I love riding my scooter. My dad rides a motorcycle and I always loved riding with him. A few years ago, I gave up my car (by “give up”, I mean totaled, and refused to replace). I’m not a terribly good driver, and it is much harder to get distracted on my scooter. I chose a scooter partially because I have a tendency to wear skirts every day; I’m not much of a lady most of the time, but straddling a motorcycle in a skirt is a bit beyond my comfort level. This leads to an interesting world in which some motorcycle riders acknowledge me as two-wheeled kin, and some don’t. I love seeing motorcyclists and scooterists on the road. To me, its a party where we all try not to get killed by drivers. And I always give a head nod or wave, either way. It isn’t always returned. I’m sure there is an argument to be made that a scooter can’t always go as fast, is a cop-out, and other reasons that motor cyclists might not openly recognize me. And that’s fine. While it is nice to see a head nod, wave, or two fingers flashed over a handlebar, the absence of recognition doesn’t make me go home and cry at night.
As I rode along a few miles from home, I was thinking about how this correlates to the birth community. Some see it as an adversarial system, where OB-GYNs just want money for c-sections and their evenings free, and labor and delivery nurses are either overworked and surly or saints, midwives are angels, but home-birth midwives might be irresponsible, and doulas take over the roles that friends and families should fill and just annoy the nurses. And of course, they all have trouble working together.
I remember when I first chose to start down the path to become a midwife, I chatted with a labor and delivery nurse one night at a friend’s house. I told her I was really glad to hear what she did, and asked her some questions about her experiences. Eventually, she asked me what my plans were. When I told her I wanted to be a midwife, she laid into me saying that any time a woman had a midwife they always ended up in her care with interventions. My decision was foolish, and harmful. I was shocked at the vehemence. I never ran into her after that night, so I never had the chance to understand the experiences that lead to her frustration with midwives and home births.
Her line of reasoning didn’t make sense, from multiple angles. There are many midwives who work in hospitals, and there is plenty of evidence showing that home births and birth center births are effective for many women.
I don’t think either view has much merit. In birth, no one has a direct ride to the front of the class. Each position has strengths and weaknesses. Every care provider picked their occupation to help pregnant and laboring mothers. OB-GYNs have a level of skill that is required for more complicated cases. Midwives have skills to lead uncomplicated cases safely through pregnancy and birth. Nurses provide care and valuable monitoring and liaising with a hospital. Home birth midwives fulfill a community need for supervision and guidance, even in the simplest of cases. Doulas provide one-on-one support, hands-on assistance, and useful education. They can all work together, within their own scope of practice, to create a community that supports parents at every level.
And maybe we can all go for a ride afterwards.
There are multiple kinds of doulas, but most simply, doulas provide support. Birth doulas work with one mother throughout the whole birth, and have no other obligations or time constraints like nurses, midwives, or doctors. They provide physical, emotional, and educational support. Doulas work directly with the mother to provide natural pain and stress management. They are available wherever a woman chooses to give birth. A doula can complement a home birth, assist in a birth center, or help keep a hospital birth relaxed and make sure that the hospital staff knows your wishes.
Doulas are not only a source of strength to the mother. If a partner is present, doulas provide support to their partner, too. Doulas free up a mother’s friends and family to be supportive, instead of worrying about remembering what they’ve studied in a book or at a class.
Doulas prevent unnecessary interventions by supporting parents to be their own advocate. Studies show that having a doula results in lower c-section rates, lowered instances of forceps deliveries, fewer episiotomies, fewer epidurals, and fewer uses of oxytocin (pitocin). Doulas also results in more spontaneous births, shorter labors, better apgar scores, and higher rates of breastfeeding, both at birth and more than a month out. Women who have used doulas report their births as less difficult and painful, and report a better experience overall.
Doulas may also have other complimentary certifications, like Lactation Consultant, Childbirth Educator, and Massage Therapist.
It is wise to start looking for doula services around 30 weeks. This gives you time to meet your doula and make sure that they have a personality that complements yours, and make sure they have the training and experience to assist at your birth.