What's the Difference Between a Doula and Midwife?

While doulas and midwives both assist parents during childbirth, both fulfill different roles.

Midwives are healthcare professionals who offer comprehensive prenatal care, oversee the birth, and provide postpartum care for both parent and baby. They possess the necessary expertise to manage the medical aspects of childbirth, such as conducting vaginal examinations, monitoring vitals, and addressing complications if necessary. While doulas focus primarily on emotional support, midwives provide vital medical care, ensuring a positive and safe birth experience for parents.

Benefits of Hiring a Midwife:

1. Personalized and Holistic Care: One of the key advantages of hiring a midwife is the personalized and holistic care they provide. Midwives prioritize building a strong relationship with the expectant parents and offer individualized care based on their specific needs and desires. They focus not only on the physical aspects of childbirth but also the emotional, mental, and spiritual well-being of the mother.
2. Continuity of Care: When you hire a midwife, you can expect to receive continuous care throughout your pregnancy, labor, birth, and postpartum period. Midwives are present during the entirety of the childbirth journey, providing ongoing support and guidance to ensure a seamless, integrated experience. This continuity can foster a deeper sense of trust, comfort, and security for the expectant parents.
3. A Natural Approach to Birth: For those who desire a natural childbirth experience, midwives specialize in supporting and promoting natural, unmedicated births. They use various techniques like water birth, massage, breathing techniques, and position changes to manage pain and facilitate a positive birthing experience. Midwives also tend to have lower intervention rates, including lower cesarean section rates, compared to traditional medical settings.
4. Focus on Informed Decision Making: Midwives prioritize informed decision making and strive to empower expectant parents to make choices based on their preferences and values. They provide information and education about different options and interventions, allowing the parents to actively participate in their birth plan. Midwives believe in the importance of the birthing person's autonomy and work collaboratively with them as partners in the decision-making process.
5. Postpartum Support: Hiring a midwife means not only having support during labor and birth but also receiving care and guidance during the postpartum period. Midwives typically visit the postpartum family at home during the first week, providing assistance with breastfeeding, newborn care, emotional support, and overall recovery. Ongoing support continues through at least the first six weeks after birth. Their focus extends beyond just the physical aspects of the postpartum period and includes emotional well-being and adjustment to parenthood.
6. Cost-effective: In many situations, hiring a midwife is less expensive compared to hospital-based care, making it an attractive option for those seeking more affordable childbirth services.

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Doulas play a crucial role by offering emotional, physical, and informational support throughout the entire journey, from pregnancy to postpartum. They provide reassurance, advocate for the parents' preferences, and help them navigate the challenges of childbirth.

Benefits of Hiring a Doula:

1. Emotional Support: A doula offers continuous emotional support to both the birthing person and their partner. They provide reassurance, encouragement, and a calming presence during the labor process. This support can alleviate anxiety and help create a positive birthing experience.
2. Continuous Presence: Doulas are available to support you throughout your entire labor, regardless of its duration. They offer uninterrupted care, ensuring that you never feel alone or neglected during this transformative moment.
3. Advocate and Mediator: Doulas help navigate the intricacies of the healthcare system, ensuring that your voice is heard and your desires are respected. They can help facilitate communication between you and medical staff, empowering you to make informed decisions.
4. Comfort Measures: Doulas are well-versed in various comfort measures such as breathing techniques, massage, and positioning, effectively easing discomfort during labor. They can suggest alternative pain management techniques before resorting to medical interventions.
5. Postpartum Support: Doulas often provide postpartum care, offering guidance on breastfeeding, newborn care, and emotional well-being. Their presence can help ease the transition into parenthood, reducing feelings of overwhelm.
6. Reduced Medical Interventions and Better Birth Outcomes: Studies show that having a doula as a part of the birthing team can lower the need for medical intervention and improve birth outcomes.

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So can you hire both a midwife and doula? Absolutely! Midwives and doulas often work well together, forming a strong team to cocoon you in support during your transition into parenthood. Each has their own role throughout your journey, and both would be happy to guide and support you.

Did you have a doula and/or midwife for your birth? Tell us about it in the comments.

BRAINED: Decision Making for Labor (and Life)

Labor can be an intense, stressful time. Many people go into the birth process with a "birth plan," or a list of ideals they wish to stick to. These are often well researched ideas the family is comfortable with. But what happens when suddenly your doctor comes in and says those ideas need to change? Whether the doctor suggests additional interventions or even talks about changing the type of delivery, sometimes births do not go as planned. How can you make such a potentially huge decision during a high-stress, vulnerable time? 

We like to use the BRAINED pneumonic to talk through these situations. It can be helpful to have a neutral third party (like a doula) to help walk through these steps, but it can be a handy tool for anyone to use for any decision.

So what is BRAINED?

B: Benefits

What are the benefits of the suggested choice? Are there more benefits than there would be with the current plan? Are the potential benefits worth changing plans?

R: Risks

What are the risks of the suggested choice? Does the risk level increase or decrease with the new choice? Do the benefits outweigh the risks? How severe are the potential risks?

A: Alternatives

Are there any other alternatives to consider? What are the alternatives? How do the alternatives compare to the current options?

I: Intuition

What does your gut feeling say? Intuition can be a powerful thing, and it is there for a reason.

N: Nothing

What happens if we decide to do nothing or stick with the original plan?

E: Evaluate

Evaluate these considerations as well as any other questions you have.

D: Decide

Decide what is the best option for you.

The BRAINED tool is most often used for labor decisions, but it's also great for really any life choice. Using this tool helps prevent making quick, emotional decisions by breaking down different considerations logically. 

Labor Inductions: What to Expect

Your doctor may recommend scheduling an induction of labor for many reasons. For some this can be a welcome suggestion; you get to know more definitively when you will meet your new baby! For others, induction can be a scary or unwanted option. No matter how you come to the decision to induce, there are a few things to consider.

1. Methods of induction

There is no one-size-fits-all approach to induction. Multiple different methods may be used based on your personal history, any medical concerns, and your doctor's preference. There can be pros and cons for each method, so it can be helpful to talk through your options in advance with your doctor. Here are some of the most common methods:

Pitocin
Pitocin is the synthetic form of the hormone Oxytocin, which helps trigger contractions during spontaneous labor. Pitocin is given through an IV line in labor, and the hospital staff may adjust the dose as needed throughout the induction. Sometimes Pitocin can cause contractions longer and stronger than spontaneous contractions would be, but it is often an effective method of induction. 

Cervidil
Cervidil is a medication that helps soften the cervix. This preparatory softening can help stronger induction medications be more productive, so many doctors will recommend Cervidil overnight the night before an induction is officially set to start. Cervidil is applied right by the cervix on a cloth tape and can be left in for many hours. Many people find this no more uncomfortable than a regular cervical check. One of the good things about Cervidil is that if the contractions are too strong or if there is a problem, the tape can be removed, limiting further effects. 

Cytotec/Misoprostil
Cytotec is a brand name of the drug Misoprostil. This medication can help soften the cervix and bring contractions, so it is often used during labor inductions. Use for inductions is actually an off-label use not recommended by the FDA, but it is often very effective. Cytotec is packaged in tablets that can be given multiple ways, but it is most often placed internally by the cervix for induction. Although it is effective, Cytotec can be a bit controversial when used for labor induction since it can produce contractions so long and strong that baby becomes distressed. Unlike Cervedil or Pitocin, Cytotec cannot just be removed or turned off if there are complications; once it has dissolved, it's gone. 

Foley Bulb/Cook Catheter
Foley Bulb Catheters and Cook Catheters are very similar options that both function the same way. Both of these options can be used to manually dilate the cervix without the use of medications. These work like balloons; a long balloon-like tube is inserted into the tip of the cervix. Saline is then used to inflate the end, which begins to wedge open the cervix. You do need to be at least 1cm. dilated for this to work, and it may not work for everyone if your cervix isn't ready. The level of discomfort this procedure causes varies person to person, but it may not be comfortable to have the cervix physically stretched. Some providers will require the patient to remain in hospital once a bulb is placed. Others will place the bulb and ask the patient to come back when it falls out, which would mean they should be 3-5cm dilated. If there are problems, the bulb can be deflated and removed quickly and easily. 

Homeopathy and Natural Induction Methods
Homeopathic remedies and herbs are not frequently recommended by OB/GYNs, but they may be a good option for some. There are multiple homeopathic remedies that may be effective to nudge someone into labor. As with any other intervention, we always recommend you speak with your doctor or midwife about what options may be best for you. 

Acupuncture is a centuries-old practice that may be used to start labor. There are specific pressure points a knowledgeable acupuncturist may use if the goal is induction, although it may not work for everyone. Sometimes multiple treatments are needed, but acupuncture can be a good option to try if one wishes to avoid a more medicalized induction. 

Chiropractic care from a Webster-certified provider does not directly start labor, but it can help align the pelvis properly so that baby can find the best position. Sometimes labor doesn't start because a misalignment doesn't allow baby to drop or sit properly; a good adjustment may help with that. 

Breast pump and/or nipple stimulation can be used to naturally produce oxytocin that may trigger contractions. It can be possible to overstimulate the uterus if this is done too frequently, so it is often recommended to stop the stimulation once contractions are established. As with anything else, it's best to check with your provider if there are concerns. 

2. What are the chances an induction will be successful?

The Bishop score is a test that looks at multiple aspects of your history to estimate if an induction would be successful. This scoring system looks at cervical position, cervical consistency (softness), cervical dilation, cervical effacement (thinning), and fetal station (how high baby is in the pelvis). These aspects are rated on a scale of 0-3, and a score of 8 or above is believed to mean that either the body will begin labor spontaneously or that an induction would be successful. Low scores often correlate with unsuccessful inductions, and the doctor may move to recommending a Cesarean birth. 

3. We've started an induction; now what?

There is no hard and fast rule about how an induction will proceed. A lot depends on how ready your body was at the beginning. For some people, a little nudge is all that's needed to push them into full blown labor. For others, the body needs a bit more coaxing, and the induction may take a bit more time. Sometimes an induction can be a lengthy process; some inductions may actually take multiple days. 

It's normal to not feel much at the beginning; depending on your personal tolerance, it can take hours for the medications used to produce uncomfortable contractions. If this is true for you, that can be a good time to rest while you can. Inductions can become very intense suddenly, so taking every chance you have to just rest and take it easy can pay off in the long run. 

Once contractions are strongly established, some providers will lower or disconnect the medications. Often the body will take over and continue contractions. Others may leave the meds running throughout to make sure contractions stay strong. If you would wish to cut the medications as soon as contractions are established, we recommend you discuss this possibility with your provider in advance. 

4. Can a doula help in an induced birth?

Yes! Doulas can be wonderful support for any type of birth, including inductions. Our support in an induction changes very little and is tailored to each client. Often, we accompany you as you get settled in to start the induction. Some clients then choose to send us home until things ramp up, but that is totally up to the client. We can stay with you, or we can return whenever you're ready. From there the support is the same as any other birth; we can help with comfort measures, talking through upcoming options, and whatever else you most need. 

Throughout the whole process of induction, communication with your provider is important. A birth plan can be a great way to go over your thoughts with your provider, but it is always important to remember that nothing with labor is ever set in stone. 

If you would like to meet to discuss how we can support you through your upcoming birth, please let us know! We'd be happy to schedule a consultation or a phone call to answer all of your questions. 

What is a Postpartum Doula?

You've built a strong support team for your birth. Wonderful! But what happens when you return home with a brand new baby?

New families often need support in the days and weeks after they return home more than ever. Whether this is the first or the fifth baby, parents can often benefit from an extra set of hands. Did you know that there are doulas that specialize in postpartum care? Postpartum doulas are specifically trained to provide education as well as direct support through the postpartum period.

Why not just have family come help? They don't charge! 
It's wonderful if you have family close by that can come visit. In many cases, family and friends can be very helpful! But sometimes, new babies can be very distracting for visitors. Who wants to chip in washing dishes when there's an adorable baby to snuggle? 
Families often don't live as close to one another as they used to; for many people, having family come by isn't even an option. 

Hiring a trained and certified postpartum doula ensures that you have a capable, professional support person available to help, whether that means running an errand, caring for baby so you can get a nap, or prepping dinners for the next week. Your doula doesn't come over to see baby; we come to help meet your needs for the day. You focus on bonding with your baby; we'll handle the rest! 

Another benefit of having this professional support is that these doulas are trained to recognize the signs of postpartum depression. Doulas are not medical providers, but we can start that discussion and provide resources when needed. The postpartum time can be a hormonally-charged period of emotions; postpartum doulas are trained to help notice when things are no longer quite normal and can point out these changes so that additional help can be sought. 

While many families feel the greatest need for support during those first few weeks, there is no time limit for finding a postpartum doula. Need a couple nights of sleep while your child hits a sleep regression? There's a doula for that! Need help prepping meals and setting a pump routine for when you return to work? There's a doula for that! Our doulas tailor their assistance to whatever you need; there is not just one plan to fit everyone. 

So what all does a postpartum doula do?
Postpartum doulas can fill in many different capacities depending on what is needed. The support they provide can include:
Running errands
Meal planning and preparation
Teaching and demonstrating infant care tasks
Basic infant care
Basic housework tasks
Educational support
Caring for baby so parents can nap or shower
Overnight care

There is a postpartum doula for every situation. Whether you are a first time parent who just needs a confidence boost or you've adopted a toddler and need help adjusting, we can support you through your parenting journey.

The Little Orchids Difference
There are many postpartum doulas, so how do you choose? When you hire the doulas of Little Orchids, you have the benefit of working with the only local group of doulas. What if your regular doula gets sick? We can send a backup so that your schedule is uninterrupted. What if you need an emergency last-minute shift worked in? Between all of us, we can usually accommodate late scheduling. What if you feel you would better connect with a different doula? That's fine! We can change assignments until you find someone you are most comfortable with. 

Interested in our postpartum doula services? Check out our website or contact us to schedule a consultation. 

Affording a Doula

Having personal, in-person doula support through your labor is an investment, and people may be surprised at cost of hiring a doula. The prices doulas charge varies widely, often anywhere from $350 to $1,200 or more. With such a wide range of prices, many families may feel that they cannot afford a doula. While the total cost might seem daunting, there is a variety of creative options you may be able to draw from to cover the fee. 

We rarely hear anyone say they regret hiring a doula, but so often we hear from many who regret not hiring one. Your baby will only have one birth; while costs are eventually forgotten you will always remember if you felt supported through that experience.

Before we talk about how to pay for a doula, I think it is also important to think about what that fee really covers. Every doula should be able to clearly lay out how many meetings and what labor support is included in their cost. Beyond that, there are still multiple other commitments a doula makes to support you. 

1. Accepting a client means that your doula is willing to be on-call 24/7 in the weeks around your due date. This means that your doula will drop everything, day or night, at your call. This means that the doula will not go too far away and will keep their cell phone handy and audible at all times. If the doula has children, this also means that they will have a solid plan for childcare for any time you go into labor. This can mean that the doula may have to cancel their own appointments last minute or miss holidays and birthdays. 
2. Doulas are unregulated, so their training may vary. At Little Orchids, our standard is that every one of our doulas is certified or trained and working towards certification as a doula with their choice of professional doula organizations. These trainings, certification, and continuing education to maintain certification and remain up-to-date can all add costs for the doula. 
3. Your doula is agreeing to support you during your labor- no matter how long that takes. Whether your birth takes 2 hours or 30 hours, your doula is there. At Little Orchids, this is one reason we work in doula teams. If you do have a longer labor, your doula can bring in their doula partner when needed to make sure you have a fresh doula to continue supporting you.
4. In many (if not most) cases, your doula is self employed. This means that your doula pays taxes and fees associated with owning a business. 
5. The cost of fuel and car maintenance can be expensive, and doulas often have to travel frequently. Although driving to and from consultations, prenatal visits, births, and postpartum visits are  the travel time associated with initial consultations, prenatal and postpartum home visits are all included in the cost of doing business, these expenses do add up.
6. Being a doula can be a physically demanding profession. Your doula may miss nights of sleep and skip meals during births. Your doula may get physically exhausted from massaging, providing counter pressure, or otherwise supporting you for hours on end in whatever position is most comfortable for you. 
7. Your doula gains experience with each birth they attend. Working with different doctors and nurses and in different hospitals and birth locations gives your doula a unique perspective that allows her to understand current policies and options. 

So, how do you pay for these services?

For some families, payment is not an issue. That’s great! For others, it can be more difficult. If you do need a bit of a boost, here are a few ideas:

1. Payment Plans
   Many doulas accept payment plans, so ask if this is an option. Generally, the fee for your doula is not due all at once, and payments can be made over time. 
2. Baby Registry
   Did you know that many doulas offer gift cards or gift certificates? Add these to your shower registry to see if family and friends would like to help chip away the cost. 
3. Health Savings Accounts and Insurance
   While many health insurance companies do not directly cover doulas, it never hurts to ask. Your doula may be able to provide a superbill for support and any classes taken with which you can request at least partial reimbursement. 
   Some doulas are able to accept payment through HSA cards. If you already have funds set aside in one of these accounts, that may be a good option for some. 

In the end, doulas are human. If you have questions or concerns about the cost of services, please ask! Many doulas are able to work with customized payment plans, and some doulas may offer occasional discounts. While we do need to make doula-ing a sustainable way to support our families, most doulas are not in it purely for the money. We truly love what we do, and we want every family to be totally supported through their birth experiences.