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Angela Ivory Angela Ivory

Can I have an OB and a Birth Doula?

Over the last two years (2020/2021) there have been more queries than ever before for those seeking the support of a birth doula. Worldwide we have a crucial shortage of midwives, and sadly NZ is no different. Anxious mothers-to-be send out bulk emails to doulas advising us that they cannot find a midwife, that the midwives don’t reply to their emails or phone messages and that they have exhausted every option of securing their support. And they so desperately want the support of a midwife. Can we help?

Our midwives are already at capacity and a few I know personally tell me they just cannot reply to every text/phone call that they receive daily. One had 46 queries in one day! They are sorry that they cannot get to you, their heart aches that they cannot offer you their support. They are then told you will be allocated a community midwife, and no disrespect at all, but this is just not what they want. They desire the continuity of care, the ‘one woman, one midwife’ relationship.

So what is Midwifery and the partnership model?

“Partnership is a key concept for the midwifery profession, whatever setting they work in. Midwives work in partnership with the woman and her family/whānau, providing or supporting continuity of midwifery care throughout the woman’s maternity experience. This partnership is based on a relationship of trust, shared decision making and responsibility, negotiation and shared understanding.

The word midwife means ‘with woman’ and is reflective of the midwife’s role in accompanying the woman on her journey through pregnancy and childbirth into motherhood. The midwife has a responsibility to share all the available information with the woman and to respect her values and beliefs. The midwife also acknowledges the woman’s autonomy in her own life and respects the decisions she makes for her childbearing experience” (NZ College of Midwives, 2021)

Why the strong desire for midwifery care over obstetric care? My clients have said the following:

  • I don’t want to only have one option - birthing in hospital

  • I can’t afford a private obstetrician

  • I want to birth at home or a birthing unit

  • An obstetrician is a doctor with specialist qualifications in delivering babies and providing medical care to women during pregnancy, labour, birth and postpartum. Obstetricians have the skills to manage complex or high-risk pregnancies and births, and can perform interventions such as ventouse or forceps deliveries and perform caesarean sections. If I have an obstertrician as my lead maternity care provider, I will therefore be more likely have more intervention.

  • Obstetricians are medically focussed - always looking for something to ‘go wrong’

  • I know I am more likely to birth as I would like to if I had a midwife who shares the same strong belief with a focus on natural physiological birth

  • If I have an obstetrician, I know I will just end up having a caesarean and I really don’t want that

When there are no midwives available - what do you do next?

You have the option of being allocated a community midwife (you will see several over the duration of your pregnancy), but you will not know who will be caring for you during your labour and birth.

You have the option of paying for private obstetric care - a team who rotate shifts, so you get to meet them all, but again, not know which one you will have when you go into labour and give birth.

Is this a bad thing?

This question can be answered in many ways. It comes down to what YOU desire, to what is important for you (and partner, if applicable). How do you build a trusting relationship with just one person if you don’t see just the one person? Who is really going to understand you, your fears, needs, wishes? Who is knowledgable but can extend their supportive hands?

And…. this is where having a birth doula comes into the picture….

A birth doula is a companion who supports a birthing person during their labour and birth. Birth doulas are trained to provide continuous, one-on-one care, as well as provide information/referrals, physical support (massage/acupressure/optimal positions for labour & birth) and offer strong emotional support to the birthing person and their partners. Their backgrounds differ but may also include holistic therapies, yoga, childbirth education, nutrition, past early childhood teachers…… we are a diverse group, but all have one thing in common. Big hearts!

It is our focus to support you no matter what birth you want. We walk your journey with you and stay by your side throughout your labour and birth, cheering you on & reminding you that you have got this, and you can do it! Let’s not forget the partners, the mother of the mother, the mother-in-law, sister, best friend…… they need support and reassurance too (and sometimes just a strong cup of tea!). We are your best birth buddy friends - with you no matter what. Read more on the evidence on doula care: https://evidencebasedbirth.com/the-evidence-for-doulas/

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But, how do you work alongside an Obstetrician?

Unlike an obstetrician, a birth doula arrives at your home when you are in early labour, encouraging you and supporting you until active labour (where possible). We massage your back, provide reassurance and unwavering support to get you through that long, latent phase. With you, we transfer to hospital and the support continues. We advocate for you if desired (but never speak for you), we remain close to you for those moments when it gets intense. We tell your partner you are in pain (but you are not suffering), we encourage them to help with massage or remind them of affirmations that you have chosen, to change the playlist, to keep you hydrated, to remind you to empty your bladder. We don’t have a medical role, so therefore don’t interfere with an obstetrician’s role. They are going to ensure you and baby are safe and healthy medically, we will ensure emotionally you are well and physically as comfortable as possible. It’s a winning team effort!

Does my Obstetrician have to meet my Doula?

No. However, it is advisable (and they will know when you go over your birth plan with them) that you tell them you have the support of a doula. A good Obstetrician will not talk you out of having extra support - they will encourage it. They too want the best outcome for you.

What if I can only just afford an Obstetrician but desperately want a birth doula too?

Find a doula that you ‘click with’, who supports your birth philosophy, and ask them if they offer a payment plan. Let them know you would love their support. They will always be willing to work something out, so don’t be afraid to ask.

Birth Doula Support here: https://www.bespokebirths.co.nz/birth-doula-support-1

Find your Obstetrician here: https://www.bespokebirths.co.nz/find-your-midwife

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References:

NZ College of Midwives. (2021). New Zealand Midwifery. Retrieved October 13, 2021, from https://www.midwife.org.nz/midwives/midwifery-in-new-zealand/

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