Choosing Caregivers

Choosing the right caregiver when you become pregnant can be overwhelming as well as difficult. In the past, financial considerations had often been the deciding factor in choosing caregivers to support you during birth. A doula may cost around $1,000. Hiring midwives used to cost around $3,500. However, midwifery services are now covered within our provincial health care insurance plan. This makes cost less a consideration than it used to be.

Choosing the right birth support really begins with some self-exploration. It is important to know what kind of birth experience you are looking for. It can also depend on your pregnancy. If your pregnancy is considered high risk and requires specialized monitoring, an obstetrician might be the most appropriate choice of care giver. Low risk pregnancies are easily managed by midwives. Doulas do not provide prenatal care. They are primarily hired for labour support. It is important to do your homework and understand the differences in the services available to you.

For many families, the correct answer to this question now is not to hire either a midwife or a doula, but to hire both. They actually play quite different roles, and their services can complement each other very well during labour and birth. Midwives are primary caregivers to pregnant families. They offer complete prenatal, birth and postnatal care, as a family medical doctor would.

Doulas offer labour support. They act as labour assistants to support a birthing woman through labour and delivery. However, they do not provide medical care or deliver babies. Their role is to help decrease the stress of the labouring woman and her partner and provide her with continuous support. Doulas help develop birth plans and help couples understand what is happening. They use comfort techniques, offer emotional support, labour coaching, massage, and breathing and meditation exercises. They work with the midwives or obstetrician and support the family in their choices. Their role is to support the family through the labour process. Some doulas also specialize in post natal care.

Midwives are highly trained professionals in Alberta. They have hospital admitting privileges, which allow them to assist their clients wherever they want to give birth. Midwives will review your medical history and help you with all your prenatal checkups. Their appointments are often longer than with traditional health care providers, because they work to support the needs of their clients on all levels – physical, emotional, mental and spiritual. Any standard medical tests offered by an obstetrician or family doctor during pregnancy will also be offered by midwives. However, midwives will generally provide more complete information about why the tests may or may not be necessary for you to support you in making informed decisions about them. They will be at your side throughout your labour and birth versus the possibility of having an unfamiliar “on-call” doctor attend the birth. They will be available by pager 24 hours a day.

Pregnancy and childbirth are intensely emotional times. Deciding who to invite to this event requires careful consideration. You must feel comfortable, confident, and content in the skills and abilities of your caregivers and support people. Some things to consider are:

  • Do you want a home birth, a birth centre birth or a hospital birth?
  • Do you want to use pain medication such as an epidural during labour or avoid it?
  • Do you prefer to birth in private or with an audience?
  • Do you prefer to have someone familiar by your side always during labour and birth?
  • Are you interested in having a water birth?

Doing your homework and knowing what you want from your birth experience will help you to choose the right support.

BIO: Jane Baker is a Calgary midwife and is the current President of the Alberta Association of Midwives.

The information provided in this article is for informational purposes only. It is not a substitute for professional advice from your primary healthcare provider. Always consult your healthcare professional.

 

What is a Doula?

Doula is a Greek word meaning “woman’s servant”. She was likely the woman who helped the lady of the house through her childbearing year.

Today ‘birth doula’ refers to a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother and her partner(s) before, during and just after childbirth.

A ‘postpartum doula’ can help after the baby is born. She is experienced in mother and newborn care, breastfeeding support, and can assist with errands, childcare and light housekeeping.

Current research has shown us that using a professional birth doula during labour provides the following benefits:

  • shorter labours
  • fewer complications
  • reduction in cesarean rates
  • reduction in oxytocin use
  • reduction in forceps use
  • reduction in epidural requests
  • reduction in analgesia use

For the mothers:

  • greater satisfaction with their birth experience
  • more positive assessments of their babies
  • less postpartum depression

For the babies:

  • Shorter hospital stays with fewer admissions to special care nurseries
  • Babies breastfeed more easily
  • Mothers are more affectionate
  • Information was obtained from the DONA website.

What does a birth doula do?

Doulas do not provide you with any clinical care, so they do not replace your doctor or midwife. Generally your relationship with your doula will begin during pregnancy. As you discuss the priorities you have for your upcoming birth, your doula will help you find ways of obtaining your goals. This may be in the form of finding the appropriate childbirth class, accessing accurate information, learning and practising techniques for labour, and assisting with writing a birth plan, if desired.

The doula joins the mother and other support people when they feel the need for extra support. She goes with them to their place of birth and stays until after the baby is born.

Doulas are proficient in massage, positioning, comfort measures, relaxation and breathing techniques. They will help you and your partner decide which position will help labour along or make labour more comfortable. Along the way she will make suggestions and reminders about simple things that are often forgotten, like going to the bathroom, or drinking fluids. A doula will usually take notes and photographs, if you would like to have some taken.

Your doula will help you remember what plans you had for labour and help you get the things that you wanted. She can also assist you when changes need to be made or complications arise.

After your baby is born she can help you with early breastfeeding and postpartum issues. Over the next few important days the doula will keep in touch by phone, and make an appointment to visit again in order to review the labour and birth with you.

Do partners feel left out?

No! Doulas do not replace the father in any way. Doulas usually take a very quiet support role, often letting the couple work together while she does other things like massage, fetching ice chips, preparing the shower, or occasionally making suggestions.

It is often forgotten that dads are experiencing this labour too and have an emotional investment. Some have a hard time remembering what was taught in class, some may not have attended classes. A doula can help the father experience this special time with confidence.

With her partner and a doula at birth a mother can have the best of both worlds: her partner’s loving care and attention and the doula’s expertise and guidance in childbirth.

Who needs a doula?

Anyone having a baby can benefit from a birth doula. Some people believe that doulas are only for women who want an unmedicated birth. This is not true. Doulas have very important roles to play in medicated and surgical births too.

Women who are planning a natural birth often do hire doulas to help increase their support team, as do women desiring a vaginal birth after a previous cesarean. High risk mothers often feel the need to have someone take care of their family emotionally, while they are receiving the best in high technological care from their clinical staff. Single mothers may choose a doula if they lack support from their family or friends.

What does a post-partum Doula do?

  • Dedicates herself to mothering the mother. · Helps her meet the physical, emotional and social needs following birth.
  • Provides education, non-judgmental support, and companionship, to assist with newborn care (i.e. breastfeeding support), family adjustment, meal preparation and light household tasks.
  • Offers evidence-based information on infant feeding, emotional and physical recovery from childbirth, infant soothing and coping skills for new parents and can make appropriate referrals when necessary.
  • Validates and enhances the parents’ intuitive ability to nurture and encourages them to develop and implement their own parenting style.
  • Enhances communication both within the family and with other support professionals.
  • Promotes parent-infant bonding.
  • Stays with each family vary as there is no precise time frame for postpartum support.

How can I find a doula?

There are many ways to find both birth and postpartum doulas, and you could begin on the Internet. Call [local doula association] referral lines, pick up a copy of Birthing Magazine, and ask your friends and acquaintances. You’d be surprised how many people have now heard of doulas and even used a doula. Interview a few doulas to find someone you are comfortable with and who you feel will work well with you and your partner. You may not feel comfortable with the first doula you meet — don’t worry, nobody will take it personally!

(Adapted from the website www.calgarydoulas.ca)

What is a Midwife?

A midwife is a specialist in normal pregnancy and birth. Viewing birth as a safe and normal passage in a woman’s life, midwives foster confidence in women; consequently women are less likely to experience interventions during pregnancy and birth. A midwife provides “continuity of caregiver,” which means she provides all the care from early pregnancy, through the birth and into the postpartum period. Primary midwives work with a back-up midwife who arrives later the in labour process.

Alberta’s midwives are professionals who provide primary care to expectant mothers in northern Alberta. They are registered by the Alberta government and meet the government’s training and experience requirements. They are members of the Alberta Association of Midwives (AAM).

Midwives are trained to focus on the normalcy of pregnancy and birth, to view these processes as safe and natural, having many normal variations. They disagree with the idea of a textbook labour, respecting instead that each woman needs to labour and give birth as her body indicates. Each woman and birth are considered unique, calling for an individual, non-routine response.

Midwives not only attend to the physical processes of pregnancy and birth, but also offer women important emotional, spiritual and psychological support throughout the transition of becoming a parent. Many consumers of midwifery care cite this as a major difference between midwifery and medical care.

Some of the care and services a midwife provides include: prenatal visits, prenatal classes, home visits, labour support for the duration of the labour and birth, as well as continuous postpartum care for as long as necessary. A midwife fulfills the role of many other professionals a pregnant woman would otherwise see — doctor, prenatal instructor, case room nurse, public health nurse, and lactation consultant. Consequently, midwives and their clients establish close relationships. This is comforting to a pregnant woman and it is also beneficial to the midwife, who, having become very familiar with her client, is quickly alert to changes in the woman’s state. If a midwife does detect an abnormal or questionable condition in the mother or child, she can supply some assistance, or procure medical support, or in the absence of medical help, execute emergency measures.

In Alberta midwives may practice as primary caregivers in the home setting, at a birth centre, or in hospitals where regional health authorities have granted midwives hospital admitting privileges. Otherwise, midwives may act as birth support in a hospital, providing continuous care to the woman and family through the labour and delivery.

In the last few decades, over two thousand babies have been born in northern Alberta with the help of a midwife. Most of these have been born at home. It is a myth that hospital births are safer than homebirths. Studies show conclusively that homebirth is as safe as or safer than hospital birth (see “The Issue of Safety”).

Midwives come to a birth with a kit which includes supplies such as oxygen, resuscitation equipment, blood pressure cuff, suturing equipment, stethoscope, drugs to treat shock and hemorrhage, suction equipment, and fetoscope. Midwives are trained to perform resuscitation on a newborn, to administer oxygen, to start an IV, and to repair tears. They also bring a scale to weigh the newborn, forms for Alberta Vital Statistics and Alberta Health Care, and vitamin K and eye drops for those families who choose to have these administered to their newborn. A planned midwife-attended homebirth is a safe alternative to a hospital birth.

If you choose to birth in your own home, you must have a midwife as your caregiver. Physicians are not allowed to attend homebirths in Alberta.

Once you have established who you will have as your caregiver, take your support people (husband, family, friends) to meet the caregiver. Everyone will be more comfortable at the birth if they have met beforehand. If at any time you become uncomfortable with your caregiver, feel free to change. It is never too late. You may feel that changing would be disloyal, but you must not compromise your health or the health of your baby. Even if health and safety are not at risk, you have the right to a satisfying birth experience. If you thought the mechanic working on your car was compromising your personal safety or simply not listening to your concerns, you wouldn’t hesitate to find a different mechanic!

If you would like to meet with a midwife, contact the ASAC or Birth Unlimited office for a list of practising midwives or check the yellow pages under “Midwifery” or simply look on the inside cover of this magazine.

This article was taken from ASAC’s Birth Issues Winter 2000. Please visit www.asac.ab.ca.

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