“Midwife means ‘with woman’ and that’s what we strive to be: with woman throughout her pregnancy, birth, and beyond.” ~Dale Cook, Gaia Midwives
Pregnant women have several options regarding how they give birth. Some choose to involve midwives and doulas during the birthing process. We’ve answered the top frequently asked questions about using midwives and doulas and also list resources on how to find one.
What is a midwife?
A midwife views birth as a natural process that should be treated as normal until there is evidence of a problem. Midwives are experts in supporting the physiology of labor, delivery, and breastfeeding. They have specialized training in both nursing and midwifery; in New York State they are required to hold a valid Registered Nurse license. They also handle well woman care: breast exams, yearly pap smears, discuss and prescribe birth control, and support women dealing with menopause.
Obstetricians have a slightly different focus. Doctors are experts in illnesses; they need to have responsibility for women with serious complications. Historically, midwives delivered most babies, and doctors were called in if medical attention was necessary. That is still the case for women in most countries outside the U.S.
Why choose a midwife for your baby’s birth?
The overwhelming majority of American women have normal pregnancies and births, yet most hospital procedures are better suited for high-risk patients. “Women without underlying health issues are at risk for unnecessary medicalization in the birth world of today, so often they seek midwifery care because they prefer low or no intervention during their births,” says Suffolk County midwife, Dale Cook. Electronic fetal monitors don’t necessarily improve outcomes for low-risk women, so most midwives will opt for intermittent fetal monitoring instead. Instead of IV fluids, women have locks (the parking space for an IV needle) and are permitted to drink clear liquids to prevent dehydration.
Freed from beeping machines and IV poles, laboring women are able to be up and active. Movement is important. Women who labor in bed are working against gravity; laying down can actually drag the process out longer. Women are encouraged to push in any comfortable position. Overall, when compared to similarly low-risk obstetrical patients, midwifery patients have fewer incidences of birth trauma, episiotomies, and maternal injuries. Additionally, they have lower c-section rates, and high rates of successful VBAC (vaginal birth after cesarean). When it comes to managing a birth, it seems that less is more.
Can women with health concerns work with midwives?
It depends. Women with pre-existing conditions like diabetes or high blood pressure can look into groups that have a midwife and obstetricians. If a health problem arises during pregnancy, a midwife can consult with a physician to determine the best plan of action.
What happens if a patient needs medical interventions? What happens in an emergency?
If an expectant mom’s birth plan needs to be adjusted, it will be. “If things aren’t progressing, even in the midwife definition of normal, interventions are used from least invasive to more invasive and medical,” says Nassau County midwife Melanie Sumersille. This doesn’t mean that the entire plan goes out the window, continued Melanie. “If we have to use interventions like Pitocin or an epidural or antibiotics, I try to still maintain aspects of the original birth plan: not cut an episiotomy, use alternate delivery positions, nurse right after delivery if the baby is stable, etc.” C-sections are major surgery that can have long-ranging affects on the mother and baby. Melanie reinforced that they’re not a quick fix to a problem labor. “A cesarean is saved for truly protracted labor or danger to the baby.”
Where do they practice?
Long Island mothers-to-be looking to work with midwives have two options: they can plan a home birth or go to a hospital. (There are free-standing birth centers in New York City for LI mothers that are willing to travel). Some midwives are strictly home or hospital-based, while others will offer both options.
Midwives are not affiliated with all Long Island hospitals. Stony Brook hospital and Nassau University Medical Center have a large percentage of their deliveries attended by midwives; many others hospitals have none. Some midwives will practice in an independent group, while others will work with a group of obstetricians. Midwifery care is covered under most insurance plans, but interested families should speak with their provider for specific information.
What’s a Doula?
A doula provides emotional and physical (but not medical) support during birth and/or early post-partum days of motherhood. Women have traditionally relied on each other to get through a birth. When births moved from home to the hospital in the mid-twentieth century, it stopped being a group event. Doulas evolved to fill the void.
“A doula may use massage, dance/movement, meditation, aromatherapy or other drug-free forms of pain relief” to help women cope with labor, says doula-in-training Tara Delmage. “She is a tireless beacon of hope and strength and helps the laboring woman to feel empowered.”
Post-partum doulas also exist. They can be a fantastic resource, especially for new families without local relatives to help them. Post-partum doulas can assist moms with breastfeeding, meal preparation, or even running errands.
Why Choose a Doula?
Expectant women need hands-on care, but it’s hard to have that need met in a hospital. Nurses have several patients and, based on the nature of their job, cannot be the hand-holders and back massagers that women need. Doctors and midwives may have other moms-to-be that need their attention. If you have a long labor, you may see several shift changes. Doulas don’t work in shifts. No one else, except perhaps the father of the child, will be with a pregnant woman for the duration of her labor and birth.
Studies have indicated that the presence of another woman in a labor room cuts down on the need for pain meds, medical intervention, and is a calming influence on the mother and father-to-be. An expectant mother’s mother/sister/cousin/friend might also be options, but they may be too emotionally invested to think clearly. A non-related doula doesn’t have the same baggage. She’ll also help a woman advocate for her wishes during birth.
What about Dad? Isn’t this his job?
Technically, yes, but an extra support person can also be helpful – and Dad can benefit from the encouragement, too. “A doula is not there to take over or to overshadow the mother’s partner, but to guide him/her and make suggestions on how to better serve the laboring mother,” says Danielle Joseph-McKay, a doula that has participated in 100+ births. Doulas are not usurping Dad’s job; they’re helping him do it better.
Where do Doulas practice?
Doctors and midwives have admitting rights to specific hospitals, but a doula can go anywhere: home, birth center, or hospital. If you plan to deliver in a hospital, speak to your caregiver and let them know that a doula will be with you. Typical costs can range from $500 to $1,500.
World Doula Week
World Doula Week begins on March 22nd and will go through March 28th annually. This week was chosen because it is the spring equinox which represents the return of fertility in countless cultures.
The Long Island Doula Association — in celebration of World Doula Week — is hosting a screening of Doula! The Ultimate Birth Companion. This is a new 60 minute documentary-style film about the work of birth and postnatal doulas. The film intimately captures in close-up detail the practical and emotional support given to the parents by their doula at each stage of their unique birthing journey. This is a fundraising event and all net proceeds will benefit the Long Island Doula Associations. Question and answer period to follow the movie. Please visit www.lidoulas.com for more info.
Doula! The Ultimate Birth Companion
Saturday, March 24, 2012
Childbearing Family Alliance
359 Route 111, Smithtown, NY 11787
3PM – 5PM
List of Resources in Long Island: Midwives & Doulas listing
By Rachel Minkowsky