Midwives and Doulas 

What is the Midwives Model of Care?

This is the Midwives Model of Care™ as defined by the National Midwifery Task Force taken directly from the website of the Midwives Alliance of North America:

Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:

  • Monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle

  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support

  • Minimizing technological interventions

  • Identifying and referring women who require obstetrical attention

The application of this model has been proven to reduce the incidence of birth injury, trauma, and cesarean section. (Midwives Model of Care definition is Copyrighted © by the Midwifery Task Force, all rights reserved)

 

Where is the Midwives Model of Care practiced?

The midwifery model of care, whether practiced in clinics, private homes, hospitals or birth centers, has at its core the characteristics of being with women, listening to women, and sharing knowledge and decision-making with women. The goal of the midwifery model of care is to support women and their families in the process of birthing their babies safely, unhindered and with confidence. Every woman deserves access to the high quality, safe, personalized, attentive, affordable, and respectful care of a midwife.

 

How does midwifery care differ from obstetrics and where are they similar?

Midwives

  • Are experts in normal uncomplicated pregnancy and natural unmedicated birth.

  • See pregnancy and birth as normal life events, not as medical procedures.

  • Generally prefer holistic, natural remedies over medical technology and drugs.

  • Provide primary care to essentially healthy women during the childbearing cycle.

  • Work to prevent any unnecessary medical interventions and accomplish normal physiologic birth, while providing a warm, family centered experience.

  • Recognize and differentiate between variations of normal and true complications.

  • Are trained to manage complications that require immediate attention, using medical technology and drugs when appropriate.

  • Collaborate with other healthcare providers when needed.

  • Transfer primary care to physician specialists when appropriate.

  • Provide care for newborn babies during the first 6 weeks of life, usually collaborating with the baby’s pediatrician.

Obstetricians

  • Are experts in disease and complications of pregnancy, birth and postpartum

  • Specialize in the use of necessary intervention during pregnancy, birth and postpartum, using medical technology, drugs and surgery

  • Often see pregnancy, birth and postpartum through the lens of a medical procedure

  • Provide primary care to women during the childbearing cycle

  • Collaborate with other physician specialists such as pediatricians, as well as perinatologists and neonatologists when a higher level of care in required

  • Are the appropriate care providers for women with complications during pregnancy, birth and postpartum

 

What’s the difference between a doula and a midwife?

Often the roles of these two childbirth professionals get confused and interchanged. While a doula and a midwife actually provide very different services to women, there are also many areas where they overlap, hence the confusion and interchange.

So, how does the role of a doula compare with the role of a midwife?

A doula is a professional trained in childbirth who provides emotional and physical comfort to a woman in labor. The doula is there to support, educate, advocate for, and help her have an empowering birth experience.

Doulas do not provide any type of medical care, although they are knowledgeable about many aspects of pregnancy, labor, delivery and breastfeeding.

The doula helps the woman understand what’s happening and offers her resources so she can find answers for herself. The doula supports the mother in advocating for herself with her care providers, and she is there to encourage the mother to plan the birth experience she wants for herself.

Midwives are licensed healthcare providers, specializing in the care of healthy women during the childbearing cycle, as well as the care of healthy newborns for the first 6 weeks of life.  

A midwife provides prenatal care, care during labor and delivery, and care for both mother and baby postpartum. Midwives use informed consent/ refusal to help mothers choose the course of care that’s right for them.  With all standard obstetric tests and procedures, the midwife offers information about why or why not it might be valuable for this woman or her baby, and then the midwife supports the mother to make her own choices and honors them.

Midwives monitor the health of mothers and babies throughout the course of pregnancy, birth and the postpartum adjustment. Midwives order blood tests, cultures and ultrasounds when needed. Midwives make recommendations for optimal nutrition, exercise, rest and stress reduction to help insure that both mother and baby thrive.

Midwives often prefer natural, holistic methods over western medicine to treat common pregnancy discomforts and problems. However, midwives are trained and competent in the use of western medicine and procedures, and they recognize the appropriate use of both. In the event of a complication that would best be treated with a higher level of care the midwife will refer or transfer the mother or baby into the care of a physician such as an obstetrician or pediatrician. Mothers or babies with complications that are not resolved quickly are taken to the hospital for treatment.

 

How do doulas and midwives differ and where are they similar?

Doulas:

  • Meet with the mother at some point before the birth to begin building a relationship with her and her family.

  • Help the mother formulate a plan for her birth, including where and with whom she will be cared for.

  • Educate the family about their choices in childbirth under any circumstance that could arise during labor.

  • Often teach childbirth education classes to couples.

  • Stay in communication and make themselves available to the mother when labor begins.

  • Attend the labor and birth as a support person, offering suggestions to ease labor and provide comfort measures, and reassurance to the family.

  • Help teach the family how to care for the new baby and offer support with breastfeeding.

  • Usually stay with the mother until she is resting postpartum.

  • Usually meet with the family at some point after the birth to discuss and process their experience.

Midwives:

  • Are primary care providers that collaborate with physicians when necessary, but generally are the sole provider of care during pregnancy, labor, delivery and the 6 weeks of postpartum.

  • Begin providing prenatal care at whatever point the mother comes into care. This is ideal at the beginning of pregnancy but can be any point before birth.

  • Educate the family about their choices in childbirth under any circumstance that could arise during labor.

  • Are on-call 24/7 for mothers in labor.

  • Attend the birth as the primary care provider for both mother and baby.

  • Manage any issues, problems, or complication that may arise.

  • Make suggestions to ease labor and offer comfort measures, and reassurance to the family.

  • Stay and care for the mother and baby until they are discharged from the birth center, or are stable enough for the midwife to leave, in the case of a home birth.

  • Continue to provide care to mother and baby throughout the 6 weeks of postpartum, often offering visits with the family in their home.

  • Discuss and help the family process their birth experience.

  • Help the family plan for contraception between pregnancies.

Still not sure if a Midwife or Doula is best for you?

Schedule a personal tour of our birth center! You’ll be able to ask questions while you visit.

 

Birth Centers

Why should I consider giving birth outside of the hospital?

We consider birth to be one of the most profound moments in a family’s life.  When this process is supported in a way that does not interfere with the woman’s natural instincts, it can be one of the most empowering and fulfilling experiences you can have and will impact everyone present in the deepest of ways.  

Outside of the hospital, you have the choice in who attends your birth and who cares for you.  You can choose what foods you feel like eating and what you want to drink. You can walk, dance or sleep uninterrupted if you want to.  A woman who feels safe, can labor without the stress hormone cortisol slowing her labor down.

If you want to, you can give birth in water and then move to a cozy bed where you are given the space to bond with your baby without unnecessary interventions inhibiting the serenity and connectedness of the precious moments following the birth.

If there is extra care needed for you or your baby, we do it with baby in your arms, with full explanation to you about what is happening.  

Giving birth outside of the hospital allows for more of what you want during the labor and birth process while we as midwives provide the safety net for you to do what comes naturally to you.

Your baby floats in warm water in your womb during the nine months of pregnancy.  For this reason the warm water in the birth tub is an environment that’s comforting and familiar to them.  They often don’t even cry when they’re born into water. They just open their eyes and look around. They recognize your voice because they’ve been hearing you from inside the womb and then they look straight into your eyes and connect with you.

We encourage you to set up a tour of our birth center to experience the environment for yourself. Starting September 27, we offer complimentary tours from 9:00am-3:00pm. Sign up is required but easy!

 

Why water birth?

The benefits are in the relaxation and comfort that warm water provides. Think about how good it feels to climb into a warm bath after a long stressful day. Once in the tub, you feel any muscle tension melt away.

The key to coping with contractions is to stay relaxed. The use of warm water submersion in labor is one of the best tools available to help you cope with contractions.

Because your baby floats in warm water in your womb during the nine months of pregnancy, the warm water in the birth tub is comforting and familiar.

Babies often don’t cry when they’re born into water. Once they’re brought to the surface, they feel the air on their face and begin breathing. Then they open their eyes and gaze straight into your face.

 

Who will attend my birth?

We attend your birth as a team. There will always be at least one midwife present assisted by another midwife or skilled nurse. We want to be certain we have enough skilled hands during the birth and to assist in cleaning up afterwards.

If a birth is going through the night, we want to be at our best. We take turns getting a few hours sleep while one of us monitors your progress, listens to baby, and makes sure everything is going smoothly.

 

What type of care do you provide?

We work with women that have low risk pregnancies. We do not consider age or weight significant factors in determining risk. (For more specifics about what is and isn’t considered a risk factor, please contact us directly.)

We provide all of your prenatal care, from beginning to end. It is not usually necessary for you to meet with an obstetrician before your birth. We do however have OBs available. If we have a concern about you or your baby during your pregnancy, we have you see a physician.

We perform all standard blood work, cultures, urine testing, well-woman gynecological care and holistic treatments for specific vaginal and hormonal imbalances.

We offer informed consent/refusal for all standard tests and procedures. We then ask you to decide for yourself what is most appropriate for you.

We do not currently offer ultrasounds, but we have several referral offices we can send you to.  We do not perform amniocentesis, CVS testing, or any in vitro procedures.

 

What happens during a prenatal exam?

We spend about an hour on each prenatal appointment.

The physical exam portion of your appointment usually consists of checking your blood pressure and weight, testing your urine, listening to your baby’s heartbeat and checking your baby’s size and position.

Our care is family-centered. You are welcome to have your partner, children and anyone supporting you through your pregnancy, join us during our visits. We make ourselves available to support your whole family.

During prenatal appointments we discuss your pregnancy and birth options by counseling you and honoring your choices.

We follow the standard pregnancy calendar for prenatal appointments:

*every 4 weeks until 28 weeks gestation

*once every 2 weeks from 28-36 weeks gestation

*once a week from 36 weeks until delivery

During your exam we thoroughly answer all of your questions, preparing you for birth and parenting.

We give nutritional advice based on your individual practices and inquire into other aspect of your well being.

We discuss signs of preterm labor, as well as other pregnancy concerns.

Emotional support and counseling are offered as needed.

 

What happens during my birth?

We monitor you and your baby through labor in a non-invasive way; always respecting your need for privacy, warmth and quiet. We keep the lights low and speak softly, as well as use a gentle touch.  

If you lose confidence in yourself we provide comfort and support by reminding you that you were designed to give birth and have everything you need inside you.

If dad wants to be in the tub with you or catch the baby, he’s welcome to do so.

When your baby’s born, he or she goes straight into your arms and stays there.

We usually do not cut the umbilical cord until after the placenta is born. When the umbilical cord remains intact, it continues to provide oxygen to the baby for about five minutes. This gives the baby some transition time while learning to breathe.

After we’ve made sure that you and your baby are stable, we give you some private bonding time while we do paperwork in the next room.

During the first few hours after the birth, we do a full newborn exam, help you breastfeed your baby, feed you, clean you up and teach you how to take care of yourself and your baby.

If you need stitches, we can give them to you.

 

What kind of postpartum care do you provide?

We come back to your home to evaluate and support you and your baby at:

24 and 48

3 to 4 days

7 to 10 days

We see you at the birth center at:

3 weeks

6 weeks

We provide breastfeeding assistance, answer your questions, make suggestions, examine you and the baby and discuss postpartum family adjustment.

In the unlikely event that you become depressed, we will support you.  We are very skilled at working with postpartum depression, and collaborate with therapists who specialize in PPD.

 

What if there’s a complication?

Complications are something many families have concerns about.  Many of the interventions that are routine in the hospital, such as pitocin and epidurals, actually cause more problems than they prevent in healthy low risk pregnancies.

If you look at the countries in the world with the lowest infant mortality rates, you see they have excellent outcomes by using midwives and out-of-hospital birth for low risk women. Another important factor in those good outcomes is obstetrical back-up is available and ready to take over if necessary.

We have obstetrical backup available when we need it. If a problem develops during labor, and we feel you or your baby would be safer in the hospital, we call ahead and then take you there. We do not want to risk an emergency transport situation, so we go to the hospital before we have an emergency on our hands.

Most of the problems we see are things that can deal with safely in the home, such as heavy bleeding postpartum or a baby that needs help to start breathing.

The number one reason we go to the hospital is for failure-to-progress. This situation is not an emergency; we just need to go to the hospital and get more help. Usually the baby is not in a good position and is not fitting in the pelvis properly.  In this case a caesarian delivery might be necessary.

If a woman does need to go to the hospital, we go with her and continue to support and advocate for her. When she goes home we will continue her postpartum care in her home and at the birth center.

 

What if I can’t cope with the pain?

Labor is hard work; that’s why we call it labor.

Staying calm and relaxed is the most important thing you can do to cope with the discomfort. Being tense causes contractions to hurt more and be less effective. That’s why privacy and being in warm water can make such a big difference.

Laboring in the birthing tub relaxes and soothes you, helping to make contractions bearable.

It’s important to remember that women were designed to give birth. We have millions of years of evolution designing us to give birth perfectly.

Many women, especially with a first birth, get to a point in their labor that feels too hard. That’s the transition point; usually right before you start pushing.

Undisturbed and supported, you can make it through labor. After getting over that wall you will be so proud of yourself. Knowing your own strength and endurance is extremely valuable as you’re heading into motherhood. Nature definitely designed birth to be that way.

 

Who can attend my birth?

Anyone you would like to have there. It’s your birth; you get to say what works for you.

We do have some suggestions to support you based on what we’ve seen work well. Often what’s needed for you to progress in labor is privacy.  Sometimes it works best to have your guests wait in another room and come in after your baby is born.

 

What about my children?

Children usually do quite well at birth as long as they’re prepared beforehand with books and videos.

Being at the birth helps your child understand and adjust to the new baby.

If your children attend your birth we include them in what’s happening and reassure them if they get concerned.

Having someone whose only job is to support, reassure and care for your children is really important. This person can also take them out of the room if your children decide they don’t want to be there.

 

What are the benefits of giving birth at the birth center?

The most important factor in choosing where to give birth is deciding where you feel most comfortable.  For many women, being in the privacy and serenity of the birthing rooms at the center is where they feel best.

If you are concerned about not having much space at home, or you have a concern about privacy, the birth center could be a good choice for you.

The rooms are like a bed and breakfast inn; warm and beautiful. All you have to do when you go into active labor is call us and we meet you there. You just things you’ll need for your baby.

Everything is set up for you, you just come and we take care of you.

 

What is a birth center?

A birth center is a healthcare facility, staffed by midwives, where mothers receive prenatal, labor, birth and postpartum care. The midwives monitor the labor and wellbeing of the mother and baby during birth. Should additional medical assistance be required the mother can be transferred to a hospital.

A birth center presents a more home-like environment than a hospital labor room, typically with more freedom and options during labor: food/drink, music, and the attendance of family and friends if desired. Other characteristics can also include queen-sized beds large enough for both mother and father, and birthing tubs or showers for water births. The decor is meant to emphasize the normality of birth.

In a birth center, women are free to act spontaneously during their birth, such as squatting, walking or being in other positions that assist in labor. Being active in labor is encouraged.

The length of stay after a birth is shorter at a birth center; usually 6 hours after birth the mother and infant can go home.

There are certain requirements that a woman needs to meet in order to be able to birth at a birth center. First, she must have an uncomplicated, low-risk pregnancy.

It’s best to discuss any risk factors with a midwife to determine if you are a good candidate for a birth center birth.

Freestanding birth centers have hospital backup in case complications arise during labor that requires more complex care. However, even if a delivery cannot happen at the birth center due to a high-risk pregnancy, birth center midwives will provide concurrent prenatal care as well as doula services for mothers who must birth in the hospital.

 

What happens during my birth center delivery?

You call us and let us know when you go into labor. You and your midwife will decide together when to meet at the birth center.  

When you arrive at the birth center in active labor you’ll be given one of our four birthing suites.  During your stay at the birth center your birthing suite is yours to make yourself at home in. Bring whatever you need from home to make the space feel like yours. Each birthing suite has large birth tub and a private bathroom for your use only during your stay.

Your family and friends are welcome to be with you in your suite. If more privacy or space is needed there’s a family kitchen and lounge area for your guests to use during your stay at the birth center.

When you come to the center in labor, make sure to bring snacks and whatever food you’ll want to eat after giving birth. Your family is welcome to prepare food in our kitchen.

After giving birth you’ll climb into the queen sized bed with your new baby and the two of you will be cared for by your team until you’re ready to go home about 4-6 hours after the birth.

 

Home Birth

What are the benefits of giving birth at home?

It is our experience that many women feel most comfortable in their own nesting space, immersed in their own familiar sights, smells and sounds.  

You don’t have to drive anywhere in labor.  All you have to do is call us and we come to you.  We bring a birth tub and set everything up.

After giving birth, you climb into your own bed with your baby and stay there. We stay with you and provide postpartum care for about 6 hours, then we take everything apart and clean house as it was before we came.

 

Is my home too small for a home birth?

We’ve done hundreds of births in small apartments and it’s not a problem. The birth tub is about 5 ½ feet in diameter and can be placed in a corner. Usually moving a coffee table to the side makes enough room.

Although we bring a lot of equipment with us, none of it is large and it can be laid out on a small table.

 

What equipment do you bring to my home birth?

For monitoring:  A waterproof doppler to monitor the baby’s heartbeat, infant and adult stethoscopes, blood pressure cuffs and thermometers.

For the birth:  Instruments and clamps for the umbilical cord, a baby scale and measuring tape, a heater for towels and blankets, supplies to sterilize our equipment, suction devices and bulb syringes, erythromycin ointment, vitamin K, disinfectants and many other sterile supplies that we rarely use.

If problems develop:  IV bags and supplies, neonatal resuscitation equipment and oxygen tanks, anti-hemorrhage drugs such as pitocin and cytotec, ammonia inhalants, syringes and sharps container, antibiotics and urinary catheters.

If you tear:  Instruments, supplies and lidocaine for suturing.  

For comfort and support:  Medicinal herbs, a homeopathic kit, and other natural remedies for labor and birth, as well as birth stools and a portable birth tub with a disposable liner.

You need to buy:  Disposable supplies such as plastic-backed sheets, chux underpads, sanitary briefs, lubricating jelly, sitz baths herbs, and umbilical cord care products. These items can be ordered as a birth kit that you purchase online prior to giving birth.

 

What about the noise?

Women rarely make a lot of noise during birth. Unlike in the movies, you probably won’t scream or yell at your partner in labor.

Most women make soft grunting noises and don’t want to talk at all. The baby will probably make much more noise than you do. We have never had a problem with neighbors complaining.

 

What areas do you cover?

We work within a 25 mile radius of our birth center.