Doula or private midwife?

[HannahBerry]

Hi, I am keen to get your responses on this. I would love to have a water birth at home. I am moving house a month before my due date, so to limit the disruption that would cause, I thought of hiring the services of a doula or midwife. A doula costs under £1k, but midwife over £4k! We would have to put the latter on the credit card as we can't really afford this.

My worry is that if I end up is hospital anyway would it have been a waste of money hiring a private midwife. On the the other hand, having a private midwife would increase the probability of having a water birth at home. Has anyone faced this dilemma before? Which would you choose? Thanks Hx

Regardless of your preference for childbirth which is entirely up to you and your choice - if you can't afford it do not do it , whatever it may be - holiday , car etc - and certaintly don't do it on credit card.

I've used IM's 3 times - the first time we didn't book unit 36 weeks, but they made such a difference it was the first thing we planned for when considering having any more children.

From my experience, the benefits of having an IM are as much (if not more) to do with the continuity of care during the ante- and post-natal stages as what happens during the birth - but it took us going through the process with DC1 to learn that. How much of that support could have been provided by a doula I don't know as we've never used one.

With regards the exact dilemma of winding up with a hospital birth, that's what happened with DC2 for us - if anything it made us appreciate our IM all the more as we wound up in hospital as the pregnancy had not ended to plan, which made the whole situation more traumatic than we had hoped. The level of care and support we got during and after the event was far in excess of what we could have hoped for with the NHS and that made dealing with the aftermath much easier (for us).

For us, an IM is money well spent - wherever I wind up giving birth. But that's us and our family with our finances. I'd suggest you make yourself as well informed as possible about what the scope of services you can expect from a doula vs. and IM would be and decide which you think you would prefer. It might also be worth working out what you think you want and then calling up a few local IM's and doulas for a chat and seeing how you feel about them - an IM might be the theoretical best choice, but if there are only a couple in your area and you don't feel comfortable with them then it won't be the right choice for you.

There is a reason why doulas are cheaper, they aren't medically trained, they are meant to support you emotionally and to be your advocate.

Hi HannahBerry. Are you not able to book a home water birth via your local NHS community midwives? I've assisted at numerous home water births attended by great local NHS midwives.

I think (for me) it would depend what the home birth provision and support was like in my local NHS team.

If you have a dedicated homebirth team and will have a chance to meet them in advance and/or feel that they are supportive of your wishes, then (as an IM is going to mean stretching yourself financially) a doula could be a great option. As DoulaKate says (and I'm a doula too) there are some great NHS midwives out there. A doula would mean you have some continuity when you move house, help you prepare emotionally and practically for the birth and be a supportive presence on the day. As MiauMau says we aren't medically trained so you would need a midwife there too (though they often arrive after us and leave before).

If you don't feel well supported by the team in your new area though an IM would, as you say, mean you're much more likely to have the birth you want. There are so many brilliant ones and you have the stability of knowing the midwife who will be at your birth. If it wasn't going to be a huge stretch financially then maybe this would be a great option if you weren't confident in the local homebirth team.

I'd also suggest finding out about your local homebirth support group see www.homebirth.org.uk for more details.

What squiggleywiggler said.

I've had one HB with a doula and two with an IM.

The doula was great up to a point. But she was only there for the birth, so I had no support during the antenatal appointments with a very unsupportive midwife who was beyond unhelpful and prone to lying. Then during the birth, despite my birthplan and the doula's support, the MW were very keen to follow their own agenda - and although her presence tempered that to some extent, when you have two medical professionals telling you that you have to do something, one none-midwife was not enough. Also, she left the room occasionally to use the toilet and eat/get me food which they seemed to see as an opportunity. Afterwards there was only so much she could do - her BF support was excellent, but Dc2 was jaundiced and there was meconium and I was left with NHS midwifery "we should be here at some point next Wednesday, probably in the afternoon" appointments.

The IM however Hour long antenatal appointments in my own home at my convenience, asking my permission to do things like take blood pressure, explaining everything, talking to my other children and involving them in the pregnancy/birth (her encouraging DC1 and DC2 to make tiger noises at the poolside when DC3 was born is a fond memory). There was almost too many AN appointments, mostly fortnightly then weekly for 35 weeks. She came daily for a week after birth, then weekly for 6 weeks. Whether we could afford her for DC4 was a factor in his conception, I could not have gone back. Dc4's birth was not straightforward and without her there I have no doubt I would have been given a CS. She's his godmother and still involved in our lives.

Your first birth is the most important one to get right, the one where you have the most questions, the one that affects every other pregnancy you might have. If I wasn't sure, I'd book with NHS midwives and almost interview them, same for a local doula (asking questions about their experience with the local midwives/hospital etc) and IM. Join the UK yahoo Midwifery and HB groups and read the archives, read every article on www.homebirth.org.uk.

If you ask, most doulas will come to antenatal appointments with you. They will also see you regularly before the birth, to discuss your preferences and fears, and to get to know you. It is very unusual for a doula just to be there at the birth.

I had a home water birth with excellent NHS midwives, and plan to do the same this time around. Like Avantia, I would never put something on the credit card I couldn't afford. To be honest we have the savings to pay for an IM - but given the very good care I received last time on the NHS we won't be going down that route.

Hmmmm hard choice. We went with doula then chose kick ass one rather than hippy dippy type. She came to appts and supported me so I got the hb I wanted, on the nhs so much cheaper. Check but I think if youu get admitted to hospital your mw isn't allowed to be more than a birth partner - bit of a waste of money if you can't really afford it. Our doula was ace and really knew her stuff - I was happy with her fighting my corner and a good local mw team

Hmmmm hard choice. We went with doula then chose kick ass one rather than hippy dippy type. She came to appts and supported me so I got the hb I wanted, on the nhs so much cheaper. Check but I think if youu get admitted to hospital your mw isn't allowed to be more than a birth partner - bit of a waste of money if you can't really afford it. Our doula was ace and really knew her stuff - I was happy with her fighting my corner and a good local mw team

What Squiggley said too.

One thing to think about with an IM is the lack of indemnity insurance. If you have a google you'll see the whole sad business, which reflects very badly on the insurance industry and has been very difficult for independent midwives. It may not bother you, but it is something to be aware of.

Personally I would go for a doula if an IM would be a financial stretch. I wouldn't want £3k on a credit card hanging over me like that. My doula was totally kick ass brilliant.

Hi, I had an IM, had planned home birth, but had to go in due to health issues, so couldn't have home birth. But I would say definitely not a waste of money at all, she helped so much. I was in for a week, she was there every day, she helped me make good choices on CS vs. induction.

I think you have to think whether you want a midwife to lead your health care or a really competent birth companion - a doula is not a cheaper version but a totally different service.

Post natally I cannot praise my IM highly enough but I was a strange case as my baby was ill and my IM was utterly amazing.

Yes! SpareChair has it in a nutshell - midwife to lead care or a really competent birth companion totally sums up the choice to me.

Wow, thank you everybody. That is really helpful. And Crotchflakes for the useful comparison. The problem is I won't get to meet the new team until at least 32 weeks! But now I have some more info to make my decision, and I guess I'll let you all know in due course! Thanks again, Hx

Btw- you can INSIST that a MW visits you every day at home for the first 14 days after your baby is born...
And then you can ask the HV to visit you regularly...

That's if you see the midwife to 'insist' Nonno. Some areas send out Maternity care assistant's for the first home visit. Then its off to the clinic after that.

I think mumsnet should start a campaign about the nhs cutbacks in midwifery care, but then that's whole other thread.

Nonno - please can you advise how you can "insist" on daily post-natal visits for 14 days and make it happen when there are so many stories of women unable to get regular antenatal appointments?

I had mainly NHS care when pregnant with DC1 - about 6 years ago. The CMW was deploring the fact that of the 2 post-natal visits they were providing, plans were in place to switch at least one of them to a clinic rather than a home visit. I'm not sure how things are likely to have changed since then to make daily home visits a practical proposition .

Actually, our CMW also resonates with another point that's been made - around here the MW rota for HBs is generated from CMW in a 40 mile-ish area. IIRC there's a pool of 20-40 MWs involved. During the first 36 weeks of my pregnancy I'd met one of those MWs - and she was so unsupportive of HB that the low probability of her arriving for the birth had turned into a positive point. From talking to other mothers, many of the other CMW's have a very different attitude but around here at least, there's no way to be sure of who you'll get on any given day. For me, knowing that 2 MWs (that I got to know better in the last 5 weeks of my pregnancy than I had my CMW in the preceding 36 weeks) who I trusted and had confidence in would be coming when I called gave me a LOT of comfort. Its worth checking the system in the area you'll be moving to as I've heard very different stories from different regions.

(As an aside, there's an e-petition currently operational asking the government to take urgent action to protect maternity services from cuts and to recruit 5,000 full-time equivalent MWs. As I understand it, the irony is that the UK is not short of trained MWs - they just need an opportunity to get a job when they first qualify and/or the support to do that job in a way that means they don't leave the profession due to stress :()

Thank you for your post and for providing that link to the e-petition tangle.

I am very worried about the care I will receive as it is my first baby. I am moving area from a good foundation hospital in East London to one with the busiest labour wards in the UK (in NW London). Along with the usual horror stories I have heard about, this place seems to have more than its fair share.

Moving so late into my pregnancy is far from ideal but I am much more worried about the cuts affecting my care during and after the birth, than the actual birth (pain). It is an unknown quantity, and I want to take some control over the situation hence hiring a doula or IM. It is a shame that I do not feel I can trust the NHS alone.

I had my dd with the midwife led care team at the Lansdell in St Thomas and they were amazing. I saw the same midwife at home for my entire pregnancy and she was with me throughout my labour. I delivered in 7 hours start to finish, in water with only gas & air. I am sure the trust I had in her was a major part of what made this possible.

I am now pg again and have found that the midwife led team isn't at St Thomas anymore so am looking at the private midwife option. I am confused though how it works with hospitals. So I decide I'd like to go back to the St Thomas, see my private midwife throughout my pg, then she comes with me to the hospital I have chosen and works with their team to deliver the baby? Does this work? I can't imagine rocking up to a hospital with a midwife they don't know.

As I understand, when you go into hospital with an IM, they are out of their remit and the hospital team take over, she would remain as a birth partner, but not part of the medical team.

Hi, going off track a little. I just wanted to ask a bit about being a doula. I've just booked an introductory day to possibly do the training which is exciting. The only thing is, I'm friends with a midwife and she told me not to do it as doulas aren't well liked in the midwife profession. I'm all confused now. Do you find it's difficult to form relationships with midwifes? I could ask so many questions right now. Hope it's ok to ask these questions on this thread as I'm new to this group. Thanks x