Tag Archives: midwives

Midwives & Medicare

Midwife Salome at Jesus' birth

The Post-Gazette reported that the new health care law means that midwives will be getting the same reimbursement as doctors for births and prenatal care.

“In short, it says certified nurse midwives will now receive the same Medicare reimbursement as physicians when they provide the same services, from prenatal care to routine deliveries. They had been getting only 65 percent of the physician’s fee.”

This change will mean that more people will be using midwives more regularly and that midwives will be able to afford remaining midwives. In Pittsburgh, many midwives have had to change their practices or stop practicing because they couldn’t afford to keep being midwives. This is a banner day for birth!

Why Hire a Doula If…

A midwife, dad and two doulas support a mom's labor.

I Am Hiring a Midwife Already

Moms usually decide to hire a midwife for several reasons. Midwives specialize in normal pregnancies. They are very good at helping mothers feel confident and comfortable with their pregnancy. Midwives usually stay longer with their patients during labor. Midwives tend to ask permission before doing any interventions, even checking a mom’s cervix. Midwives support breastfeeding and many of them have breastfed their own children.

So why would a mom who is seeing a midwife want to hire a doula?

Doulas are hired to be on-call for your birth and don’t have other clients in labor at the same time. Midwives can’t control whether you will be their only patient when you go into labor. Your midwife might have to split time between you and other patients.

Midwives are care providers and have to be responsible for your health and the baby’s health. This is a good thing, but it means that sometimes your midwife will be busy protecting or monitoring your health, meanwhile, your doula can be helping with your comfort.

There is always enough work to go around at a birth. In my experience, midwives enjoy having a doula around who can assist you and make sure extra things are taken care of. Your midwife only has two hands.

Midwives understand that a doula’s scope of practice is different from theirs. Doulas never provide medical care or interpretations. We do not overlap what the midwife does for you.

Sometimes if a midwife is very tired from a long shift, she can feel confident that your doula will support you while she takes a short nap. This means that your midwife can be refreshed when you need her. Your midwife can trust that your doula will call her if she is needed. The relationship is mutual. Doulas enjoy working with midwives and midwives appreciate the support that a doula can give you.

Feeling helpless

When you are pregnant especially for the first time, it is easy to feel helpless when doctors or nurses tell you some procedure is necessary that you did not want to do. You are naturally concerned for your baby. You know that you hired the medical professionals to tell you when medical things were necessary. So how do you sort out what is really necessary for you and your baby from what is the normal way they do things which you don’t really need?

First, remember that you are the health care customer. It is true, you are the mom, not the doctor (even if you are a doctor – in this situation you are the mom). You can always go and get another opinion or even vote with your feet and get another care provider. This is much more difficult during labor. So if you have real doubts about the compatibility of your caregiver or birth site and your wishes, figure it out before labor begins!

Second, remember that birth is a normal physiologic process. Doctors are supposed to assist you, not hinder you in your normal physiologic process. Midwives often say they have “caught” a baby, not “birthed”. It is up to the mom to birth her baby, everyone else should be on her birth team and working for her!

Third, it is your birth and your baby! True, you have hired people (like midwives, doctors or doulas) to assist you and help you achieve your birth vision. They have expertise that you probably don’t have. But this is your birth and your body and your baby. Anything that comes up regarding the care of your baby or birth should have a decent, medical reason for it. When your doctor explains why something is necessary, it should make sense to you. You should always be able to have a dialogue with your care provider. If you can’t, you can vote with your feet!

image from Women's International League for Peace and Freedom