Hiring a Doula

I am a firm believer that doulas come in all shapes and sizes.  Some of us choose to certify, and some of us don’t.  I know some doulas who are not certified, but hold more birth knowledge and experience in their little finger than many of us do in our entire bodies. I have seen doulas who took an online certification course (with no in-person training or experience required) and tout that they are experts in their field. Believe me, not all doula certifications are created equally, and certification is not the only way to pursue this work. Some doulas prefer to gain their experience through apprenticeship and community involvement rather than going through organizations like DONA.  There is no perfect path to becoming a doula.  What makes us doulas isn’t a title, it is the heart that drives our efforts to support families and bring positive changes to our communities. 

So what do you look for in a doula?  How do you know that you are getting the quality that you expect in your experience?  Research.  Just as a business owner would look at a resume, check references, and have some email correspondence with a new recruit before an interview.  Check out their website, look at their reviews on multiple platforms (Facebook, Google, and Doula Match), look into the organizations they are associated with and ask around your local birth community to see if the doula is well recognized. 

I clicked around on my certifying organization’s website and found a few lists that might be helpful when beginning this process.  Those lists are in bold and the links to more information are cited at the end of this page. 

Wondering what you should look for when hiring a doula? Here are a few key points that parents consider.

  • Training
  • Certification status
  • Experience
  • Availability
  • Services offered
  • Conversational compatibility
  • Fees
  • General instincts about having the doula in your home or private space

Another common theme that comes up during interviews is the list of questions that we see in so many mommy-blog articles.  “10 Questions to Ask Your Doula in an Interview,” and so on… Don’t get me wrong, questions are a great tool to help you narrow down which doulas you want to meet with, but the most important purpose of an interview is connecting.  Most reputable doulas list their training, experience and philosophies on their websites.  If they don’t, or they don’t have a website, this is a great time to connect pre-interview through email.  You would be surprised at how well you can connect with someone before you meet them face-to-face, and I don’t know any doula who isn’t willing to answer questions or offer a list of references ahead of time through email correspondence. BUT, more than anything, don’t forget that the interview is allllll about connection.  It is important that you feel comfortable inviting your doula into your home and into some of the most intimate moments of your life; otherwise, things can be just plain awkward during your birth. So yes, a few prepared questions or talking points are great to bring to an interview, but remember that the interview is about connection… and a long, tedious list can be more distracting than helpful in finding the right doula for you. 

Questions to Consider After a Birth Doula Interview:

It’s a wonderful opportunity to choose a doula to be a part of your birth experience! Sometimes, you just know that a particular doula is the one for you, and sometimes you need several interviews to find just the right person (or people, some doulas work in teams). These questions might be able to be helpful as you choose a doula who is the right fit for your family.

  • How comfortable was I with the doula/s?
  • Did the doula/s communicate well with me and my family?
  • Do I feel confident that the doula/s will be able to work collaboratively with my birth team?
  • What was the doula’s level of knowledge? Did one seem more knowledgeable than another? Did I feel that my questions were answered thoroughly?
  • Do I feel comfortable having this doula (these doulas) in my home?
  • If there are unexpected situations, or if I need support early in labor, do I feel confident that this doula (these doulas) can offer what I’ll need at the time?
  • Who is the right doula to nurture and support my family through this process? Did I feel a connection?
  • What does my overall intuition say?

To recap, when hiring a doula, do your research.  Not all doulas are created equally.  Learn about them and find what drives their work before meeting them.  Understand how they gained their knowledge-base and what organizations they associate with. If you aren’t able to answer the important questions through your own research, begin a dialogue via email or text. Go into your interview looking for connection, take note of how you feel, whether or not the doula will flow well with your vision for your birth, and more than anything listen to your intuition. Because any good doula can agree with me that our goal is for you to have a beautiful birth experience, and connection plays a huge role in how well-supported you feel during your birth.  You’re likely to be in a room with your doula  for a very long time.   Feeling comfortable is key.  And if you don’t feel that magical doula connection you think you should feel, I promise we won’t have our feelings hurt — we probably know another doula who might be the perfect match for you. 

The lists included above were found on the DONA International website:

What to Look For When You Hire a Doula

No is a Complete Sentence.

Let’s talk self-advocacy…

Lately I’ve received a lot of messages, and have seen questions on social media, where a pregnant person is asking for research and data to argue a point (or prepare to argue a point) with their care provider.  This was a huge mistake that I made during my pregnancy and my hope is to address this as simply as possible so that I can help others avoid unnecessary anxiety.

If we trust our care provider and are on the same page about our wishes from the very beginning, the likelihood of disrespect and confrontation is much lower.  This is why building a trusting relationship with our care provider and keeping an open line of communication is so important.  I find that there are two common reasons why many of us find ourselves in this defensive position: 

  1. We never really researched and interviewed care providers to be sure that we were on the same page.  So many of us continue with our OBGYN as usual when we become pregnant without considering whether they hold the same values that we do about birth.
  2. We’ve had a previously traumatic experience and have an underlying distrust of care providers. Unchecked, this can lead to iatrophobia, which is a fear of doctors that can cause anxiety and panic. 

No is a complete sentence.  It’s that simple.

Arguing your opinion is counter-productive and unnecessary. No is a complete sentence. Your care provider is there to answer your questions and provide information and support, NOT to convince you of anything.  But we are all human beings, and sometimes personal bias creeps into the equation, even when we have done everything in our power to create and maintain a healthy relationship.  So how do we prepare for those circumstances without living in fear or anticipation that it will happen or that we will have to fight or argue our point? 

There is a reason why this is such a common concern.  As humans, our immediate response to confrontation is fight or flight.  When perceiving a threat, we always react in one of these two ways, but just as I mentioned in this post about facing our inner tigers, sometimes all we need is to find our inner truth and know how to respond confidently.  Because some tigers feel very real but are only in our heads.  We have the choice to react or respond

So what do we do when we are feeling pressured or unheard by our care providers?  How do we respond without reacting?

  • First, take a deep breath bringing your attention back to the breath helps bring you out of that fight-or-flight reaction and grounds you so that you can respond appropriately.
  • Ask any questions you may have, but if you already know your answer, “Yes” and “No” are both complete sentences.
  • If you don’t feel heard, calmly reiterate that you understand your options, you’ve made a decision and you don’t wish to discuss it further.  This normally gets the point across.
  • If you still don’t feel heard, ask the provider to make a note in your chart.  Whether you are saying “no” or you feel that symptoms aren’t being addressed or taken seriously, a care provider will almost always pay closer attention or take a more serious look if asked to document the encounter. 
  • If you have done all of the above and the provider continues to disrespect your personal choice, calmly dismiss yourself and find a new provider. 

I want to stress that finding a new provider should be your very last resort.  And that brings us back to finding a provider you trust with your choices from the very beginning.  The provider-client relationship is the most important part of your pregnancy.  Just as I advise all of my clients to interview 2-3 doulas before making a final decision, I also suggest they interview multiple providers at the beginning of their pregnancy.  If you’re not sure about how to interview a care provider or what questions to ask, I have a printable PDF that can help you get started.

If you’ve experienced previous trauma and need more thorough communication throughout your experience, consider choosing a smaller practice where you have a better opportunity to get to know your provider during your pregnancy.  Tell your care provider that you have had negative experiences before and that communication and understanding are important to you.  Hypervigilance is a sign of anxiety, and if you find yourself in the position where you trust your provider, but are inclined to prepare for every possible situation where trust could be breached, this is something that needs to be addressed sooner rather than later.  If we don’t unpack our trauma, it will follow us into our births, especially if that trauma is care provider related.  Hire a doula, find a therapist who specializes in pregnancy and postpartum, and face your paper tigers now so that you can better recognize them as they are when you are in labor.

Doulas are for Partners too…

One of the most common conversations that I have when I first meet a client is about the partner. So many partners are intimidated by doula support because they are worried that the doula will 𝘳𝘦𝘱𝘭𝘢𝘤𝘦 them during the birth. This is a common misconception. ⁣⁣⁣⁣⁣⁣⁣⁣

Partners, there is no one in this world who knows your partner better than you — and no one can touch the level of emotional support you will be able to provide. 𝘠𝘰𝘶𝘳 𝘪𝘯𝘵𝘪𝘮𝘢𝘤𝘺 𝘮𝘦𝘢𝘯𝘴 𝘺𝘰𝘶 𝘢𝘳𝘦 𝘵𝘩𝘦 𝘣𝘦𝘴𝘵 𝘴𝘰𝘶𝘳𝘤𝘦 𝘰𝘧 𝘴𝘶𝘱𝘱𝘰𝘳𝘵 𝘵𝘩𝘢𝘵 𝘺𝘰𝘶𝘳 𝘱𝘢𝘳𝘵𝘯𝘦𝘳 𝘸𝘪𝘭𝘭 𝘩𝘢𝘷𝘦 𝘥𝘶𝘳𝘪𝘯𝘨 𝘭𝘢𝘣𝘰𝘳. ⁣⁣⁣⁣⁣⁣⁣⁣

But I hear you asking, “if I’m the best source of support for my laboring partner, what value does a doula bring to our experience?” ⁣⁣⁣⁣⁣⁣⁣⁣

The answer is this: 𝐲𝐨𝐮 𝐦𝐚𝐲 𝐤𝐧𝐨𝐰 𝐲𝐨𝐮𝐫 𝐩𝐚𝐫𝐭𝐧𝐞𝐫 𝐢𝐧𝐭𝐢𝐦𝐚𝐭𝐞𝐥𝐲, 𝐛𝐮𝐭 𝐲𝐨𝐮𝐫 𝐝𝐨𝐮𝐥𝐚 𝐤𝐧𝐨𝐰𝐬 𝐛𝐢𝐫𝐭𝐡 𝐢𝐧𝐭𝐢𝐦𝐚𝐭𝐞𝐥𝐲. Your doula has seen countless people birth babies. We offer unattached support— we are not emotionally intermeshed in your experience, and there is so much value in having a support person who isn’t attached to an outcome, or upset to see their loved one in so much discomfort. It allows us to keep a clear head so that we can best support the family through the process of birth. We have had a lot of training that helps us better understand how and when to help, and to be honest, sometimes the partner needs just as much support as the birthing parent. Birthing babies is hard work!⁣⁣⁣⁣⁣⁣⁣⁣ I included the featured image of this post because it specifically shows how hard the entire birth team works to support the birthing parent. It truly takes a village, and everyone involved will play an important role in the process.

As a doula it is my job to support the birthing parent 𝐀𝐍𝐃 𝐭𝐡𝐞𝐢𝐫 𝐩𝐚𝐫𝐭𝐧𝐞𝐫 during birth. It is common during labor for a partner to want to help, but not know how to support the mother through the intensity. This is where the doula steps in. Your doula can help you better support your partner and give you more confidence in your role, as well as offer breaks so you can take care of your own needs. Doulas are there to work as a team with the partner (NOT replace them) so that the birthing parent is given the best, most well-rounded support possible.

⁣⁣⁣⁣⁣⁣⁣⁣𝘐𝘵 𝘪𝘴 𝘪𝘮𝘱𝘰𝘳𝘵𝘢𝘯𝘵 𝘵𝘰 𝘳𝘦𝘮𝘦𝘮𝘣𝘦𝘳 𝘵𝘩𝘢𝘵 𝘰𝘯 𝘱𝘢𝘱𝘦𝘳, 𝘭𝘢𝘣𝘰𝘳 𝘪𝘴 𝘢 𝘭𝘪𝘴𝘵, 𝘣𝘶𝘵 𝘪𝘯 𝘳𝘦𝘢𝘭𝘪𝘵𝘺, 𝘪𝘵 𝘪𝘴 𝘮𝘰𝘳𝘦 𝘰𝘧 𝘢 𝘭𝘢𝘣𝘺𝘳𝘪𝘯𝘵𝘩. Your doula will help you and your partner understand the long list of options that are available to you, and how each option will impact your experience. They will help you find the tools that will best prepare you to advocate for yourselves. It takes a village to bring a baby into the world. A good doula will work with you and your birth team to help each part of the process transition as smoothly as possible so that your family can have a beautiful experience. And partners, we flow with the energy of the room. 𝗪𝐞 𝐰𝐚𝐧𝐭 𝐲𝐨𝐮 𝐭𝐨 𝐝𝐨 𝐚𝐧 𝐞𝐱𝐜𝐞𝐥𝐥𝐞𝐧𝐭 𝐣𝐨𝐛 𝐚𝐭 𝐬𝐮𝐩𝐩𝐨𝐫𝐭𝐢𝐧𝐠 𝐲𝐨𝐮𝐫 𝐩𝐚𝐫𝐭𝐧𝐞𝐫, and we will support you both, in whatever way you need.⁣⁣⁣⁣

Becoming a Dad

Did you know that both parents’ brains physically change between the periods of pregnancy and postpartum? While mom experiences changes beginning immediately, your brain will begin changing around the sixteen week period and will continue for up to two years. Thus begins the magical period of your dad superpower development. Studies show that while the core of mom’s brain changes (the area involving care, nurturing and risk detection), the outer sectors of dad’s brain change (the area involving thought, goal orientation, problem solving and planning). This happens for a reason! Biologically and psychologically, moms have a lot going on in the first few years after conception. To put it into perspective, her hormonal changes are so strong that they are causing your body to have a hormonal reaction that changes your brain. That is intense. The good news is that you can use your awesome new brain growth to help mom move smoothly through pregnancy, birth and the postpartum period. Here are a few ways to do that!

Before Baby is Born

Support her emotionally: This is the most important thing you can do. Pregnancy hormones can be a crazy experience, and between physical and emotional changes/discomfort, some mamas can feel unrecognizable to themselves during this immense transition. A woman’s estrogen levels during pregnancy are equal to taking 100 birth control pills per day. Remind her that what she is experiencing is normal and that she is amazing for making these sacrifices to create life and grow your family. Be patient with her. Tell her she’s beautiful. And more than anything, remind her that all of this is temporary.

Learn about the process with her: Outside of supporting her emotionally, trying your best to understand the physical and emotional changes she is experiencing, and being active in helping her prepare for her birth will make a huge impact on both of your experiences. This will give you the opportunity to better understand her experience, understand her birthing wishes and rights well enough to advocate for her if necessary, and physically and emotionally support her during her birth. I cannot over-stress the importance of educating ourselves about our bodies.  An intensive childbirth education course is an invaluable part of the experience. And if a class is just something that will not work for you, I have so many reading recommendations. Reading together can be a new way to bond through the experience.

Attend care provider visits as much as you can: During checkups you will be able to hear your baby’s heartbeat and hear about his/her development first hand. This can help you feel a stronger bond with your baby during the pregnancy process and is another way to help your partner feel supported.

Support her nesting process: Nesting is some serious stuff. We are biologically hardwired to begin preparing the “nest” for baby, and there are so many aspects involved — lists of things you will need. Do what you can to help her prepare physically and emotionally for baby’s arrival. It is just another opportunity to bond during the pregnancy experience.

During the Birth

Birth is one of the most beautiful and difficult things that we do. As the birth team, we will all be doing a lot of work helping mom through the process of birth, and your job is the most important. You know mom better than anyone in the birthing room. Let her know that you think she is a magnificent goddess for doing the work she is doing. She will need to hear those things and see your awe. Hiring a doula and taking a childbirth education course will help you learn more about how you can physically support your spouse, but the best thing you can do during this birth will be to help her see that you believe in her and to help her keep the oxytocin flowing. What’s all this about oxytocin, you ask? Oxytocin (a.k.a. the love hormone) triggers The Endorphin Effect: it stimulates the production of beta-endorphins, which are 18-33 times more powerful than morphine. That means that your love can actually improve her pain management. That’s pretty amazing, right? But how do we create oxytocin during labor? I’ve included some ideas below.

Laughter: fill your brain with funny stories that you know will make her laugh before the big day. You’ll know when to use your jokes, and they’ll likely keep a good vibe in the room as well as encourage labor progression.

Creating a calm environment: this will be something that your doula will help with… lighting, candles, music etc… your doula will be the one making sure that happens, hopefully without notice. But I like to stress this importance because you will play a huge role in maintaining that environment. As her birth partner,  you will be her voice when she is unable to use it. If things seem crazy at any point don’t hesitate to ask for a moment to yourselves — and you bet your doula will be making that suggestion and clearing the room if you guys need some space.

Kissing, nipple stimulation & sexual intercourse: try treating the early labor experience (if it’s not late at night when you should both be resting/sleeping) as a romantic date night. Light some candles, turn on some relaxing music and profess your love to her. It could possibly help her progress faster, and it’s also a great way to pass the time.

Making sure she is eating and drinking: mom will be working very hard to open and release her baby, and eating and drinking may be far from her mind. Studies show that even hunger, which also causes the body to go into a “fight or flight” response, can stop labor from progressing. This is something we can work together to keep up with. I just like to make note of why it is important.

During the Postpartum Period

The early postpartum period can be crazy. This will be the biggest paradigm shift you experience in your lifetime. And if this is not your first child, you already know this, but you will still experience a period of transition while you integrate a new member into your family. Mom will be experiencing a hormone flush like no other while healing physically from her labor experience and creating a maternal bond with your new baby while she and baby learn their breastfeeding relationship. There are so many things you can do that will help her in this process.

Be sure she is eating, and drinking plenty of water: there are some things I mentioned above (like emotional support) that will be universal through the entire process. Being sure she is given plenty of nutritious food and water will be at the very top of your list along with the others. Breastfeeding is hard, and is a full time job. She will need reminders to take care of herself, and will greatly appreciate not having to think about it. Create several breastfeeding stations around the house (and keep them filled) for her so she never has to think about finding food. Get her a giant water bottle. She will use it.

Keep the peri bottle flowing: The best thing my husband did for me during my early postpartum period was maintain the peri bottle tea. We used a healing herbal tea in my peri bottle and having warm tea in my bottle at a moment’s notice made a huge difference in my comfort levels, and in my healing.

Pay close attention to mom’s emotional health: ask her how she is really feeling, and give her “touch breaks” whenever you can. The postpartum period can be the most difficult part of the entire experience for some moms. January Harshe couldn’t have said it better:

“Because the truth is this — the first few years postpartum are going to pull you so far away from who you used to be — and then they’re going to put you back together as the person you’re meant to become.”

Patience and empathy is so important during this period. If you feel like she is (or both of you are) in over her head, reach out for help. You will be her sounding board during this period. If you feel like things are too intense for too long, voice that. There are so many resources. Your doula can lend an ear and offer suggestions, and finding a support group with others who relate to your experience can make all the difference.

Give her some me-time: When mom isn’t nursing, give her an opportunity to do something for herself. When you have a tiny human attached to your body, regular touch breaks are a godsend. As a new mom, me time is food for the soul.

The most important thing you can do at this point is listen to your instincts. You’ve spent nine months bonding with your partner on an entirely different level. Your doula will have educated you and your spouse about the postpartum period and you will be physically prepared. You will know what to do. And if you ever feel lost, talk about it. There are so many resources. Your doula and childbirth educator will be great points of contact in the coming months. Just remember through the entire process, the more you connect and support your partner throughout your entire experience, the more prepared you will both be as you step into parenthood.

What is a Midwife?

stethoscope near decorative coil tie in heart shape on pink surface

The first thing I recommend to any newly pregnant person is to take some time and effort to find the BEST care provider for their particular pregnancy.  This is a task that is often overlooked and can seem daunting to first time parents. Many pregnant people continue seeing their trusted OBGYN for obstetric care out of mere convenience.  While the relationship that has already been developed is beneficial, it is important to consider that our wants and needs may not be the same as our care provider’s expectations or philosophy of care.  Communication is an integral part of creating the perfect birth team, and being on the same page as our care providers lays the groundwork for a great birthing experience. 

With the rising maternal health crisis in our country, it is important that we educate ourselves about our bodies and make the best possible informed decisions about our care.  The midwifery model of care supports this process. Dr. Timothy J. Fisher, OB-GYN residency program director at Dartmouth Hitchcock Medical Center and assistant professor of obstetrics at the Geisel School of Medicine at Dartmouth University, states that “the midwifery model of care emphasizes normalcy and wellness. It empowers women and gives them greater ownership of their health, their pregnancy, and the outcomes of that pregnancy based on choices that they’re able to make.” In honor of National Midwifery Week, let’s explore this option and understand the different experiences we might have with a midwife. 

What is a midwife and how does midwifery differ from obstetric care? 

A midwife, like an obstetrician, is a trained professional who helps pregnant people through their pregnancy, birth and after the birth of their babies.  The major difference between obstetric and midwifery care is philosophy. A midwife has been trained to work with pregnant people through pregnancy and birth as a natural, physiological experience, whereas an obstetrician is a trained surgeon that has been specifically trained to help patients with complications through their pregnancies and births. Obstetricians are doctors whose education is based around treatment and how to intervene when necessary, while a midwife’s education is based around supporting birth as a normal physiological process. There are also differences in practice. In a birth without complications, a midwife will support the pregnant person throughout the entire labor, while an obstetrician will usually appear at the end of the pushing phase to deliver the baby and the placenta. 

In what types of settings does a midwife work?  What does a birth experience look like in each of these settings? 

Midwives work in multiple settings.  Where with most obstetricians, you are limited to a hospital birth, when choosing a midwife you can find practitioners who specialize in home births, birth center births, and hospital births. In each setting, a midwife will be prepared with the appropriate tools and medications necessary for a safe and healthy birth experience.

Hospital birth with a midwife: A hospital based midwife offers low-intervention birth support with the convenience of hospital amenities. Just as an obstetric patient, the midwifery patient labors at home and is admitted in triage between 4-5cm dilation. The midwife works with the patient intermittently throughout the birth and plays an active role in the patient’s birth experience. If the patient prefers medication like an epidural, an anesthesiologist is available to administer. Think of a hospital midwifery experience as a hospital experience with a more patient-centered model of care.

Birth center birth with a midwife: A birth center midwife is similar to a hospital birth midwife with the exception that the patient will labor at home, come to the birth center to have an unmedicated birth at around the same time of admission as the hospital (4-5cm), and return home within a shorter time frame than they would with a hospital birth — usually 3-6 hours compared with a 24 hour hospital stay. The midwife will remain in close contact with the patient for the first few weeks. Just as with an obstetrician or hospital based midwife, they will see the patient at a six week follow up appointment. This is a great alternative for patients who don’t have an ideal home environment to give birth and don’t have access to hospital based midwifery. 

Home birth with a midwife: Home birth midwives offer much more personalized care than other providers.  During prenatals the midwife will take extra time with their patients to better understand the wants and needs for their pregnancy and birth.  This may not be possible with a hospital based midwife or obstetrician who usually work in larger practices with larger amounts of patients and stricter schedules. It is typical to receive at least one home visit so that the home birth midwife can become acquainted with the patient’s home. As soon as labor begins, the midwife and her assistant will come to the patient’s home and offer support until the baby is born. They will clean up any messes, tuck the new parent and baby into bed, and make plans for home follow up visits before leaving. They will maintain regular contact until the patient is released from care.  

Psychologically, birth is one of the greatest paradigm shifts of our lives.  Studies have shown that birthing parents’ memories of their experience are clear even decades afterward. Proper support during labor can be life changing.  So how do we know that we’ve made the right choice? How do we know that we’ve found the perfect care provider? There are so many questions that we should ask ourselves when considering what type of care provider we want and whether the care provider we are interviewing is a good fit.  If you’re not sure where to begin in finding the right care provider for you, I’ve created a free printable guide that covers questions you should ask yourself and your care provider when making this important decision. If you’d like to know more about how the midwifery model of care and childbirth education will play a integral role in the de-medicalization of birth, you can read about it in depth here.

The De-medicalization of Modern American Birth:  Finding Balance through Childbirth Education and Midwifery

man love people woman

Over the centuries, birth has been revered by cultures around the world as a sacred rite of passage, and celebrated with dramatically different spiritual, medical and cultural rituals.  Through the development of western medicine and the transition toward obstetric care from traditional midwifery, we have nearly lost the importance of mind-body connection during birth, and in turn, the spiritual and psychological significance that birth has on the female condition.  This has resulted in a shift toward medically treated care and minimized focus on individualized, support-centered care in our society, which has brought a rise in prenatal and postpartum depression, as well as higher cesarean rates and other medical interventions.

The 20th Century Shift Toward Obstetric Care

During the early 20th century, traditional immigrant and African midwifery in America was replaced with modern obstetric care, and for the most part, midwifery was only utilized in underprivileged communities of color.  White birthing parents were fully transitioned into obstetric care, and by “1921, the majority of [individuals] who gave birth under conditions that were indigenous, eclectic, spirit based, and not according to the standards of modern medicine, were the rural black birthing [individuals] of the South” (Kelena Reid Maxwell, Oct. 2009). Traditional methods of childbirth had been replaced with hospital-centered care, medication and later, machine monitoring.  

The spiritual and psychological processes of learning to trust, surrender control, and listen to our bodies during labor were nearly lost within the modern medical system. Fear-based mentalities that we are unable to safely handle the difficulties of birth without being medicated and carefully monitored by machines and obstetricians became the social norm leading into the 21st century.  Birth had fully transitioned from a normal physiological experience to a hospital based medical experience enmeshed with unnecessary intervention, and without evidence of effectiveness.

Currently, the United States holds the highest rate of maternal mortality in the developed world, which continues to rise as it declines elsewhere.  According to this National Geographic article, “more than 700 [birthing parents] die each year in the U.S. from causes related to pregnancy or childbirth. Black [individuals] have a maternal mortality rate three times higher than that of white [individuals]. At least 60 percent of maternal deaths are preventable.”

Minimizing Unnecessary Intervention while Increasing Support

The WHO estimates that almost 15% of birthing parents develop complications during pregnancy and childbirth.  In these cases, obstetrics can be life saving and beneficial. But in the other 85% of birthing parents, obstetric intervention may be unnecessary and pull focus away from support-based care, which can cause a significant impact on the birthing parent’s psychological health during and after childbirth.  This is where midwifery, a medical profession that focuses on normal, uncomplicated birth and continuous support during labor, can play a significant role.

According to a Canadian study of factors influencing parents’ satisfaction with the birth experience, “[birthing individuals] cared for by midwives were three times more likely to be satisfied with their care (OR 3.32 [95% CI 2.26-4.86]) when compared with obstetrician-led care.”   New guidelines by the WHO suggest that a greater focus on childbirth education, and a collaborative midwifery-obstetrician model of care (where care is provided primarily by midwives, and obstetricians provide 24-hour back-up support without competing clinical duties), along with insurance reforms that equalize fees for vaginal and cesarean births, can reduce overall cesarean section rates. An article from the British Journal of Medicine states that the de-medicalization of birth will require “taking pride in a low cesarean rate, developing a culture of birth as a normal physiological process, and having a commitment to one to one supportive care during active labour.”

In 2012, the University of Toronto published a paper in the Cochrane Database of Systematic Reviews. That report, which analyzed over 15,000 births, found that parents with continuous labor support are more likely to have a shorter, spontaneous vaginal birth and less likely to have a cesarean; they are less likely to require medication, and less likely to report dissatisfaction, while their babies are less likely to have low five-minute Apgar scores. This evidence shows that in most cases, when parents birth in a natural, physiological way, there are fewer complications for parent and child.  

Education is KEY.  

Continuous support is KEY.  

Insurance reforms that equalize fees for vaginal and cesarean births are KEY.  

Obstetricians and midwives working together to create a better system of care is KEY.  

There is no excuse for the United States to have such high maternal mortality rates. Use your voice, make an informed choice. Hire a doula. If you are experiencing a low risk pregnancy, do your research and find a care provider who specializes in low intervention and continuous labor support. We can make a difference in modern maternal care, but until we take steps to make change, there will be no change. Let’s make a conscious decision to make things better for birthing parents in the American medical system.

“There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them.”

— Dr. Dennis Waitley