There is a massive movement in the current birth culture that is sweeping across the gulf and the south Asian countries, and is giving birth to the need, the recognition and the licensing of professional and autonomous midwifery. The changes are happening swiftly all over and with this there is a rising need for childbirth education. With the updated international guidelines concerning various birth related outcomes, the medical birth professionals are now ready to explore the non-medical perspective and its impact in the birthing world. They are ready to embrace the existence of the role of childbirth educators and the birth doulas. And therefore, a new role of a doula is born. Doulas and midwives share the same yet complementary work space in the current birthing landscape.
To begin with, let us understand who actually is a birth professional and how are they classified. A birth professional is someone who is skilled in providing medical or non-medical care, attendance, information and services to the mother during or related to pregnancy, labor and birth. Ideally, birth professionals are classified as medical and non-medical. Since, we are now talking about childbirth educators and doulas, they fall under non-medical care providers.
A holistic maternity care includes having a complete support system framework that works towards a shared common goal and this complete support system comprises of the care from all the birth professionals, the medical and non-medical. Now, when we talk about goal it is imperative to know that it should be a same shared goal. This shared goal is usually phrased as, “healthy mother and healthy baby” but the real question here is about the route that is taken to reach the goal.
Is it the same or are there any major differences?
Are the medical care providers, the mother, the doula and her birth partner all on the same page?
Do all of these people speak the same language and are on the same page of the birth plan?
These are some of the questions we need to keep asking while we focus on giving the best possible
outcome of the birth plan as a birth team, and this is what ideally defines the birth team.
When you look at the illustration of the concept of Birth Team you can see the contrasting roles of midwives and doulas- while they work together along with the other birth team members to give the mother a better positive birth experience. A midwife here is a medical care provider with her objective of taking care of the mother medically and perform all the clinical tasks. At the same time, she is more focused on perceiving birth as a physiological event. She most likely exercises midwifery model of maternity care unless stated otherwise, and works towards making birth as a shared memorable family event. A doula on the other hand stands more as a support person and shares the space with the other non-medical birth partner. This birth partner is most likely someone whom the laboring mother chooses for herself and feels safe and secure to be around. You can see below the common space that both the doulas and midwives share with each other.
So, to have both the midwife and the doula side by side in a birth team is to have the best of the best when it comes to benefits for the birthing mother. While the mother would recognize that her midwife would support healthy low risk birth she would also see the benefit of hiring a doula to improve her birth outcome. The mother if informed and educated of the roles of both of them, she would understand how important it is for them to collectively stay within their scope of practice without feeling the need to get territorial or defensive. She would also understand that having doulas in her early labor would increase her chances of giving birth vaginally.
At the same time, the doulas and midwives need to respect each other’s role. They need to know they wear their own respective hats; only one at that time while they attend the laboring mother, which means that the midwife wears her hat of a midwife and doesn’t play the role of a nurse or a doula in between for that particular labor and similarly, a doula wears her hat of a doula and not perform any clinical tasks whatsoever or give any medical advice for that particular labor even if she is certified as a different medical practioner alongside of a doula. Respect and trust in each other’s abilities and mutual understanding of their respective boundaries while working collaboratively will give the best birth outcome for all.
So far, we have an idea of how doulas and midwives together bring simple yet overlapping skills and abilities to the sacred and intimate event of birth. We also can see the contrasting yet complementary roles of both the midwives and doulas in the birth team. So, now where do you think both the doulas and midwives stand in the current birthing landscape?
With the rise of midwives who are advocating midwifery model of maternity care there is the birth of doulas, and the need for childbirth education to impart knowledge and information on these changes and roles.
In order to fill this gap we need more birth doulas, childbirth educators, and pre and postnatal coaching and counselling. This is crucial when we talk about birth reform. We need to understand the need for doulas to be recognized alongside midwives in a new way that shows our support for bridging any gaps between these two communities. Doulas and midwives working alongside each other in their realm of work with good coordination can make a big difference in the current birth culture and in improving maternal and neonatal health outcomes. Having additional doula support during labor and birth with the primary care providers being the midwives is more likely to lead to improved health outcomes which may result in greater acceptance and demand of midwifery on the whole.
When doulas are given this safe and shared space along with the midwives at this level in the current birthing landscape, we will have achieved it all i.e. a safer, healthier, positive and an empowering birthing experience while we witness the transition of our women to stronger, informed, fulfilled, confident,empowered and fierce mothers. Imagine a generation that would come from them…… So, what are we waiting for?
Doulas and Midwives: Transforming the Landscape, Together by Courtney L. Everson and Melissa Cheyney The
article first appeared in Midwifery Today, Issue 123, Autumn 2017
About the author:
Zahra is a Bachelor of Information Technology, certified AMANI Birth Childbirth Educator, Birth Doula and AMANI Girls Facilitator. She’s also NBM certified VBAC Practioner Coach. She has volunteered in Almana General Hospital, al Khobar from December 2018 till April 2019 to establish their in-house Natural Childbirth Department and has coached over 600+ expecting couples as a part of their team. She is currently working there as a consulting Childbirth Educator, Birth Doula, VBAC Coach and Prenatal Fitness Instructor. She also has keen interest in birth art and loves blogging. You can get in touch with her at http://www.amanibirth.com/zahra.batool or firstname.lastname@example.org She believes that birth is a transfer of
control where if it is given to the woman who is to birth will most likely leave her empowered and in control of herself and the events surrounding her for the rest of her life!