Doula : Midwife :: ____________ : ____________

You remember these from the SAT, right?

communication : telephone :: _____ : scissors

a) blades
b) metal
c) cutting
d) tool

I LOVED those kind of questions. And I just learned they're a lot easier to answer than to compose! But I digress.

In a previous post Kim asked what the merits/overlap would be in having both a doula and a midwife. I get this question from prospective clients all the time.

The answer (chime in doulas, midwives, moms with experience in this arena) is that because the midwife is responsible for your and your baby's health and well being, and the doula is responsible for your comfort and confidence, there's little overlap in the written job descriptions. The merits of hiring a doula -- continuous physical and emotional support during labor, education and empowerment in advance of labor -- are the same whether your health care provider is a midwife, family practice doctor, or OB/GYN.

In reality, things aren't exactly that cut and dry. If you are planning a homebirth, your midwife is likely to bring a team that includes her assistant and an apprentice. Because you're at home, your overall level of anxiety is probably going to be lower than at the hospital. And because you're planning a homebirth, you can handpick your birth support team to include the family and friends you think will best encourage and hold you through the process.

It is quite likely that in this environment, a doula will duplicate much of the support you'll already have present. Your need for reassurance will probably be lower and you'll have more people to provide it. I'm hoping this is the reason I have never gotten an inquiry from a prospective doula client planning a home birth. She doesn't feel she'll need anyone else.

While this is likely true, I would argue that doulas have a place at homebirths. Midwife friends have said to me that a common misconception is that your midwife will also be your doula. She will not. The midwife has a unique charge that includes making judgement calls about what's best for the mama's and baby's health. She might want to rub your back or hold you in the birth pool, but if heart tones are low, she'll have her ear to the doppler. At that time, the extra presence of a doula could be invaluable.

Similarly, some small number of homebirths end with an unplanned transport. When the midwife takes a patient to the hospital, she (usually -- see my midwife-blog-heroes for some hopeful counterexamples) loses any status as care provider. Depending how hostile the hospital is, the midwife may not even be allowed to go in with her patient. The doula might be one of the few people who could be present at home AND in the hospital to provide that continuity of care.

If you are talking about having a hospital birth with a nurse midwife, then the doula is every bit as important at that birth as at a physician-attended birth. CNMs in the hospital setting may be juggling multiple patients. Nurses definitely will be. Hospital policies will take priority over your and the midwife's preferences in most cases. For these reasons, a doula is a good idea. She can help you advocate for your wishes. She can help bring new CNMs and nurses up to speed at shift changes. She can be there with you every minute, even as the midwife pops back over to the clinic to see patients and the nurse checks in on her other beds.

A big advantage to having both a doula and a midwife is that they tend to be favorably disposed toward each other, at least from a professional point of view. Midwives usually view doulas as an ally. Doulas are more inclined to trust midwives' motives than O.B.s'.

My two cents is that the decision to hire a doula should be determined by where you plan to birth, rather than whom you plan to have catch your baby.

And now, any thoughts on completing the analogy above? It's hard because each of them has a relationship to the birthing mother but not to each other. Give me your best shot, but I think there is no relationship analogy between them.