• The Fit Midwife

Midwives vs Doulas: Different Members of the Same Team??

(Picture from Patti Ramos)

Do Midwives and Doulas even get on? I guess there is a misconception here and when you ask most people, their answer is no, not so much. It is not uncommon to hear a Midwife groan and see her eyes roll so hard they almost roll out of her head when they are told a Doula is in the room.

I cannot lie, coming from the UK my impression of Doulas was not a good one. At all. I had spent so much time arguing with them. It was often a battle of wills. I would leave the room and they would be popping "herbal remedy" tablets in to mum's mouth. Or doing sneaky VE's (Vaginal Examinations) and telling the lady to push even against midwifery advice. Contradicting my advice openly in front of women and families, casting doubt out there. Advising women to breastfeed to stop bleeding and refuse a cannula and drugs whilst having a rather large PPH (postpartum haemorrhage). This wasn't every Doula, but certainly a well known few.... and I am sure any colleagues reading this will able to identify them too.

I used to dread looking after women who had certain Doulas. Knowing my night was going to become an absolute battle. Maybe it also had something to do with the fact I would feel like a third wheel in these situations. I would feel like my advice was being critiqued and not listened to. I really have no problem telling people why I think what I think. But then again I have always been confident and a little bit ballsy! And in my very broad northern accent and loud voice (often partnered with resting bitch face - which ironically is just my thinking face) this could sometimes result in confrontation. And I know I am not alone in this.

Also, I think we as midwives are sometimes jealous of Doulas. We go to university and are given rose tinted glasses when we arrive. It's all "with woman". It's lovely and yes, challenging, but oh so worth while. Then we get thrown in to the real world. If by third year you don't know what you are in for when you commence full time employment then I am not sure whether to pity you or envy you.

We start work in the real world we realise that the biggest part of our job is filling in countless pieces of paper work. Our time is filled ticking boxes, writing every swear word, every scream from mum, every chat with a Doctor and every fart from the sleeping husband. It can be so time consuming and arduous that it takes us away from our real job. Being with woman. The word Midwife literally means ‘With-Woman’. The job is realistically more like “With- Paperwork”.

Now physically yes, we are present. But we are often not fully mentally present. That may be because we are working under such scrutiny that we have become obsessed with our paperwork. Or perhaps because we are oversubscribed and we are responsible for more than one patient and our mind can never be fully in one room, with one family.

But your Doula, she is there for emotional support. And really, that is what we often feel we should be doing as midwives. So yeah, we can feel jealous.... put out somewhat. But the reality is that we do not have time to be in the room every single minute of your labour. And that sucks. Because that is what you need at such an important time in your pregnancy journey. And I for one can rest easy when I know women have good doula support. Even if I am a little sad that I cannot provide the whole package.

Whilst us midwives are trained to provide medical care, we also cannot get away from providing emotional care and support too. They are intrinsically linked in this profession. The second you can separate them is the second that you know you are no longer in the right career. And sometimes it is hard to see others getting the chance to have continuity with women because in the UAE midwives and women are robbed of the chance of building that relationship due to the nature of the medical care in the private sector and the underutilisation of midwifery services. Although I will add that a good midwife can form a bond with women in the shortest of time frames and often in the hardest of circumstances.

So yeah, in the UK, whatever side Doula’s were on…. I was on the opposing side. But then I came here, to Dubai. And my perspective changed. My first hospital welcomed Doulas. Much to my surprise. And man I was hesitant to work with any. My UK experience being what it was.

I have not had a single bad experience with a Doula in this country. In fact I have had great experiences. I had the most incredible vaginal breech delivery. Beautiful water births. Even the most supported and positive assisted deliveries and caesarean sections.

I have worked with some fabulous women. Who really do love what they do. Whilst there are a lot of Doula's out there merely to profit, there are just as many who do it because they have a passion. With a very over saturated market here in Dubai I suggest you make sure you find the right support for you. Do your research!

One very good friend, doula and all round beautiful soul is Lala Langtry White a.k.a The Different Doula. And different she is. I absolutely love working with her, knowing that if she is the Doula in attendance then we will work well together, for the family in our care and it will be a positive experience regardless of method of delivery! I asked her to write a few words as a Doula, so you can have both points of view:

'It's a common misconception that the role of doula and midwife are the same or even that the two conflict. This isn't, or certainly shouldn't be, the case at all. While both midwives and doulas share the same passion; to support woman in achieving their unique desires for their birth and baby, a midwife is medically trained to assist her while ensuring the health and wellbeing of both mother and baby.

A doula on the other hand, is not there to assist the birthing mother or baby medically in any way. Her role is to support the family emotionally in preparing for the birth that is right for them, not through opinion or bias but through signposting to evidence based research, treating each birth individually and supporting the mother in whatever choice is right for her as well as helping her feel confident and reassured should any deviations arise.

A doula has the ability to form a bond with the parents during their pregnancy, understanding their wishes and preferences for their birth and baby, keeping in regular contact. Historically this was a luxury that some midwives enjoyed too but in the current birth climate is rarely the case.

Similarly, where a midwife may have multiple labouring women in her care at any one time, a doula is there to provide continuous, undivided, positive, emotional and physical support and encouragement to an individual mother/family. She will remain by a mother's side whether her labour is 2 hours or 22 hours thereby removing the fear that she may bond with a fantastically supportive midwife only to have a shift change that may interrupt her rhythm in labour.

The same can be said of the early postpartum period or '4th trimester'. A doula will typically accompany the new parents to their postnatal room, ensuring the parents are supported and their needs are met so they can concentrate on and enjoy the sacred post birth bonding time and first feeds with their baby. By the time a doula leaves the family, to the best of her ability, the picture will be one of contentment, privacy and serenity. A doula will continue to follow up with and be in regular contact with the parents offering support on an as needs basis, gently encouraging parents to grow in confidence to trust their instincts and abilities as parents.

Birth is the single most transformational event a woman can go through in life. The people who care for and support a mother (and father) through their birth will likely stay part of their story for life. As parameters and care pathways change, it may be unlikely you would see your midwife after your birth in spite of their passion to continue to support you. Having a doula beside you provides you with a continuous and often life long link to this pivotal and life changing event."

Isn't it nice when you are around people who have the same ideas and passions as you? This is what the Midwife/Doula relationship should ideally be all about. If indeed the focus of our care is the women we support, as we say it is, then what we should be doing is using each others strengths to provide the best care and support for birth. Making sure the care and the experience is as amazing, as fearless and as positive as possible. After all we are all just different members of the same team. We all want the best for women everywhere.

Nikki xx

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