Independent midwives v doulas - experiences?

[downbutnotout]

I am 11 weeks pg and trying to make my mind up whether to book an independent midwife for the birth (I'm lucky enough to have the choice). My dd was supposed to be a home birth and I saw my lovely community midwives for ante-natal care. Unfortunately when I went into labour, they were unavailable and I was attended by midwives I had never seen before. I am convinced that it was a combination of this fact and the NHS protocols they applied that meant I ended up being transferred to hospital by ambulance in second stage labour. This was frightening and traumatic, and I ended up delivering normally without further interventions when I got there, so in my opinion it was totally unnecessary.

I'm very wary of trusting myself to the NHS system again as I would also like a home birth this time, but for various reasons I am dubious about going the whole way and hiring an independent. Can I achieve what I want by just hiring a doula as my birth advocate?

I'm a doula.

What I do is meet with my clients twice during the antenatal period. Then I stay with them throughout the labour, help them establish feeding and go back to do a birth de-brief a few days later. I've supported women through homebirths and hospital births. I do not do anything medical or clinical, nor do I make decisions for my clients.

An IM would take care of all your antenatal checks and give you a highly personalised service. She will attend you throughout your birth and, unlike a doula, can assist you medically as necessary. If you need to transfer in to hospital she would go with you. If she has a relationship (and I think insurance) with your hospital she'll be able to continue in her role of mw otherwise she would, effectively, become your doula. She would also do your post birth checks.

I think it's important that you think about what would suit you the most. There are some incredible IMs out there and also some incredible doulas. I think it's worth meeting people and seeing who "fits" with you be it IM or doula.

I am by no means an expert on IMs but hope I've given you a balanced view of both of our roles.

was going to reply earlier and see that mars has beaten me to it!! ditto what she said!

One point to consider is that Independent Midwives are very unlikely to have any insurance so god forbid if anything went wrong there would be little point suing.

Having said which I think in general Independent Midwives offer a fantastic service and worth the money. A close friend used one and had a successful homebirth.

Best of luck whatever you decide.

I had the same IM for both my last two births and would STRONGLY recommend it, if you can find the right midwife.

Not dissing doulas - they are generally great and can make a big difference to birth outcomes. The big advantage of having an IM though is having someone oversee your care and take full responsibility for it - for me this was the main advantage of having an IM.

I've booked IMs this time after a very similar story to you last time, though with longer time in hospital and more unnecessary interventions.

Continuity of care is the big big plus, I think. The NHS simply can't offer that.

In my limited experience of meeting IMs while choosing, it is also my impression that they are interested in the whole you in a way that NHS midwives simply don't have time to be (in fact, one of them said to me that that was a big part of why she came out of the NHS). They seem to do a lot of helping women process previous bad experiences with birth, too - there's certainly a counselling element to their role.

I had a fantastic doula with my second baby, she used to actually be a mw, but she acted only as a doula in hosiptal, ie. nothing medical. but she was SUCH an amazing support, so amazing I have just asked if she can be with me for th delivery off dc3

btw, my reasons for having a doula the second time were same as yours - they say doulas hugely reduce intervention rates etc. ds actually ended up an amazing labour in terms of I was SO in control and had no pain relief, he got stuck with shoulder dystocia but all resolved fine - sure having a doula there made a huge difference to how I felt at the time.

The lack of insurance for IMs is a scandal. Not for the IMs but for the government who has left them at the mercy of outrageous insurance premiums. I've yet to meet an IM who didn't want insurance.

Whichever way you go be sure that she's the one for you. A good IM or doula is worth their weight in gold!

what mars said basically..

the main difference is that an IM is a MW and a doula is not !

a doula cannot deliver your baby or do your antenatal care...

if you do transfer in from home to give birth, your IM will be able to come with but as a birth partner, she won;t be able to deliver your baby

definitely worth weighing up the pros and cons, meets some Ims and doulas, and see hwo you feel

Thanks everyone - I am debating fiercely with myself about it, not least because of the expense involved. But I feel so strongly that the last birth could so easily have been a postive experience if the midwives and I had faith in each other, and I feel like you only get that when you know someone well. The insurance issue is a worry though...

Also, just after I posted, I met my would-be NHS midwife and she didn't have good news. She is the only community midwife specifically covering my area and she is part-time, so the likelihood is that I will be attended by someone I've never met before for the birth. Also, they cannot guarantee me a home birth: if a midwife is not available I will have to come into hospital.

A lot of food for thought.

Why did you get transferred first time?

Depending on the reason it is still possible this could happen with independent midwives too.

If you really want a birth outside of hospital then independent midwives would give you the best chance (i.e. no excuse of staff shortages etc) but for medical reasons you might find you still end up in hospital. If you do then there is a good chance your independent midwwives won't be allowed to do anything much more than watch owing to hospital rules and lack of insurance. They can be your 'doula' although how good they are at performing this alternative role may depend on the midwives you hire. A doula rather than independent midwife might be better at supporting you and being your advocate in a hospital setting as they may be more used to it.

My own experience of independent midwives was that they were an expensive waste of money as I ended up transferring to hospital as soon as the first one came to my home to assess me. Possibly she panicked a bit as I started bleeding but blood loss was pretty small and hospital staff thought it was 'normal'. However, like you I ended up with loads of unnecessary intervention in hospital and I actually think I got worse treatment than I would have had if I hadn't been transferred to hospital from what was perceived as a 'high risk' home birth. I wasn't high risk but the hospital thought I was as they didn't know anything of my medical history. In fact I'd had lots of tests and antenatal care but midwife didn't hand over my notes to them! I'm not sure what percentage of planned home births end up in hospital but it is worth being prepared for the disappointment even if you hire independent midwives.

if ytou are told there are not enough midwives to ensure you get a homebirht, please look at the www.aims.org.uk website ,and email them if necessary. there are sample letters and things on there , you are legally entitled to have a home birth and if you book one, the hospital have several months notice to ensure there are available midwives in the community

Great - thanks for this - I have plenty to inform my research. Now if I could only make up my mind...

lulmama that link was great - am drafting a stern letter as we speak!