setting, a birthing center and at home.
A certified professional midwife (CPM) attends a school specifically for midwifery. According to Midwife International (midwifeinternational.org), it is the only credential of midwifery “required to have knowledge about and experience in out-of-hospital settings.” CPMs attend births at birthing centers as well as home births.
A midwife is a great option for women with low risk pregnancies. Typically, this means that you’re under 35 years of age, your medical record is clean with no history of STDs, high blood pressure or diabetes, and you’re at a healthy weight. A midwife has the same authority as an OB to prescribe an epidural, but because midwives often employ natural pain management techniques, the frequency of epidural usage is often less. It is worth noting that, unlike obstetricians, midwives cannot perform surgery, such as C-sections.
Woman who serves
A doula is another person you might consider adding to your birth team. Greek for “woman who serves,” a doula’s role is not one of providing medical care but rather offering maternal support. After becoming a certified doula (CD) through Doulas of North America (DONA), doulas act as your advocate during labor and delivery. But the relationship begins long before the big day. A few months before baby’s expected arrival, you can begin meeting with your doula and building a foundation of trust and support. You might discuss your fears, your concerns and your vision for how the birth will play out.
When the time comes, your doula will join you at the hospital, birth center or home and provide support throughout the process, communicating your birth plan to support staff, suggesting pain management techniques and even helping reroute unwanted visitors. Should there be a shift change during your labor or should you need to switch from a midwife to an OB for medical purposes, your doula will remain a constant and stay with you no matter the circumstance.
It’s important to note that a doula is supplementary to a labor team; she’s not a replacement for a medical professional or a partner. Angela Stocksdale, CD, CAN, of Gentle Hands Mother-Baby Care in Lutz, Florida, says, “We have a saying that a doula takes care of everything from the waist up. The doula is not the primary caregiver but is the support person trained to bring comfort, education and information to the birthing mom.” While the midwife or doctor tends to medical needs, a doula can use touch and massage to soften the pain, as the partner provides emotional support. Working together as a unified team, the trio can make the experience as seamless as possible.
Doulas are an integral part of prenatal and birthing care, but their work doesn’t stop there. In fact, doulas also offer postpartum support to moms and families. When mom needs tips on baby care or breastfeeding or when new motherhood seems impossible to handle, doulas can ease worries, lend a nonjudgmental ear and offer a helping hand.
The choice is yours
Determining the kind of care and support you desire for your pregnancy, delivery and beyond is a deeply personal decision. If you’re torn between midwife and OB, consider interviewing practitioners in both fields to see which feels like a better fit. Ask questions about where the practioner has delivery privileges, whether you’ll see her personally at each appointment or rotate through other members of the practice, and how often her patients require C-sections. (For a list of additional topics worth inquiring about, go to pnmag.com/questionstoask.)
If you’re halfway through your pregnancy and find yourself unhappy with your care, don’t hesitate to switch to a different practice. It’s imperative that you feel heard, informed and engaged in your birth experience, and it’s worth the effort to seek out a healthcare provider who ensures you do.
By Tanya Fujiki