BY JAMIE LOBER JAN 2012
Two Support Systems During Pregnancy and Birth
It is normal to be curious about the changes your body experiences before, during, and after pregnancy. Worry is another frequent emotion. Many women are opting today for more natural birthing experiences. That’s where doulas and midwives come into the picture.
As you go through physical and emotional changes, it may be soothing to have a doula at your side. “I offer information and education to help empower the woman so she can feel strongly prepared for the time when she becomes a mother,” shares Erica Lockwood, doula at Gentle Beginnings in Warner Robins. You can build an ongoing relationship with your doula. “You can call anytime, and I will go to your house and stay with you until you are ready to go to the hospital. That way, you do not have to spend the early stages of labor in the hospital,” says Wilma Matos, owner of Gentle Beginnings.
Doulas encourage you to learn all you can about pregnancy. “Part of being educated on the actual body and physiology of birth, what is happening, and why leads to empowerment for the mother. She does not feel tense about things, and it helps the couple feel prepared,” says Lockwood. Typical courses and services offered by doulas may include:
•Natural childbirth classes
•Prenatal nutrition classes
•Prenatal belly dancing
•Lactation consulting services
•Infant massage classes
•Infant CPR classes coming soon
Most importantly, the doula will help you decide which type of birth will be best for you. “We talk about medication versus non-medication. A woman who does not have an epidural, spinal block, or medication has freedom of movement. There are many other available natural options to deal with the sensations of labor. When a woman has medication, she is limited in what she can do to help make her more comfortable,” says Lockwood.
The doula can be reassuring for husbands as well. “We can guide him on how to help his wife during the process, so it is a relief for him to have someone there,” says Matos. Remember that the doula does not take the place of your medical doctor, but is rather a member of the team. “It is teamwork,” Matos emphasizes, “I do the support job and everybody needs to be on the same channel and have really good, open communication.” She cannot imagine herself holding any other job. “I see myself as a sister to the mom, like her best friend.”
Today’s doulas are much more diverse than their predecessors. In ancient times, wise women guided and helped other women through the journey of birthing. It was only in the early seventies,that these professions began to make a comeback. After decades of over-medicating women and their babies, the comeback has progressed slowly.
Middle Georgia is now catching on to the benefits of these methods. “As we become more cost-conserved in managed care, a lot of practices are moving toward having midwives,” shares Jennifer Smith, C.N.M., midwife for Dr. Kathleen Mont-Louis at Empower Women Health Center in Macon.
Three types of ‘midwife’ are credentialed in this country:
1.Certified Nurse-Midwife (C.N.M.)
2.Certified Midwife (C.M.)
3.Certified Professional Midwife (C.P.M.)
The first two categories are certified by the American Midwifery Certification Board (AMCB). C.N.M.s and C.M.s undergo rigorous training and examination, and the designation is working toward requiring a graduate degree within the next few years. The C.P.M. category, however, requires much less rigorous training. Its midwives are certified by the North American Registry of Midwives.
“Nurse Midwives practice collaboratively with OB/GYN physicians, and having a midwife in the practice provides patients with more opportunities for education and discussion of options regarding their childbirth experience,” explains Jeri Willeby, C.N.M., with Drs. Schuessler, Pope, Kehl, Barnes, and Durso. “They get the best of both worlds, a midwife for education and support and a physician for complications should they arise.”
“Midwives are trained to manage a woman’s basic healthcare from adolescence through menopause and beyond, though the majority of their practice is focused on childbearing women,” according to Willeby. “We can do her exams, pap smears, counsel her about lifestyle choices, exercise, diet, sexual responsibility, sexual dysfunction, and guide her through family planning choices and through her pregnancy and postpartum period,” Smith adds.
Still, midwives acknowledge that there is no sole preparation for pregnancy. “Every birth I have ever attended had differences that can stem from mom and dad’s personal preference all the way up to something that was outside the norm,” says Smith of her experiences.”
A midwife can generally give much more bedside support than most obstetricians. Often, an obstetrician may have to leave for an emergency during a delivery, whereas the midwife can likely stay the duration.
Smith further explains, “We are nurses first, and nurses are trained to teach. Doctors are trained to give your diagnosis, your prognosis, and your plan of care.”
Midwives recommend counseling before actually planning a pregnancy, and once pregnant, they recommend women begin prenatal care in the first trimester, at ten or eleven weeks. “I answer questions and provide a lot of education throughout,” Smith explains. Midwives want to be available to any woman who is planning for a normal, healthy pregnancy. “Should someone have a high risk indication, like being on insulin for diabetes or recurrent pregnancy losses, we want her to be with the physician under his care,” says Smith.
Willeby adds, “Many women who choose to give birth without interventions benefit greatly from the care of midwives who wholeheartedly support their choices. However, many of our patients want interventions such as epidural anesthesia, and my goal is to educate them regarding their options, and the risks and benefits involved, while supporting their choices.”
Throughout the journey, the midwife offers counseling. Smith explains, “We talk about your own individual risk factors, like achieving and maintaining a healthy body weight, exercising on a regular basis, eating a healthy diet, alleviating risk factors like smoking and drug use, and healthy sexual practices to limit exposure to disease.”
Doulas share the goal of making the woman as informed as possible. “We want women to have all the information. Once they have the knowledge, they can make their own choices, and we support them in whatever their choice is,” affirms Lockwood.
Both doulas and midwives love when women ask questions and open up about their thoughts and feelings during this magical time of childbirth. “I am always excited when a woman takes a really active role in her pregnancy instead of just allowing her care to be managed by someone else. I like a woman who takes charge of her own health. My role as a midwife is not to care for the woman. My role is to guide her as she cares for herself,” expresses Smith.
Willeby echoes that sentiment saying, “Pregnant women are not sick. They are going through tremendous physiological changes as they prepare for the most exciting event of their lives. Much of what they experience is out of their control. As their provider, I want to give them the chance to control the things they can.
Things to consider when choosing a midwife:
• What is your background, training, and experience? Are you licensed?
• What is your philosophy of birth?
• How many births have you attended?
• How long is an average prenatal visit? (Will you have adequate time to ask all of your questions?)
• Do you have a partner? If so, what is her training?
• Do you have an assistant? If so, what is her training?
• What complications have you handled?
• Do you belong to midwifery organizations and/or subscribe to professional journals to keep up with new information?
• Do you do continuing education units to keep current with new information?
• What postpartum care do you provide? How long?
• What is your c-section rate? Do you do vaginal after cesarean?
• What is your fee? Which fees are separate? What about payment plans?
• Do you accept and bill insurance? Which ones?
Things to ask when choosing a doula:
• What is your philosophy about childbirth?
• What training have you had?
• How many births have you attended or helped with as a total?
• May we call you with questions or concerns before and after the birth?
• When do you join women in labor? Do you come to our home or meet us at the hospital?
• Do you meet with me (us) after the birth to review the labor and answer questions?
• Do you work with one or more backup doulas when you are not available? Can we meet them?
• What is your fee? How do you expect payment to be made?