May 5 is International Day of the Midwife.
As a doula and a mother who has given birth to three children under the care of midwives, I’d like to celebrate midwives and the work they do. I’d like to talk a bit about what midwives are, what kind of care they provide, and where doulas fit into the picture for those who chose to give birth with midwives.
Plenty of time at visits to have each question answered and all concerns discussed
A focus on informed choice
Six weeks of postpartum care, with the earliest postpartum visits in your own home
Continuity of care
Choice of birth place: home, hospital or birth centre (in places where they exist)
The option to have a water birth
These are just some of the benefits that come with choosing a midwife for your care during pregnancy, birth and postpartum.
Midwives are experts in normal childbirth. They believe that birth is a natural, physiological event that unfolds best when left to progress with minimal intervention. Their profession became recognized and regulated in Ontario in 1993, making this the first province in Canada to take this step, funding midwifery as part of the health care system. The profession has grown steadily since then as more and more people, predominantly women, complete their midwifery education. Here in Ontario, those who wish to become midwives must complete four years of university, graduating with a bachelor of health sciences degree in midwifery. While their training is in normal childbirth, they are fully equipped to recognize and deal with many different minor complications, whether they occur in the hospital or at home. When complications arise that are beyond their scope of practice, they are skilled in recognizing the warning signs and will facilitate a transfer of care to an obstetrician who is trained to deal with births that no longer fall under the category of “normal”. Here in Ontario, where midwives are well integrated in the maternity care system, this process can happen smoothly and the midwife will remain with her client in a supportive role even after care has been transferred.
Many who have chosen midwives as their care providers have found them to be warm, sensitive and caring. They have experienced being treated as equals in their own care, feeling listened to, respected and valued as being the best person to make decisions regarding their own care.
Obstetricians play an extremely important role in the maternity care system, one that is essential to the health and well-being of many parents and babies. They are experts in complicated or high-risk birth and are the best equipped to manage birth when things go wrong. But midwives are the experts in normal, low-risk birth and provide excellent care for those whose pregnancies and births are free of complicating factors and unfolding smoothly.
Doulas & Midwives
So all this being said, if midwives are such wonderful, supportive care providers, where does a doula fit in? Is it really necessary to have a doula if you have chosen the care of a midwife? Won’t your midwife’s support, along with that of your partner, friend or family member, be all you really need? Your midwife will be there from the time of active labour, until after baby arrives, and will understand your needs and desires She’ll be able to provide all the support you would need, won’t she?
Although many confuse the two, the role of a doula and the role of a midwife are actually quite different. A doula does not provide any clinical care. She won’t take your blood pressure or check fetal heart tones. She won’t do vaginal exams, place an IV or assess whether your blood loss is within a normal amount. A midwife will do all of these things. A midwife is in charge of making sure you and your baby are healthy throughout pregnancy, birth the early postpartum weeks, and that things are progressing as they should be. She will be charting every detail of your birth as it happens and monitoring you and your baby along the way. A doula, on the other hand, is responsible solely for your emotional and psychological wellbeing and comfort (and that of your partner, if applicable). She is trained in providing emotional, physical and informational support. If complications arise, it is not her responsibility to deal with them and she is able to continue providing a source of calm, comforting support while the midwife provides the necessary attention to address whatever is happening from a clinical standpoint. The presence of a doula in the birth space frees up the midwife to focus on the health and clinical care of you and your baby. This is not to say that midwives can’t or don’t provide physical and emotional support and comfort measures. Of course they do! But it is only one of their many responsibilities and not something they can devote 100% of their focus to.
Another way in which the care of a midwife and the care of a doula differs is when they will join you in your birth process. A midwife may come and assess you at any point, but she won’t stay with you until you’ve reached “active labour” which is typically defined as the point at which your cervix is 4cm dilated. For many birth-givers, especially those giving birth for the first time, the process of reaching 4 cm dilation can be long and challenging. Extra support and reassurance during this first phase of labour may be extremely helpful. This is where a doula comes in. Your doula will be ready whenever you first contact her and will remain in contact throughout the beginning of labour. If you are in need of her support, she will come join you whether you are 1, 2, 4 or 6 cm dilated, providing whatever comfort measures and emotional support she can to get you through the early stages of your birth process. Once you’ve reached “active” labour, your midwife will join you as well and she will be rested and ready to provide sound clinical judgment as your active labour unfolds.
The role of a doula and the role of a midwife complement each other. In my own births, I found that having the care and support of both a midwife and a doula allowed me to have the best support I could have had. There were a set of hands, a shoulder to lean on, an encouraging voice, always at the ready and I felt confident that I was enclosed in a circle of care, love and support that would surround me the whole time until my baby was in my arms.
Having been fortunate enough to experience this type of multi-faceted care myself, and having since moved into the work of being one piece of the support puzzle for birthing people, today I celebrate midwives. The work they do is invaluable. The care the provide is so important to their clients and will be remembered with fondness and gratitude by so many families. As I witness them at work from my vantage point as a doula, I am often in awe of their skillful care, their calm demeanour and their ability to multi-task and keep many balls in the air. It is a privilege to work alongside them at births as part of the circle of care and support that help to make birth a positive experience for growing families.
If you live in Kingston, Ontario, you can learn about the midwifery services offered here at: https://www.kingstonmidwives.ca/
If you live elsewhere in Ontario, see here to find a midwife near you: https://www.ontariomidwives.ca/