Doula & Midwife Conflict?

Hello!

I have been thinking about getting a doula because I really like the idea of having a constant support person there who understands what is going on and can reassure me it is all normal!

But I am going public, and at my last hospital visit, I asked some of the midwives what their attitudes towards doulas were, and they were not positive. They were kind of the opinion 'we can do all that, and you have your partner/ mum for emotional support so you don't need them'. This attitude really made me question getting a doula because the last thing I want is conflict between the midwives and the doula- especially when the doula leaves and the midwives look after me for the next few days! I have to say, the midwives at my hospital have been fantastic and I love them, but I just worry about not having the amount of support I really want.

What do you all think?

Thanks!

Hi Jessica,
I say go with the doula, it's what you want.

I had a fantastic midwife with DD (infact she was that great that we have requested her again, so fingers crossed!) But the thing about having a doula is you have that constant support. If the midwife needs to leave for a while for some reason & your DH isn't all that good at giving you the support you desperately need (some DH's dont understand just how much support we need!) then having a doula there will be just what you'll need.

I've never used one but am now seriously having a trainee doula at my upcoming birth in August.

Good luck with making a decision.

You've also got to remember that a midwife has to uphold hospital protocols and policy - so if you don't want something and it's protocol, then the midwife can't tell you otherwise. Also I find having a doula there, you don't get that intense emotional connection there as you would your mother or partner... I have heard mothers tell their daughters that they didn't like seeing them suffering and get very uncomfortable seeing their daughter in pain. I have also see men panic and demand epidurals. So having someone there keeping it normal and putting pain into perspective is a huge diff. Also study shows that the positives of having a doula, i.e. 50% less c/s, less epidurals/forceps yada yada is not replicable with just your partner or a hospital staff member etc.

I think the only reason some midwives and doctors have bad ideas about doulas is because they don't understand their role properly, they haven't seen the research and perhaps they have had a bad experience with one. There is nothing in the doula industry to standardise anything, no regulation... so I would interview a few doulas and talk to them about how they feel with what the midwives have had to say and see how they respond. No strings attached, just do some meets and greets. You'll soon know if you would like a doula there and what they can offer.

ps. What hospital is it, sounds like I need to send them some information ;)

i guess you have to look at what you really want hun - doula's aren't there to do the midwives job - they're there to be support not only for you, but for your husband. they're there to be a consistent support - the same person through your pg and through labour. chances are you won't have the same midwife through your entire labour, and as good as a birth plan will be they can only look at so much - they have other labouring mothers to look after too

i see a doula as being your voice - the person that can stand up for you when it gets too much for you to make decisions yourself. the one that understands the medical jargon and can say "ok, you've given us the options, now let the parents make the choices" - she can remind you of your intentions - tell you the implications of what has been suggested by your carers. your doula is there through it all. she is the one that can step in as your support if DH has to leave the room. She's someone you know from before and someone you already have a relationship with - unless you're at a really small hospital that has minimal births, i doubt you'll get the same one on one attention and commitment from a midwife. it's not that they don't want to be there - but they have a job to do, and it isn't being there JUST for you...

ultimately, it's up to you. the Doula isn't going to be there to give the midwives grief - she's going to be there to help you make informed decision and to ensure you have the birth that YOU want. maybe have a read of this article and work out whether it is something that will benefit you. Personally, i've already decided to have a doula when we have children as i know my local hospital has a reputation for being "difficult" to deal with if you don't have a text book birth... but as i said - it's very much about YOU and what YOU need - don't let someone else make your decisions for you.

good luck making your decision

BG

I can understand where the midwives are coming from - it IS their job to give you the best birth possible so I can understand that they would feel threatened by a doula.

Having said that, this is about you and your birth and it's not up to you to try and avoid putting their noses out of joint.

I would have thought a good doula will make sure that, if at all possible, she gets the midwives on-side, not up their noses (unless she really needs to go into bat for you and then a bit of no-nonsense straight talking will be required of course).

And it's not always about conflict and negotiation. As the others have said, the midwife may have other people she needs to attend to and it may be at a crucial moment when you have a bit of a panic about whether you can carry on. It's not necessarily always about the pain level either - it can be about the length of the labour.

I know after nearly three days of being in labour, I had that panic and asked for an epidural because I just wanted to press the pause button! I don't regret it but if I'd had a doula she may have been able to encourage me to keep going without or have said "look, why don't you try the gas first." At that stage, I'd completely forgotten that gas existed, so had my DH and so, apparently, had the midwives because they never even offered it to me.

So I think definitely go ahead with your plans to have a doula and perhaps ask the ones you interview how they go about dealing with midwives and building a positive relationship with them in the delivery room.

Best of luck.

I do find it an odd attitude, having dealt with 2 hospitals this time around, both of them are fine with doulas. At the first hospital at my booking in appointment the midwife said "I have seen some of those women perform miracles" and thought doulas were a great idea. Due to moving I have had to change hospitals and broach the subject again. Initially the first midwife (over the phone) did struggle to understand why I wanted a doula, but once I met the midwives and they heard about my last birth, they are fully supportive of them and are in fact helping me find someone down here who can help. They understand the difference between a midwife and a doula. One has said how good it can be just to support a women through labour without having to worry about the paperwork, routine checks etc.

After a long labour, where both DH and I were tired, a doula would have been appreciated, especially when DH started snoring in the corner and having to deal with the ob from hell. As already said it is your decision. If they are funny about you having a doula, don't even mention who the person is, just that they are your 2nd birth support person, a close friend for example. Good luck

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I can understand where the midwives are coming from - it IS their job to give you the best birth possible so I can understand that they would feel threatened by a doula.

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Actually, I have to say that I disagree: I can't understand why a midwife would be threatened by a doula. I do agree that a midwife's job is to help a woman achieve the best birth possible for her. Absolutely. The majority of midwives I have worked with have been excellent, they understand the With Woman concept (that's what 'Midwife' means) and the reason they are positive about doulas is because they understand so well what enhances birth - and the continuous emotional support of a familiar, known and SELF-CHOSEN support person really does. This is why several obstetricians I've worked with are also positive about the presence of doulas. It's nicer for all if the birth goes smoothly and the expertise of obstetricians is only called for when necessary.

Midwives are aware that in our current system, the one-to-one care that is safest and best for women, and more satisfying for midwives, is rare, because midwives here are not empowered as autonomous professionals to the degree that they in other countries (yet). Therefore, it is not always possible for a midwife to follow-through a woman throughout her pregnancy, labour, birth and post-natally - although that is what many midwives would prefer (case-load care). Midwives also know that they cannot always be with a woman throughout the labour. They may have other patients to care for, or they may need to go off duty at the change of shift. A doula, however, is not employed by the hospital but by the woman and her partner - so she is able to stay with the couple the whole time.

I've had some great experiences of doula-miwife harmony, and very warm feedback from midwives who have seen the difference a doula makes. (One of the nicest times was after our client joyfully gave birth to her baby in the birth pool in a Melbourne birth centre - and as we left mum, dad and babe to enjoy some privacy, myself and two midwives had a spontaneous celebration hug/dance outside in the hall.) You're right - a good doula will always do whatever she can to work towards a harmonious relationship & good diplomacy between all people involved in the birth. But her first loyalty and responsibility is always to the mother. Most of the time, and ideally, these two concepts are intertwined.

I have had a few occassions in which hospital staff have been dubious or hostile towards doulas. And I have to say - in my experience, an environment that is hostile towards doulas tends to be one that is also hostile towards birthing women in general. When the control of caregivers, and their "territory" or policies, or procedures, or preferences, or legal safety, or not getting flack from the Higher Ups matters more than this woman and this baby's individual welfare (emotional and psychological, not just physical), that is not an environment conducive to normal birth. Fortunately environments with vibes like this are rare - but they are out there and that's where each woman's choice, street-smarts, gut instincts, assertiveness and self-preservation must be drawn on to make good, safe, choices to set ourselves up for the best chance for a good birth experience.

So I would be wary of careproviders who are threatened by doulas in general.

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I would have to also disagree that doulas do not step on the toes of midwives. If you feel that you would like a doula at your birth it is important for you to make this happen. This is your experience and you will always remember this so its so very important to have what you feel is right. The majority of midwives are very open to doulas and have a very positive partnership with them. What is important is for you to choose the doula who is right for you. Both parties focus is on making the experience most positive and empowering for the woman. Midwives who are not comfortable with doulas are those who have had negative experiences with a doula. If a doula acts out of her/his scope of practice and interferes with the woman/midwife relationship, this can impede on the whole birthing experience so I would recommend to find a doula who is professional and you feel most comfortable with. I wish you all the best with your pregnancy and birth and hope that you choose what is right for you.

Leanne - student midwife/ registered nurse