A husband and wife came to interview for the possibility of a birth center water birth from Burnet, Texas. Toward the end of the interview the husband asked, "if you have a doula, what does the midwife do?" Well perhaps that husband was from Killeen or Temple, I can't quite remember. His questions was inspiring and had me thinking. What is the difference between a midwife and a doula?
The midwife is the guardian of a safe happy home birth. A midwife isn't magic and can't change karma. She can't eat for you. She can't exercise for you. She can't change your behaviour. She can't even get in your mind and change how you feel about your birth. But she can walk beside you and help you create your healthy birth experience. She can offer healthy choices for your particular circumstances. It's up to you to follow through.
If you aren't healthy, or if your baby is born with issues that require hospitalization...then the home birth experience might not be the best outcome. That is what the midwife seeks to avoid, a bad outcome. A doula doesn't have that knowlege.
Your midwife is walking beside, guiding you on healthy choices. For example- The placenta delivers oxygen and nutrients to your baby. Where do these nutrients come from? For good oxygen exchange between you and your womb, it requires iron rich blood. Iron creates the hemoglobin that carries the oxygen molecules to your baby. Hence why the midwife offers the testing of your hemeglobin and hematocrit and may suggest iron rich foods, or even iron pills. For a healthy oxygen echange. A doula supports that, but it is not her primary role.
Placenta's require protein, antioxidants, and various vitamins for health. For instance, the placenta is mostly vascular. Baby's blood vessels form a beautiful tree that intersperse through the protein material interacting with layers of tissue. Collagen and vitamin C make up strong healthy membranes to prevent premature rupture of the membranes. Bioflavanoids and vitamin C make for strong healthy blood vessels for the baby.
A strong healthy placenta makes for a healthy growing baby. The goal is a strong heart beat in labor. No fetal distress. And there fore no transport.
But, your midwife can't eat for you. All she can do is guide you to healthy choices. She has to guide you into changing habits. Prenatal care is about choices, and a healthy life style. It's also about developing trust in the birthing process and trust in the one holding the space for you during labor.
As a woman lives, so shall she give birth. If there are issues in the marriage, if your husband isn't as supportive as you wished he was, or if he is having an affair, this adds up to a long hard labor. Many women don't want to talk about these issues, but they are important to talk about before the birth. Or if you had an epidural with your first birth, and "it didn't take well"... the midwife encourages you to prepare for the sensations of birth which can be very intense, maybe even painful. So the midwife is like a counselor all the while assessing your health because after all we want a beautiful, easy, healthy birth for mother and baby. This is why prenatal visits last about an hour.
This all weighs heavily on the midwife. Each woman is going to have a unique experience. The midwife keeps guiding you toward health.
During birth, the midwife's primary responsibility is the health and safety of mother and baby.
We listen before during and after two contractions to be sure baby's heart beat is strong and healthy duriing the "stressful" part of labor i.e.the contraction. We listen for the pattern of the FHR. Does baby move and the heart rate raise 15 or more beats. That tells the midwife that baby is well oxygenated in this moment. In otherwords, the midwife has specialized knowlege that she is using to assess mother's health and that of baby through out the birth. That is a knowlege the doula does not have. The doula is working toward a comforable, beautiful birth, but she doesn't have the health knowlege the midwife has. In partnership a doula and midwife meet all of a woman's needs in labor along with her partner whom whe loves.
The midwife uses her knowlege to prevent tears of the perineum during the birth process, or to sew them up. Yes, your husband can catch your baby, but he doesn't know how to prevent tearing. In otherwords the midwife does everything to help mother be happy, to heal well, initiate a good breastfeeding relationship... and she continues that guardianship into the post partum for the next few weeks.
The doula is a great adjunct. The doula is supportive. She offers emotional and physical support that is always available to mom. I used to believe that I was a good doula and a good midwife. However, while rubbing mom's back, I would get interrupted to listen to baby's heart beat or give a homeopathic remedy. I couldn't do everything. When I worked in the hospital as midwife, I could doula really well, because the nurses were monitoring baby... or there was continuous monitoring and I could continously hear the baby's heart beat while I rubbed a back or gave a reiki energy session. But, at home, that is not the case.
That very mistaken dad has no idea that the role of the midwife and the role of the doula are not interchangeable. The doula is there for mom's and dad's physical comfort, because birth is NOT always easy. Dads work hard too at comforting mom. Birth is a beautiful, intense moment of greeting a brand new baby who is transitioning from breathing through a placenta to breathing air. The midwife is there for medical and health reasons so that birth is healthy. The midwife is watching for medical issues in both mother and baby in the first few post partum days. A midwife is trying to prevent or treat any excessive bleeding in mome if it happens. The midwife is the guardian on so many levels.
The midwife's goal is something Reba Rubin coined back in the 1950's: " Safe Passage" for mother and baby while supporting a joyous beautiful birthing.
Yours in wonderful waiting....
Sandra Tallbear 2/7/2018