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Why You Need a Birth Team, Part 3: Choosing Your Doula and Midwife

In the first two parts of this blog series, we discussed WHY you need a birth team, and WHERE you might decide to give birth (click HERE for part one and HERE for part two if you need a refresher). This week, we’re finishing out this 3-part series by discussing the most important piece of the birth puzzle—WHO will be there with you when you have your baby; how to choose the best midwife and doula for YOU.

Assembling Your Birth Team

Assembling a birth team is a lot like dating. You’ll want to start by letting your friends who’ve had babies know you’re looking. See who was on their team, and what their experience was like. Ask them if there was anything they would change if they could, and if they can recommend a doula, midwife, and/or OBGYN. Once you have a list of recommendations, set up a few “dates” to interview potential candidates. Start early—I recommend you begin the process of assembling your birth team in the first trimester.

If you are planning a homebirth, you may want to find a midwife who is experienced/certified in home births before finding a doula. Your midwife may have a doula/doulas she works with regularly that she can recommend.

If you decide to have your baby in a hospital or birth center, you will need to choose an OBGYN/Nurse/midwife who has privileges at the hospital/birth center, and you may not get to choose who delivers your baby. In that case, the doula relationship is much more critical, so I recommend choosing your doula first.

How to Choose a Doula

In addition to asking for recommendations, check dona.org to find DONA (Doulas Of North America) certified doulas in your area. While there are many wonderful doulas out there are not DONA certified, unless you have several strong recommendations from other parents, it’s best to go with a doula who’s been through a stringent certification process to make sure they are experienced, well-trained, and prepared for all of the unpredictable things that can occur during labor and birth. The more experienced your doula is, the safer you’ll feel.

This first thing to consider when interviewing a potential doula is to ask yourself how you feel when you’re around them. Remember, this is a person who’s going to see you at your most vulnerable, in an extremely intimate space. You’ll need to absolutely trust them (much like a sexual partner—another similarity to dating!). You should feel as comfortable as possible, like you can ask this person whatever you need to ask, and as safe as possible. And most importantly, you should feel confident that they’ll be in your corner if you need someone to advocate for you during labor.

You’ll also want to make sure you have similar philosophies with regard to your birth plan. If you plan to have a home birth, your doula should have plenty of experience with home births, and if you decide you’ll feel safer in a hospital, you’ll want to choose a doula who has experience in a hospital setting advocating for a laboring mother’s birth plan.

Another important thing to consider is how your spouse/partner and other family members feel about your doula. They’ll also need to rely on your doula for help, support, and advice, and they should feel comfortable and safe with your doula as well.

Your budget will also be something you need to consider, as doulas are not covered by insurance. If you have financial concerns, DON’T assume you can’t afford a doula. Doulas in training are required to obtain a certain number of hours before becoming certified, and so they may offer doula services at a discount. Many certified doulas also reserve a few “scholarship” spots in their practice for parents who are unable to afford doula fees. Speak to doulas in your area, and ask for help! Having a doula assist you during labor and delivery is critical to you and your baby’s health and well-being.

Here are a few important questions to make sure you ask a potential doula:

  1. What made you decide to become a doula? What is your favorite thing about being a doula?
  2. How long have you been a doula?
  3. Which organization did you get your training/certification through? Do you take continuing education courses?
  4. What are your rates and accepted payment methods? Do you offer payment plans or scholarships? What do your fees include?
  5. How many births have you attended? Have you attended home births? Hospital or birth center births? Medicated and unmedicated? Induced? High-risk? Cesarean? VBAC?
  6. Do you have a partner or back-up doula that you consistently work with? Can I meet them?
  7. Do you have a midwife/OB-GYN practice that you routinely work with?
  8. How often will we meet in person before I go into labor? What will happen during our appointments? What is the best way to get in touch with you?
  9. If planning a home birth—have you attended a birth that was planned at home, but ended up in the hospital? What is your process in an emergency hospital transfer?
  10. Do you offer postpartum support? If not, do you have postpartum resources?
  11. Do you offer breastfeeding support? If not, do you have resources?
  12. Do you offer placenta encapsulation? If not, do you have resources?

How to Choose a Midwife

As I said before, your choice of midwife will depend on whether you’ve decided on a home birth or hospital/birth center, as midwives will usually be certified for one or the other, but not both.

If you already have a doula, ask her if there is a particular midwife she likes working with, or that she’d recommend for you in particular. Does she have any experience with specific OB/GYN practices or hospitals in the area? If you’re not planning to have a home birth and you’ve already been researching places to have your baby, you can find midwives who are affiliated with the hospitals or birth centers you’re considering.

You can also check midwife.org and plan to set up interviews the same way you would for a doula. Many of the criteria that applies to choosing a doula also applies to choosing a midwife. How comfortable do you feel around them? Do you feel safe? Do you share similar philosophies when it comes to labor and birth? What about the other people in their practice, or their backup midwife? Make sure you can meet everyone who might be present during your birth, if at all possible, and trust your instincts!

Here are some important questions to be sure and ask a potential midwife:

  1. How long have you been a midwife?
  2. Which organization did you get your training/certification/degree through?
  3. Do take continuing education courses?
  4. How often will we meet during my pregnancy? What will happen during each appointment?
  5. Do you use a fetoscope? A doppler?
  6. Will you require an ultrasound and/or vaginal exams during prenatal appointments?
  7. Do you require a gestational diabetes test? What is the course of treatment if I test positive?
  8. Do you test for GBS+? What is the course of treatment if I test positive?
  9. Do you recommend vaccines for pregnant women?
  10. Do you differentiate between high and low risk pregnancies? What happens if my pregnancy is determined to be high-risk? Will my care be transferred to a physician? If so, who? Can I meet him/her?
  11. How do you help women manage labor pain?
  12. Do you have experience with water births?
  13. Do you have a backup midwife that you routinely work with, and can I meet her during my pregnancy?
  14. What kind of postpartum care do you offer? If none, do you have resources?

If you are planning a home birth these additional questions are important to ask:

  1. How many home births have you attended? How many births do you average yearly?
  2. What are your rates and accepted payment methods? What do your fees include? Do you offer payment plans or scholarships?
  3. What labor positions and pain management methods have you found to be most effective?
  4. What kind of problems have you encountered during home births? Do you have experience with postpartum hemorrhage, shoulder dystocia, breech baby during labor, or cord prolapse?
  5. What happens if I develop a problem or complication during my pregnancy? During labor? Postpartum?
  6. Have you completed training in neonatal resuscitation?
  7. What happens if I need to be transferred to a hospital during labor or postpartum?
  8. If my baby or I need to go to the hospital during labor or postpartum, do you have admitting privileges at the hospital? If not, will you still stay with me for support?

If you are planning a delivery at a hospital or birth center these additional questions are important to ask:

  1. What insurance does your practice accept?
  2. How do you determine if I need a cesarean birth? What is your cesarean birth rate?
  3. Do you support women having VBACs?
  4. What support can you offer me for a vaginal birth?
  5. What positions can I labor and push in? Can I eat and drink during labor?
  6. Do you actively manage the birthing of the placenta or allow it to be birthed on its own?
  7. Is the hospital where you have privileges baby friendly?

Remember your Mom, Sisters(s), Aunties, Grandma(s) and Best Friends!

In the first post in this series, I discussed how critical it is to have other women present during labor, especially other women who have given birth. So far I’ve focused on professionals like midwives and doulas, but studies have also shown that the presence of ANY support person, including close female relatives and friends, reduces anxiety and maternal stress, decreases the length of labor, and improves childbirth outcomes. Anecdotally, I’ve heard a LOT of women talk about how much they wanted their moms during labor!

Remember—the best thing you can do for yourself during labor is find a way to feel as safe as possible. People who care about you AND have experience with labor like your mom, aunties, best friends, sisters, etc., can sometimes offer the best kind of care and support.

So even regardless of where or how you give birth, make a plan to have AT LEAST ONE woman who knows you, loves you, and has experience with birth present during your labor. It will make all the difference!

In a nutshell

  1. When it comes to finding a doula and midwife, treat it like dating, and trust your instincts.
  2. The best choice is the one that makes you feel safest.
  3. Remember the other women in your life!

Let’s Talk!

I want to hear from you—leave me a comment and we can continue the conversation!

Are you pregnant now? Do you have a birth plan?

Have you chosen a doula? A midwife?

Have you already given birth and found that having a doula or midwife made a difference? Were you able to stick to your birth plan or did things go differently than you expected?

Spread some pregnant mama lovin’! I bet you have some friends who would love to read this too :).

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Looking to have a more in-depth conversation about creating your birth team and deciding how to choose a doula and/or midwife? Schedule a consultation with me!

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