April 18, 2011 • 20 mins
Midwives and doulas are often present at natural childbirth. But what do these people actually do? Join Cristen and Molly as they explain the differences between midwives and doulas.
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Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to stop? Mom? Never told you?
From House top Works dot Com. Hello and welcome to
the podcast. This is Molly and I'm Kristen. Kristin one
(00:20):
of our most requested topics, and sometimes I feel like
I say that about all the topics but requests, because
don get lots of requests. But this is one that
has stood out is midwives. And so we're going to
approach midwives today with by asking the question what's the
difference between a midwife and a doula? Because I gotta
say I was not aware of the term doula before
(00:42):
a few years ago. Right, I think that you're seeing
a really big renaissance in both midwives and dula's being
present at childbirth, and it it kind of gets into this, uh,
you know, debate over what childbirth should look like. Uh.
In recent years, you hear a lot of things, a
lot of terms like the medic clisation of childbirth and
this move towards natural childbirth UM and a lot of
(01:05):
so people recommended to us the movie Business of Being Born,
which deals with that debate and uh, midwives and duels
are two people who tend to show up when there's
a natural childbirth versus one that's um you know, very
medicalized to use that that term of the debate in
that you know, your lying float on your back in
a hospital, you have an epidural, the doctor comes in out.
(01:27):
Childbirth is you know, that kind of childbirth is often
a stereotyped, is very impersonal, not the way it's supposed
to go. That if you want sort of the to
connect with your ancient uh female ancestors in the way
they've always given birth, then you contact midwives and dulas well.
And midwives and duels may also be present in a
hospital birth, but we do associate them more with natural childbirth.
(01:49):
And why don't we start out with midwives what exactly
midwives do? Because there are different categories of midwives um,
some of which are more contra virtual in the medical
world than others. So let's stop at the top two.
Start at the top tier with certified nurse midwives. And
these are trained as both nurses and midwives, as the
(02:10):
name implies, and they have at least a bachelor's degree
and pass a certification exam from the National College of
Nurse Midwives and receive a state license to practice. So
these are the most accepted among the more mainstream medical community,
and they are often working in hospitals. And then going
down from there, we have certified midwives, which are a
(02:32):
relatively new specialty and they're also college educated, but not
every state is going to license as certified midwife. They
aren't certified as nurses and midwives. And then we have
certified professional midwives and direct entry midwives. And direct intry
midwives are the most controversial because they don't have to
have a bachelor's degree and they don't go through the
(02:53):
more formalized training process, so usually apprentice under a midwife,
but they're not necessarily um passing these exams from the
American College of Nurse Midwives, and not all states are
going to recognize direct entry midwives, and sometimes uh women
are worried about having a direct instrum mid wife help
(03:14):
them with a home birth because if something goes wrong
and they take them to the hospital and they're not
recognized by the state, that direct entry midwife could have
charged legal charges pressed against her right and you know,
a direct entry midwife would say, hey, it's not that
I am not trained. It's not that I don't have
a bachelor's degree. I am trained in the way that
all midwives have been trained for centuries. You know, this
(03:35):
was um art that was passed down from woman to
woman in the village because you know, there were no
doctors for a long time, and so if you were
going to deliver a baby, you would call the local
woman who knew how to do this and direct intry midwife.
Say they're sort of carrying on that tradition. Uh, and
they don't need that, you know, rigid medical training, because
again there's this debate over whether you know, child worth
(03:56):
is something that a woman's body just knows how to
do and she just needs this assistant there or when
something goes wrong with which is what the medical com
you would say, can you have a doctor there in
two minutes to save the baby or save the mother? Right?
Because the doctor's argue that if something goes wrong, it
goes wrong very quickly and very suddenly. And even though
with this idea of ancient midwiffery that women are just
(04:18):
innately given these capabilities to know what to do to
help in a crisis, doctors aren't so sure. But let's
talk a little bit about where this began in the US.
So it started in the States with a woman named
Mary breck and Ridge. She wanted to bring better healthcare
to people living in the remote Appalachian mountains. So she
(04:39):
goes over to Europe taking some notes. She notices how
well these British nurse midwives are assisting women who are
going through labor. So she starts the Frontier nursing service
in rural Kentucky and it's the first real nurse midwiffery
program in the country. And that's right, we should know
(05:00):
that in Europe it's still pretty common to have a
midwife adula. It's not really even a distinction that people
have to make. So this is sort of a uniquely
American question we're asking because while yes, Mary Breckenridge is
establishing midwife programs in rural areas, the people in the
more urban areas are electing around this time to start
going to doctors. Because doctors are putting out the note
(05:23):
that you know, they've got the latest medical advances, they've got,
you know, the ways to save you in childbirth if
something goes wrong. So it's really it starts a big
class divide in that the poor rural people are going
to midwives and the people who have more means are
going to doctors. So then in nineteen seventy six, big
turning point, big turning point, a hippie. We'll just go
(05:47):
in and and call her hippie because she's hippie. Clearly, a
hippie named I Am a Gascon writes this book called
Spiritual Midwiffery that becomes the midwives Bible and not just
Midwife to get spread around to women of the time.
And everyone's like, yes, Aina May has the answer. Ainame
has the answers because, as you can imagine, as part
(06:09):
of the hippie movement, Aina May is all about home birth,
and she or bust birth or bust birth right because
she and her husband and a bunch of other hippies
get together in a bus in the sixties is how
all great stories begin. And they go across the country
(06:31):
and a lot of the women on the bus are priggers,
and you know, at some point those babies gotta come out,
and hence all these home slash bucks bus births begin happening.
An Aname Gaskin becomes kind of like this default midwife. Yeah,
and you know it was sort of maybe the right
time for in her life for that to happen, because
(06:53):
she'd had a really traumatic hospital birth a few years before.
So she kind of finds her calling and she writes
this book about how you know, you don't need to
go to the hospital, you can just have your baby
in the back of the bus. I mean, I'm paraphrasing
and simplifying, of course, but um, she becomes renowned for
starting this commune called the Farm where women still at
this day can go to um work with midwives trained
(07:16):
by Anime Gaskin to have these really natural, beautiful uh births, right,
and uh, just just to go back to to the
bus situation for a second. And by the way, the
bus was referred to as the caravan, the strip that
they were all on. There were eleven babies that were
born on the bus and gascon rights and spiritual midwiffery.
When each birth took place, we all parked in a
(07:37):
sort of protective formation around the bus in which the
birth would take place, and everyone waited for the babies
first cry. So you can kind of get hints of
where that spiritual aspect of us the title comes from.
But this is really sad actually the tenth birth, that
of her own child and in death of her two
month premature son. But that only reinvigorated on his quest
(08:02):
to improve women's home birth experiences and become a better midwife. Right,
So people start passing this book around in the seventies.
Um it's been, you know, just the de facto thing
that you do to go to the hospital, see the doctor,
have your baby. You know, the guy waits in the
waiting room. UM, and Iam is presenting this very radical
idea for our country that you don't have to do
(08:22):
that anymore. Like we said, you know, it's kind of
very American that this is still um a divide, whereas
in Europe it's it's not in another place. It's not
just because you know, there may not be a medical
facility to go to. But anyway, this book gets passed
around and tons of women. There's really a huge resurgence
in the late seventies early eighties, huge new interest in midwives.
And to give you an idea of the size of
(08:44):
growth in the midwife practice, it went from around twenty
thousand births midwife attended births in the US and nine
to almost two d and forty thousand in nineties six,
and I'm sure that number has only gone up. That
still represents only about six percent of the country's total
births attended by midwives. But nevertheless, like we said, it's
(09:06):
still there's there's been a resurgence in the home birth
movement and along with that the use of midwives and
gascon I think we should note is credited with the
development and growing use of something called the gascon maneuver,
which is an approach to dealing with um a complication
a birthing complication known as shoulder dystocia in which a
(09:29):
baby's shoulder becomes stuck in a laboring woman's birthing canal,
and so she figured out a way to to get
the baby out safely. And while the American Congress of
Obsetrics and Gynecologists are very much against midwive assisted home
births for the reasons that we talked about earlier, just
due to maternal safety, there are studies to indicate that
(09:51):
women need fewer um medications. Obviously, there are fewer c
sections that are involved. There's a study in the Journal
of American Public Health Association that found that only two
percent of women who gave birth at home experienced interventions
such as four steps, vacuum extractors, or c sections, while
(10:12):
of those getting birth in hospitals encountered these outcomes. Right,
So it all depends on what your priorities are. You know,
you hear a lot of people talking about making a
birth plan, and you know your birth goals and how
you want just a birth to come out. And for
a lot of women, this return to natural childbirth is
really important, and those kind of statistics really, uh, you know,
speak to the importance to these women of having a
midwife present, someone who can help you use your body
(10:35):
to deliver the baby naturally, as opposed to you know,
maybe a doctor who wants to just get out there
and hurry it along and stuff like that. Right, But
we haven't said single word, Molly about the doulas. Let's
talk about it. Let's talk about dola. Not surprisingly, this
is a Greek word. Da sounds very Greek. Sounds Greek
to me. It's a Greek word that is usually translated
(10:56):
as female servant, and ulas are pretty distinct from midwives.
They're not actually going to be down there catching the baby,
doing any Gaskin maneuvers or anything like that. But as
we'll get to in a second. They will interact with
the doctor if there's one in the hospital. Duelas, though,
are pretty much there to make the mother as comfortable
(11:18):
as possible and help the birthing process along in terms
of positioning the mother or getting her to do calming,
breathing exercises, things like that, kind of like a birthing coach. Yeah,
Kristy and I have both discussed how having just a
duela for real life would be pretty awesome. Yeah, like
around three pm when you're getting stressed, someone just comes
up and he's like Kristin's brief, Hey, Janina, Gina Nick massage. Yeah,
(11:41):
do you need a cool cloth on your forehead? Man? Do?
If that's great? I mean I would call my Dulah
by is there her first name? Because I I also
would not gender discriminate. I could have a male duela.
There are a handful of dula's out there, despite the
translation usually having female in the translation. You mean there
are some male duelas out They're small, small group, but
they are out there. I'm surprised it hasn't been made
(12:02):
into a comedy starring Vince Vaughan. Oh Christ and Your
Dreams are about to come true, because there is a
movie in production. I don't know if it's in production,
it's in it's in pre production. It's a comedy starring
Vince Vaun about a male dula. Okay see aren't wow?
Okay great? And like midwives, dulas have become more popular
(12:25):
in recent years along with the whole home birth natural
birth movement. But a lot of times they are not
going to have any type of certified training and they
are by no means recognized by the American Congress of
Obstetricians and Gynecologists or the American Medical Association, because like
(12:46):
we said, they're really there just to make the mother
more comfortable. And a lot of times they're used by
more affluent couples because they're sort of like a little bonus.
It's it's kind of interesting because in a rural areas
that might not have access to gynecologists who can or
hospitals where women can go, they might not be able
(13:06):
to afford it. Midwives will step in. But dulas are
kind of on the flip side of this, where where
they cost extra. Yeah, and you know, despite the fact
that there are a lot of the same benefits of
using a duela as there are using a midwife there,
they may not be covered by insurance, whereas you may
be able to get a midwife assisted birth covered by
your insurance. So um, adula can cost anywhere from three
(13:27):
hundred dollars to a thousand dollars and um so, yeah,
they are seeing a sort of a luxury extra item. Um.
Although there are programs in some cities to provide low
cost duelists to low income women, some dulas will barter
with you. Um so it's they're only used at about
one percent of births, which is kind of surprising when
you hear all of the benefits which a duela can provide. Statistically,
(13:49):
the Cissian rate is reduced by half, the need for
an epidural is sixty pc less, and labor time is
twenty five percent shorter for women who are using dulas,
So might be worth the extra cost. Yeah. And also
there's been a study that shows that women who use
duelists are more affectionate with their babies after the birthing process,
they're more nurturing. Um than dula can help a new
(14:12):
mother breastfeed, and you can also hire a postpartum dula
to help you make that transition to being a new
mother in your own home. They can run errands, they
can babysit your older children, they can cook meals. And
those duelas are usually paid on an hourly reach right,
And typically duels will either specialize in labor or postpartum
one or the other. But if you decide to have
(14:35):
a baby in a hospital and you want to bring
along your dula, get ready for a due. Uh. Yeah,
we have a lot of stories out there, and maybe
the New York Times was just turning making amount and
out of a mole hill. But duelas don't seem to
get along very well with nurses and doctors. Well, you know,
(14:57):
I think some for the same reason that midwives don't
always get uh the loving support they need from doctors.
It's just, you know, it's an extra person in the room.
So from a doctor's per seerspective, that could be annoying.
But yeah, The New York Times also paints a picture
of some duelas who get kind of in the doctor's faces,
or this woman needs some help and you better helper well. Also,
since they're so focused on keeping the childbirth as natural
(15:18):
as possible, they might argue with a doctor about doing
something like a C section or an epidural. They might
get in the nurses way just trying to keep the mother, uh,
you knows, as all natural as possible. And there were
anecdotes of some mothers getting really frustrated with their duela
for not kind of stepping back and letting them more
medical professionals take over. But again it might have been
(15:40):
you know, that's that's a handful of anecdotes. Yeah, and
you know it's everyone's experience is gonna be different. Probably
not everyone wants a duela or a midwife, but some
people really do. And the hospitals and other birth and
facilities are kind of having a hard time kind of
figuring out what everyone is going to do in these
kind of situations. A lot of states are looking at
laws that would signs or of a midwife to a doctor,
(16:01):
so the midwife could be doing a birth and if
something goes wrong, the doctor has to come in. Doctors
don't love this idea because then they've got to just
basically come in and take over someone set of problems.
And we met this woman, so it's it's very sticky politically,
and you know, the options over what you can do
when you have a kid um. They don't seem to
be going away in terms of this natural versus hospital
(16:23):
or well, because there also hasn't been any conclusive research
saying that doctors are better than midwives are delivering. You know,
we've tossed out these studies saying that um there are
fewer incidences of cesareans and complications and uh needs for
epidurals with midwife assisted and Dulah assisted birth. But that
(16:46):
might also have to do with the fact that women
who are having um children at home might be going
into it a little bit healthier than women who would
know beforehand that they would need to be in a
hospital in case of risks. Right, midwife's I had to
stay with low risk pregnancies, which means a woman who
is between a T and thirty four, who has had
a healthy pregnancy, who doesn't have you know, multiple fetuses,
(17:08):
who you know, it should be a routine birth. And
that's the argument these midwives make is that for a
routine birth, they can handle it, they don't need the doctor.
And so it's a question of when does that low
risk pregnancy become a high risk one. Because the doctors
are saying in a blink of an eye. That's what happens,
and that's why you need to have a doctor there.
So we can't answer the question, but I bet plenty
of listeners out there have had babies a and have
(17:33):
may or may not have used a Duela and or
a midwife and may have Duela's midwives out there too. Yeah, exactly.
So if you have any any connection, any experience with this,
we would love to hear from you and get your thoughts.
You can send it over to our email address at
mom stuff at health stuffwork dot com, or we'd love
for you to share over on Facebook and Twitter. And
(17:53):
I have an email here from Angela and it's about
the vitamins podcast and she had two quick tips that
she wanted to share. Uh, she writes, I donate platelets
on a regular basis because my blood type is compatible
with most people in need of them. And when I
first started giving blood, I noticed I got very weak
and did not feel well for the rest of the
day after the donation. The nurses gave me times for
(18:16):
the cal semuth beginning throughout the donation, but I was
still noticeably weak the rest of the day. Once I
began taking a woman's multi vitamin. Though, these weaknesses all
but disappeared, and I can now give higher amounts of
platelets on regular basis. While multi vitams are not always
the best way for your buy to absorb all the nutrients,
they work for me because of the increased stress my
system goes through during the donation. And her second tibit
(18:38):
is that if you are looking into taking a multi vitamin, uh,
note that it had may have caffeine in it, because
Angela took wine got a little jumping and Woozy didn't
need that. Well, I've got one here from Hannah and
this is in response to our podcast on abortion, and
she writes that I think you did a great job
of discussing the topic neutral e and with minimum gore,
(18:59):
But hearing all the seizures described made me stick to
my stomach. I was determined to tough it out, but
did end up doubled overholding my stomach by the end
of the last description. As negative as this might sound,
I don't mean it as a criticism. Actually, if more
young women heard these descriptions in their high school sex said,
I'm willing to bet that teen use of condoms would
go way up in my sex said class, we learned
(19:20):
about all the places you can go for abortion resources,
but we never learned about abortions themselves. I think a
lot of girls in their teams feel that if they
get pregnant, they can just have an abortion, But maybe
if the information was more widely available, they might not
take that option so lightly, because the procedure sounds extremely
unpleasant under any circumstance. And I do want to concur
in my in my high school, like sex said, kind
(19:42):
of didn't exist, and we really didn't even talk about abortion,
which less what was involved in it. So I think
it would be important for people to know a little
bit more about it. So if you have any questions, comments, concerns,
feel free to a email us at mom Stuff at
how stuff works dot com, be Twitter at moms Stuff podcast,
and see like us on Facebook and me the comment
(20:07):
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(20:34):
Brought to you by the reinvented two thousand twelve camera.
It's ready, are you
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to stop? Mom? Never told you?
From House top Works dot Com. Hello and welcome to
the podcast. This is Molly and I'm Kristen. Kristin one
(00:20):
of our most requested topics, and sometimes I feel like
I say that about all the topics but requests, because
don get lots of requests. But this is one that
has stood out is midwives. And so we're going to
approach midwives today with by asking the question what's the
difference between a midwife and a doula? Because I gotta
say I was not aware of the term doula before
(00:42):
a few years ago. Right, I think that you're seeing
a really big renaissance in both midwives and dula's being
present at childbirth, and it it kind of gets into this, uh,
you know, debate over what childbirth should look like. Uh.
In recent years, you hear a lot of things, a
lot of terms like the medic clisation of childbirth and
this move towards natural childbirth UM and a lot of
(01:05):
so people recommended to us the movie Business of Being Born,
which deals with that debate and uh, midwives and duels
are two people who tend to show up when there's
a natural childbirth versus one that's um you know, very
medicalized to use that that term of the debate in
that you know, your lying float on your back in
a hospital, you have an epidural, the doctor comes in out.
(01:27):
Childbirth is you know, that kind of childbirth is often
a stereotyped, is very impersonal, not the way it's supposed
to go. That if you want sort of the to
connect with your ancient uh female ancestors in the way
they've always given birth, then you contact midwives and dulas well.
And midwives and duels may also be present in a
hospital birth, but we do associate them more with natural childbirth.
(01:49):
And why don't we start out with midwives what exactly
midwives do? Because there are different categories of midwives um,
some of which are more contra virtual in the medical
world than others. So let's stop at the top two.
Start at the top tier with certified nurse midwives. And
these are trained as both nurses and midwives, as the
(02:10):
name implies, and they have at least a bachelor's degree
and pass a certification exam from the National College of
Nurse Midwives and receive a state license to practice. So
these are the most accepted among the more mainstream medical community,
and they are often working in hospitals. And then going
down from there, we have certified midwives, which are a
(02:32):
relatively new specialty and they're also college educated, but not
every state is going to license as certified midwife. They
aren't certified as nurses and midwives. And then we have
certified professional midwives and direct entry midwives. And direct intry
midwives are the most controversial because they don't have to
have a bachelor's degree and they don't go through the
(02:53):
more formalized training process, so usually apprentice under a midwife,
but they're not necessarily um passing these exams from the
American College of Nurse Midwives, and not all states are
going to recognize direct entry midwives, and sometimes uh women
are worried about having a direct instrum mid wife help
(03:14):
them with a home birth because if something goes wrong
and they take them to the hospital and they're not
recognized by the state, that direct entry midwife could have
charged legal charges pressed against her right and you know,
a direct entry midwife would say, hey, it's not that
I am not trained. It's not that I don't have
a bachelor's degree. I am trained in the way that
all midwives have been trained for centuries. You know, this
(03:35):
was um art that was passed down from woman to
woman in the village because you know, there were no
doctors for a long time, and so if you were
going to deliver a baby, you would call the local
woman who knew how to do this and direct intry midwife.
Say they're sort of carrying on that tradition. Uh, and
they don't need that, you know, rigid medical training, because
again there's this debate over whether you know, child worth
(03:56):
is something that a woman's body just knows how to
do and she just needs this assistant there or when
something goes wrong with which is what the medical com
you would say, can you have a doctor there in
two minutes to save the baby or save the mother? Right?
Because the doctor's argue that if something goes wrong, it
goes wrong very quickly and very suddenly. And even though
with this idea of ancient midwiffery that women are just
(04:18):
innately given these capabilities to know what to do to
help in a crisis, doctors aren't so sure. But let's
talk a little bit about where this began in the US.
So it started in the States with a woman named
Mary breck and Ridge. She wanted to bring better healthcare
to people living in the remote Appalachian mountains. So she
(04:39):
goes over to Europe taking some notes. She notices how
well these British nurse midwives are assisting women who are
going through labor. So she starts the Frontier nursing service
in rural Kentucky and it's the first real nurse midwiffery
program in the country. And that's right, we should know
(05:00):
that in Europe it's still pretty common to have a
midwife adula. It's not really even a distinction that people
have to make. So this is sort of a uniquely
American question we're asking because while yes, Mary Breckenridge is
establishing midwife programs in rural areas, the people in the
more urban areas are electing around this time to start
going to doctors. Because doctors are putting out the note
(05:23):
that you know, they've got the latest medical advances, they've got,
you know, the ways to save you in childbirth if
something goes wrong. So it's really it starts a big
class divide in that the poor rural people are going
to midwives and the people who have more means are
going to doctors. So then in nineteen seventy six, big
turning point, big turning point, a hippie. We'll just go
(05:47):
in and and call her hippie because she's hippie. Clearly, a
hippie named I Am a Gascon writes this book called
Spiritual Midwiffery that becomes the midwives Bible and not just
Midwife to get spread around to women of the time.
And everyone's like, yes, Aina May has the answer. Ainame
has the answers because, as you can imagine, as part
(06:09):
of the hippie movement, Aina May is all about home birth,
and she or bust birth or bust birth right because
she and her husband and a bunch of other hippies
get together in a bus in the sixties is how
all great stories begin. And they go across the country
(06:31):
and a lot of the women on the bus are priggers,
and you know, at some point those babies gotta come out,
and hence all these home slash bucks bus births begin happening.
An Aname Gaskin becomes kind of like this default midwife. Yeah,
and you know it was sort of maybe the right
time for in her life for that to happen, because
(06:53):
she'd had a really traumatic hospital birth a few years before.
So she kind of finds her calling and she writes
this book about how you know, you don't need to
go to the hospital, you can just have your baby
in the back of the bus. I mean, I'm paraphrasing
and simplifying, of course, but um, she becomes renowned for
starting this commune called the Farm where women still at
this day can go to um work with midwives trained
(07:16):
by Anime Gaskin to have these really natural, beautiful uh births, right,
and uh, just just to go back to to the
bus situation for a second. And by the way, the
bus was referred to as the caravan, the strip that
they were all on. There were eleven babies that were
born on the bus and gascon rights and spiritual midwiffery.
When each birth took place, we all parked in a
(07:37):
sort of protective formation around the bus in which the
birth would take place, and everyone waited for the babies
first cry. So you can kind of get hints of
where that spiritual aspect of us the title comes from.
But this is really sad actually the tenth birth, that
of her own child and in death of her two
month premature son. But that only reinvigorated on his quest
(08:02):
to improve women's home birth experiences and become a better midwife. Right,
So people start passing this book around in the seventies.
Um it's been, you know, just the de facto thing
that you do to go to the hospital, see the doctor,
have your baby. You know, the guy waits in the
waiting room. UM, and Iam is presenting this very radical
idea for our country that you don't have to do
(08:22):
that anymore. Like we said, you know, it's kind of
very American that this is still um a divide, whereas
in Europe it's it's not in another place. It's not
just because you know, there may not be a medical
facility to go to. But anyway, this book gets passed
around and tons of women. There's really a huge resurgence
in the late seventies early eighties, huge new interest in midwives.
And to give you an idea of the size of
(08:44):
growth in the midwife practice, it went from around twenty
thousand births midwife attended births in the US and nine
to almost two d and forty thousand in nineties six,
and I'm sure that number has only gone up. That
still represents only about six percent of the country's total
births attended by midwives. But nevertheless, like we said, it's
(09:06):
still there's there's been a resurgence in the home birth
movement and along with that the use of midwives and
gascon I think we should note is credited with the
development and growing use of something called the gascon maneuver,
which is an approach to dealing with um a complication
a birthing complication known as shoulder dystocia in which a
(09:29):
baby's shoulder becomes stuck in a laboring woman's birthing canal,
and so she figured out a way to to get
the baby out safely. And while the American Congress of
Obsetrics and Gynecologists are very much against midwive assisted home
births for the reasons that we talked about earlier, just
due to maternal safety, there are studies to indicate that
(09:51):
women need fewer um medications. Obviously, there are fewer c
sections that are involved. There's a study in the Journal
of American Public Health Association that found that only two
percent of women who gave birth at home experienced interventions
such as four steps, vacuum extractors, or c sections, while
(10:12):
of those getting birth in hospitals encountered these outcomes. Right,
So it all depends on what your priorities are. You know,
you hear a lot of people talking about making a
birth plan, and you know your birth goals and how
you want just a birth to come out. And for
a lot of women, this return to natural childbirth is
really important, and those kind of statistics really, uh, you know,
speak to the importance to these women of having a
midwife present, someone who can help you use your body
(10:35):
to deliver the baby naturally, as opposed to you know,
maybe a doctor who wants to just get out there
and hurry it along and stuff like that. Right, But
we haven't said single word, Molly about the doulas. Let's
talk about it. Let's talk about dola. Not surprisingly, this
is a Greek word. Da sounds very Greek. Sounds Greek
to me. It's a Greek word that is usually translated
(10:56):
as female servant, and ulas are pretty distinct from midwives.
They're not actually going to be down there catching the baby,
doing any Gaskin maneuvers or anything like that. But as
we'll get to in a second. They will interact with
the doctor if there's one in the hospital. Duelas, though,
are pretty much there to make the mother as comfortable
(11:18):
as possible and help the birthing process along in terms
of positioning the mother or getting her to do calming,
breathing exercises, things like that, kind of like a birthing coach. Yeah,
Kristy and I have both discussed how having just a
duela for real life would be pretty awesome. Yeah, like
around three pm when you're getting stressed, someone just comes
up and he's like Kristin's brief, Hey, Janina, Gina Nick massage. Yeah,
(11:41):
do you need a cool cloth on your forehead? Man? Do?
If that's great? I mean I would call my Dulah
by is there her first name? Because I I also
would not gender discriminate. I could have a male duela.
There are a handful of dula's out there, despite the
translation usually having female in the translation. You mean there
are some male duelas out They're small, small group, but
they are out there. I'm surprised it hasn't been made
(12:02):
into a comedy starring Vince Vaughan. Oh Christ and Your
Dreams are about to come true, because there is a
movie in production. I don't know if it's in production,
it's in it's in pre production. It's a comedy starring
Vince Vaun about a male dula. Okay see aren't wow?
Okay great? And like midwives, dulas have become more popular
(12:25):
in recent years along with the whole home birth natural
birth movement. But a lot of times they are not
going to have any type of certified training and they
are by no means recognized by the American Congress of
Obstetricians and Gynecologists or the American Medical Association, because like
(12:46):
we said, they're really there just to make the mother
more comfortable. And a lot of times they're used by
more affluent couples because they're sort of like a little bonus.
It's it's kind of interesting because in a rural areas
that might not have access to gynecologists who can or
hospitals where women can go, they might not be able
(13:06):
to afford it. Midwives will step in. But dulas are
kind of on the flip side of this, where where
they cost extra. Yeah, and you know, despite the fact
that there are a lot of the same benefits of
using a duela as there are using a midwife there,
they may not be covered by insurance, whereas you may
be able to get a midwife assisted birth covered by
your insurance. So um, adula can cost anywhere from three
(13:27):
hundred dollars to a thousand dollars and um so, yeah,
they are seeing a sort of a luxury extra item. Um.
Although there are programs in some cities to provide low
cost duelists to low income women, some dulas will barter
with you. Um so it's they're only used at about
one percent of births, which is kind of surprising when
you hear all of the benefits which a duela can provide. Statistically,
(13:49):
the Cissian rate is reduced by half, the need for
an epidural is sixty pc less, and labor time is
twenty five percent shorter for women who are using dulas,
So might be worth the extra cost. Yeah. And also
there's been a study that shows that women who use
duelists are more affectionate with their babies after the birthing process,
they're more nurturing. Um than dula can help a new
(14:12):
mother breastfeed, and you can also hire a postpartum dula
to help you make that transition to being a new
mother in your own home. They can run errands, they
can babysit your older children, they can cook meals. And
those duelas are usually paid on an hourly reach right,
And typically duels will either specialize in labor or postpartum
one or the other. But if you decide to have
(14:35):
a baby in a hospital and you want to bring
along your dula, get ready for a due. Uh. Yeah,
we have a lot of stories out there, and maybe
the New York Times was just turning making amount and
out of a mole hill. But duelas don't seem to
get along very well with nurses and doctors. Well, you know,
(14:57):
I think some for the same reason that midwives don't
always get uh the loving support they need from doctors.
It's just, you know, it's an extra person in the room.
So from a doctor's per seerspective, that could be annoying.
But yeah, The New York Times also paints a picture
of some duelas who get kind of in the doctor's faces,
or this woman needs some help and you better helper well. Also,
since they're so focused on keeping the childbirth as natural
(15:18):
as possible, they might argue with a doctor about doing
something like a C section or an epidural. They might
get in the nurses way just trying to keep the mother, uh,
you knows, as all natural as possible. And there were
anecdotes of some mothers getting really frustrated with their duela
for not kind of stepping back and letting them more
medical professionals take over. But again it might have been
(15:40):
you know, that's that's a handful of anecdotes. Yeah, and
you know it's everyone's experience is gonna be different. Probably
not everyone wants a duela or a midwife, but some
people really do. And the hospitals and other birth and
facilities are kind of having a hard time kind of
figuring out what everyone is going to do in these
kind of situations. A lot of states are looking at
laws that would signs or of a midwife to a doctor,
(16:01):
so the midwife could be doing a birth and if
something goes wrong, the doctor has to come in. Doctors
don't love this idea because then they've got to just
basically come in and take over someone set of problems.
And we met this woman, so it's it's very sticky politically,
and you know, the options over what you can do
when you have a kid um. They don't seem to
be going away in terms of this natural versus hospital
(16:23):
or well, because there also hasn't been any conclusive research
saying that doctors are better than midwives are delivering. You know,
we've tossed out these studies saying that um there are
fewer incidences of cesareans and complications and uh needs for
epidurals with midwife assisted and Dulah assisted birth. But that
(16:46):
might also have to do with the fact that women
who are having um children at home might be going
into it a little bit healthier than women who would
know beforehand that they would need to be in a
hospital in case of risks. Right, midwife's I had to
stay with low risk pregnancies, which means a woman who
is between a T and thirty four, who has had
a healthy pregnancy, who doesn't have you know, multiple fetuses,
(17:08):
who you know, it should be a routine birth. And
that's the argument these midwives make is that for a
routine birth, they can handle it, they don't need the doctor.
And so it's a question of when does that low
risk pregnancy become a high risk one. Because the doctors
are saying in a blink of an eye. That's what happens,
and that's why you need to have a doctor there.
So we can't answer the question, but I bet plenty
of listeners out there have had babies a and have
(17:33):
may or may not have used a Duela and or
a midwife and may have Duela's midwives out there too. Yeah, exactly.
So if you have any any connection, any experience with this,
we would love to hear from you and get your thoughts.
You can send it over to our email address at
mom stuff at health stuffwork dot com, or we'd love
for you to share over on Facebook and Twitter. And
(17:53):
I have an email here from Angela and it's about
the vitamins podcast and she had two quick tips that
she wanted to share. Uh, she writes, I donate platelets
on a regular basis because my blood type is compatible
with most people in need of them. And when I
first started giving blood, I noticed I got very weak
and did not feel well for the rest of the
day after the donation. The nurses gave me times for
(18:16):
the cal semuth beginning throughout the donation, but I was
still noticeably weak the rest of the day. Once I
began taking a woman's multi vitamin. Though, these weaknesses all
but disappeared, and I can now give higher amounts of
platelets on regular basis. While multi vitams are not always
the best way for your buy to absorb all the nutrients,
they work for me because of the increased stress my
system goes through during the donation. And her second tibit
(18:38):
is that if you are looking into taking a multi vitamin, uh,
note that it had may have caffeine in it, because
Angela took wine got a little jumping and Woozy didn't
need that. Well, I've got one here from Hannah and
this is in response to our podcast on abortion, and
she writes that I think you did a great job
of discussing the topic neutral e and with minimum gore,
(18:59):
But hearing all the seizures described made me stick to
my stomach. I was determined to tough it out, but
did end up doubled overholding my stomach by the end
of the last description. As negative as this might sound,
I don't mean it as a criticism. Actually, if more
young women heard these descriptions in their high school sex said,
I'm willing to bet that teen use of condoms would
go way up in my sex said class, we learned
(19:20):
about all the places you can go for abortion resources,
but we never learned about abortions themselves. I think a
lot of girls in their teams feel that if they
get pregnant, they can just have an abortion, But maybe
if the information was more widely available, they might not
take that option so lightly, because the procedure sounds extremely
unpleasant under any circumstance. And I do want to concur
in my in my high school, like sex said, kind
(19:42):
of didn't exist, and we really didn't even talk about abortion,
which less what was involved in it. So I think
it would be important for people to know a little
bit more about it. So if you have any questions, comments, concerns,
feel free to a email us at mom Stuff at
how stuff works dot com, be Twitter at moms Stuff podcast,
and see like us on Facebook and me the comment
(20:07):
and you can always read our blog during the week.
It's stuff Mom Never told You from how stuff works
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Is it how stuff works dot com. To learn more
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