Hiring a doula (for OB vs. midwife care)?

[namasteak]

I used a midwife and doula for my first 2 births. A midwife and doula provide different services...A doula is more for mental support and the midwife is more for the medical side of things.

Are you delivering in a hospital or a birth center or at home? If its anywhere but at home I would definitely suggest a doula because the other places the midwife will have to split their attention.

[namasteak]

Also, breech does not necessarily prohibit natural birth.

[gastro]

I am not considering this. Given my age, previous birth etc I will be delivering at a hospital with an OB (hopefully the one I am seeing but she has small kids and if not scheduled induction which I may need I will deliver with the oncall OB). I mostly want to be in a hospital with all the NICU services right there.

That said my first was born in the UK and as standard practice saw only midwives during my prenatal care. It wasn’t always the same midwife because national health care, but they were all very supportive and knowledgeable and I felt I got great care. They did suppport/advocate for unmedicated births.

I think figuring out where you want to give birth is important. And if it’s a hospital does this midwife practice have privledges to have you deliver there.

Edit: just saw you were delivering at birth center at hospital.

[zarapipe]

I'm also interested in a doula but it's really not in our budget to hire one for $1k so I assume I'll go without. I would like to go med free, but it just depends. I've been induced twice already so I think the likelihood of another induction is high which makes me think epidural, so idk.

[namasteak]

Dec 5, 2018 15:12:37 GMT -5 melmaria said:

namasteak , I am delivering at a birth center inside of a hospital. My midwives don’t do home births.

My thought was to labor at home for as long as possible and that it would be nice to have a doula for that part of the process as well.

That sounds like a good plan! A doula can help with pain management techniques and figure out when its time to head to the birth center.



Is this your first?

[namasteak]

gastro Doulas help with hospital and medicated or section births too! FWIW I'm delivering in a hospital this time and will be getting a doula.

zarapipe Look for a doula in training, they are often less expensive. Like I said to gastro, Doulas are for all kinds of births. Doulas job is to help support you in the birth you want!

[namasteak]

Dec 5, 2018 15:28:14 GMT -5 melmaria said:

Dec 5, 2018 15:22:54 GMT -5 namasteak said:

That sounds like a good plan! A doula can help with pain management techniques and figure out when its time to head to the birth center.



Is this your first?

Yes, this is my first.  I'm 32 and so far having a low-risk/normal pregnancy.  

I'm afraid of the pain, but I'd still like to do what is helpful to achieve an unmedicated birth if I can.  (Except for hypnobirthing/hypnosis.  I know myself, and that stuff is not for me.  I don't think I could keep a straight face.)

Doulas can help you learn pain management techniques but so can a good birth class. SO it really depends on what you think you will need and how you think your partner will respond in labor. 

Surprisngly, DH was so upset by seeing me in pain that he was not much help and I was thankful to have my doula. Fwiw, I don't want people touching or talking to me for most of labor but it was VERY helpful have her there when it was time to push. 

[Susie]

I thought about it with my first, because I wanted to try for an unmedicated delivery, and MH is not historically great with medical situations, pain, or gore.  My OBs were fine, but support for an unmedicated delivery was not on their priority list.

Ultimately I didn't hire one because MH was pretty adamant that he didn't want extra people there, and he promised to rise to the occasion.  We took lamaze classes at the hospital instead, where many of the nurses are very supportive of med-free/etc. birth experiences.  It ended up fine.  MH rose to the occasion, the nurses helped, and it was all over really fast anyway. Knowing what to expect from the class helped me quite a bit.  I'm glad I didn't spend $$$ on a doula, because one probably would not have even made it to the hospital in time.  I had a roughly 4 hour labor, and delivery about 20 minutes after I arrived at the hospital.  My OB only made it because he was already at the hospital with another patient.  At the speed I delivered, there was no time for any pain meds until lidocaine for stitches afterward.

I'm currently with the same OB practice and planning for the same hospital for #2.  I'm not hiring a doula because man, if #1 was fast, what is #2 going to be like!?  I also just feel a lot more confident going into it this time, having done it before.  I will spend $$$ on a photographer this time before a doula.

[namasteak]

melmaria I found a bath or shower and squatting were the most helpful until I hit transition. Then I wanted to push on my back with someone helping hold me knees up as close to my shoulders as possible (thus opening my hips in a similar fashion to squatting).

Learning to focus on my breathing really helped me breath through the pain of contractions.

[hamster]

I planned on it for my first, because I had no idea what to expect, wanted somebody there who could better explain pros and cons, and a general support person for both myself and H.

He ended up being a breach c section planned in advance so I did not move forward with the idea.

[kitkat1502]

I had a Doula, I still got an epidural though. She provided an attentive level care that I really liked. Spouses are great, but she knew different methods and techniques to try. I think I held off on the epi longer with her there vs if I was alone. I also think the induction played a role in the epi, the contractions were so fast and painful early on I couldn't stop throwing up which that is what really made me ask for it. It was comforting to have her during the epi process since DH had to leave, and she was hands-on afterwards when I got horrible shakes. Disclaimer though, my midwife practice had something called a "Doula Pool" where they offset the price of the doulas they work with, so my cost was $300.

[ebeth]

I delivered without pain meds in a hospital with a MW. I had a doula. The midwife tried to be with me as much as she could be there were 5 other midwifery patients in active labor at the same time so I didn't see much of her until it was time to push (and I don't *think* she was there for all of the pushing because I pushed for like 3 hours).

The doula was useful because a) the MW just could not be there for the entire time b) she was quite good at calming me and H (but mostly H) when we were worried if something was normal and c) she was very good about suggesting alternate positions for contractions and pushing. I had to be induced so I didn't labor at home at all, and had a short labor generally, but doulas can also be helpful if you're in active labor for a long time (getting you snacks/drinks, giving your spouse a break to shower or eat) and telling you when it's time to go if you are laboring at home. My doula also came to visit me a couple times post-partum and helped me with breastfeeding at home which was really nice.

Basically, I strongly recommend a doula even though I didn't really 'use' her too much

(not currently pregnant just accidentally ended up here instead of H&F and saw this post. wanted to respond because delivering with MW or even having a doula with an OB attended birth is definitely not the norm in this cohort)

[katespade]

I'm a FTM, hoping for an un-medicated birth with a midwife at a hospital, and we've hired a doula.

My doula provides prenatal and postpartum support, along with birth services. She and I have been communicating pretty regularly for the majority of my pregnancy, and we had our first official prenatal appointment with her yesterday. We talked through all sorts of things, like how H and I are both feeling as we get closer to full-term, birth plan considerations, pain management options, ways that H can help me with prenatal pain/tension, labor positions, breathing techniques, counter pressure options, and some of the basics as far as the stages of labor, what to be aware of as things start get moving, and how H can support me throughout the process. Since baby is currently breech, we also talked through some of the options for flipping her and how H and I are feeling about the possibility of a c-section if she doesn't flip and whatnot.

Overall, I already feel like it's been well worth our money to hire her. This is all uncharted territory for both of us, and we both feel like it will be really beneficial to have someone there in the moment to provide us with guidance and emotional support, so that the rest of the medical team can be focused on baby and we can still feel like there's someone in our corner to take care of us.

[Susie]

Dec 5, 2018 15:46:25 GMT -5 melmaria said:

Susie , that is a fast labor for a first time mom!

What was most helpful for you for doing it without meds? Positions, breathing techniques, counterpressure, etc.?

I labored in the tub at home, which helped me be more comfortable.  I'm pretty sure in retrospect that I went through transition in the bathroom at home, because I was having trouble not involuntarily pushing in the car and was fully dilated upon arrival in L&D.  That was actually kind of scary, because as a FTM I just assumed my labor would be like a day, and I thought the pain I was in was normal and would persist for hours and hours and hours at that level.  It probably helped that there was no one offering me an epidural or anything so the temptation was never there, but I never felt like I couldn't handle it.  I would not say it's the most painful thing I've ever done.

I breathed through the contractions, which Calvin timed.  I just told him when they started and stopped.  Nothing more exciting than that.  I did not want hands on me, or help, or talking.  There were no birthing balls, massage, pressure, or anything like that.  I just went to the same mental space that I used to go in the last couple miles of a long race.  When I was pushing I remember telling Calvin and the nurse, who were holding my legs, that I wanted them moved, held higher, etc.  That helped.

I must have done ok, because the OB, who came in at the last minute, did not realize I didn't have an epi.  After I delivered DD and the placenta, he went to work repairing a tear.  OMG WITHOUT PAIN MEDS.  After all that.  I made him stop and give me some lidocaine and let it work before that shit went any further.

[babybuffalo]

To offer an alternative perspective, I used an OB practice and at the end of my pregnancy rotated through seeing most of the doctors in the practice. Once you start going biweekly/weekly, it was just a lot easier to go with whoever was available that worked with my schedule. In the end, I ended up delivering with one of the two OBs I had never met, but it was 100% fine and I honestly did not care at all in the moment.

I always hear that people fear that the OB will only be in for the end of pushing, OB was in the room frequently as I labored, seeing if I needed anything, checking on my progress, offering help and advice. She stayed in the room for the entire 3 hours I spent pushing. It was a really good experience.

[mccallister84]

Susie 😮 to repairing the tear sans meds. I HAD an Epi both times and both times my OB numbed me before stitching me up (I guess they turn off the epi pretty quickly after delivery?).

[Queen Mamadala]

melmaria, is this your first? I definitely recommend a doula if you're planning to go med-free. CNMs can be great, but they're not going to be a hands-on support person throughout your labor. They'll check up on you here and there, but won't stay with you, especially if you have a longer active labor.

I had the option of a doula with #6, but decided that, because I precip and my husband was going to be there, it seemed best for my husband to assume that role. (I saw OBs and a midwife -- former homebirth provider throughout my pregnancy) But...looking back, I wish I had opted to have the doula stay with me. Babe was ROP (posterior position) the entire time. It took f-o-r-e-v-e-r for labor to finally start. I wanted as few interventions as possible, which my midwives (and OB) were aware of and 100% supportive. He was in a really stubborn position, so there was just a lot of waiting and waiting and H and I doing things to get labor going naturally. And more waiting. It was...boring. I was impatient and the hospital bed was super uncomfortable. Had the doula stopped by, she could have assisted me in various exercises and movements to help him turn LOA or OA. Exercises that I couldn't do on my own and you need someone familiar with the techniques.

I probably would have done a few things differently to avoid all the waiting and delay. My H was great. We watched a lot of HGTV and movies and he picked up Italian food and massaged my feet and back. We did lots of walking and I took a hot shower hoping it would get things going like with #2. I ended up needing pitocin to get into active labor, despite being 7 cm. My oldest hung out and assumed H's role while he checked on the younger kids and got lunch.

[cherryvalance]

I had an entirely different perspective/desire for my first delivery, but I also echo babybuffalo . My OB stayed around and was available throughout my entire labor (just about 24 hours) and I appreciated that he had seen me through the entire process and accurately evaluated what was going on so he could advise me appropriately. I felt entirely comfortable with the options he gave me and had an awesome c-section experience, which I partly credit to his attentiveness.  ETA: I'm only sharing this to say, I think most of this is provider-dependent, so I would go with whatever practice made me feel comfortable. 

The nurses were also great. I really wanted to labor on my own without people around, lol, but when I needed someone, they were there and they made it clear they were happy to stay with me. I think that's entirely staff and hospital dependent, so I'd ask how hands on they are if you are planning on doing a tour.

I did share your concern about delivering with someone I didn't know, and I'm glad it was my OB who did my c-section, but ultimately I realize I probably wouldn't have cared in the moment. I'm sure that's person-dependent.

All in all, I think you have an excellent grasp on what you want, what might happen, etc, so I don't think it would hurt to ask everyone (your midwives, staff at the birthing center, the doula) what role they'd each play, how attentive they'd be, etc and then decide from there.

[Susie]

mccallister84, for real. And then he turned to my H and said "I'll make it look like nothing ever happened."

That + postpartum care that I didn't love were the primary reasons I was planning to leave the practice for #2. Nothing bad happened, I just didn't really feel as supported as I wished I did, especially then as a FTM and being brand new to EBFing. But I went for an appt in October at the OB & CNM practice that was recommended to me by a whole bunch of people, and the gossiping nurses and the overall structure of their care didn't appeal to me so I went back to the devil I knew.

[namasteak]

Susie it sounds like you really don’t like the practice you are at. You are still early enough to research and transfer care to a provider you feel better about.

[Susie]

Dec 5, 2018 21:27:33 GMT -5 namasteak said:

Susie it sounds like you really don’t like the practice you are at. You are still early enough to research and transfer care to a provider you feel better about.

I researched before I got pregnant with #2, I tried another practice when I got pregnant, and I researched again after I didn't like them.  There isn't a practice to switch to that is a significantly better fit.  At least for now, I've decided that going back to the practice that I went to with DD is the best combination of hospital privileges (at the hospital nearest my house) for delivery, an office that's convenient to my work for appointments, is pretty well run and timely, and where I really like 1 in 4 OBs.  The other 3, at least I know what to expect with.  

I'm envious of the people who love their birth experience and care providers, but I'm in a small city with finite choices.  My choices are further narrowed by my hospital preference, which is mostly based on my history of precipitous delivery and worry about having to drive any further.  I don't love my practice, but for now going with what I know is less stressful than constantly hunting for a better option. 

[woowoo]

We are hiring a doula. I love my husband, and he's been incredible through the last year of infertility treatments and through this pregnancy so far, but he's positively clueless regarding labor, delivery and postpartum everything. I'd like a doula for help pre and post, laboring at home, goal of a med-free birth, and BF assistance.

My mom will hopefully also be here (she's booked her flights for a week pre and post my due date). She's been a nurse for 35 years and will help support us from a medical perspective if something goes wrong, etc. But I need to know I have someone if I go into labor early.

Susie, it's interesting to hear you compare your mental state in transition towards the last leg of a long race. I have another friend that has done half/full ironmans and said the exact same thing. She also sipped Tailwind through most of her labor (was allowed clear liquids) and swear that helped her get through. I'll be doing the same for sure!

[Susie]

Dec 6, 2018 5:55:09 GMT -5 woowoo said:

Susie , it's interesting to hear you compare your mental state in transition towards the last leg of a long race. I have another friend that has done half/full ironmans and said the exact same thing. She also sipped Tailwind through most of her labor (was allowed clear liquids) and swear that helped her get through. I'll be doing the same for sure!

I had gestational diabetes last pregnancy, so I knew that they planned to check my blood sugar hourly during labor.  You should have seen the stock pile I had prepped for L&D:  in case my sugar was high I had low cal Gatorade and Nuun.  In case it was low I had my regular sports nutrition products, I had gels in case it dropped really low... lol.  I seriously prepared for it like it was an HIM.  I was allowed liquids and sports drinks as long as they were not red.

I didn't end up using any of it because my labor was so fast, but it WAS handy to have a huge stash of drinks for when I was later BFing.  It made me indescribably and insatiably thirsty for months.  It also just helped me feel more in control to draw the analogy to something I knew how to do and approach.

[ivy]

I had a doula with my first and was with a midwife practice. They actually encouraged it. I ended up with an epidural 24 hours into my induction, and we both still got a lot out of having a doula there. They're very helpful for med-free births, but just as helpful in my opinion for medicated deliveries as well, especially if it's your first. She knew where the sick bags were when I got sick going through transition. She put fresh wet wash clothes on my while I pushed and fed me ice chips. After the baby was born, she was basically the one who told my H what to do (go be with the baby) because it was an intense delivery and DD was taken away immediately. She got pictures of DD for me after she was worked on and before they took her to the NICU which was the first time I was able to "see" her. When my H went to the NICU with DD (she was there for less than an hour thankfully), the doula got me food and cut it up for me. She called the hospital LC for me before she left. I don't know what I would've done if my H and brand new baby were gone and I was all alone after delivery. I mean, nurses were there, but they were cleaning me up and cleaning up the room. It was nice to have someone there who was just there for me.

I wouldn't hesitate to hire one again except I'm having twins this time. Waiting to see what the chances are for a vaginal delivery first.

[namasteak]

((( Susie ))) I realized how bossy my post came across, sorry!

[pooh8402]

Dec 6, 2018 9:36:20 GMT -5 melmaria said:

I’m starting to think my complete lack of athleticism is not going to help me with labor. LOL.

Hopefully the half-assed walking and prenatal yoga I’ve been doing will be enough. I am not a marathoner/Ironman/triathlete/CrossFitter/etc.

You might be surprised. I'm as unathletic as they come, and while I'm a wimp as far as pain goes and got an epidural pretty early, it turned out I was a pretty good pusher and it only took 2 contractions. I do think walking and staying limber helps.

[Susie]

all good, namasteak

[Deleted]

Not getting a doula is my absolute, without a doubt, number 1 regret with babyharpy's birth. I wound up being induced on 39/6 with a ridiculously unfavorable cervix (1cm, 0 effacement, +3 station). The process took for-fucking-ever and was super stressful to me. The childbirth education class I took at the hospital made it seem like the nurses would be hands on in the labor process, suggesting positions, helping with comfort measures, etc. I did not find that to be the case at all. All told, it was 42 hours from the start of the induction to babyharpy's birth via C-section. I stalled at 9cm for 6 hours. My OB says my pelvis is narrow. We'll obviously never know if I could have delivered vaginally had we done anything different, but I absolutely do not believe that we did everything possible to promote a vaginal delivery. (My OB thinks we did because we gave it a lot of time, but I was prone with an epidural the whole time and the nurses didn't even suggest something like the peanut ball to open my pelvis. My OB finally said to try it 22 hours after my water broke, but by that time, I'd been stalled at 9cm for 4 hours and my uterus was just too tired.)

I didn't want to spend $1,000 on a doula because we'd already spent so much money keeping H alive in 2017. But if I could do it over again, I absolutely would get one. I had zero instincts kick in with how I wanted to labor. My H was as clueless as I was. We had taken the childbirth class at the hospital, but when it was actually go time, it was just so overwhelming.

I don't really have the time right now, but one thing I hope to do in years to come is to do some advocacy work to get doulas at least partially covered by insurance. Research shows that having one-to-one support throughout the labor process improves outcomes, which would reduce costs for insurers, so I think it's in their interest to lay out $500-$1000 at the beginning to try to reduce the incidence of C-sections (mine was billed at $74,000).

[Deleted]

melmaria, obviously my experience was not necessarily the norm. Some people have a clear idea of what they think will help. Some people have strong instincts that kick in and they want to be in XYZ position. I basically spent two days lying in bed, crying because I was anxious AF. At the time I would have needed to book a doula, I had no idea that's how it would go. The other hospital my OB delivers at offers doulas for $75 - I really wish every hospital did that.