Your Birth, Your Way: How Midwives and Doulas Can Help You Have the Childbirth Experience You Want
Words: Kendra Lee
Working with these maternal health experts and advocates can make all the difference.
This piece is part of our Empowered Birth series, highlighting ways Black women can have birth experiences that leave them and their families feeling safe and respected. Click here for more stories.
All they wanted was to have their own way.
Elise Mussen, admittedly not the biggest fan of Western medicine, was looking for an experience where she would have some control.
Diyasha Smith wanted a “natural learning experience” free from intervention.
Both women got their wish when they chose midwives to deliver their children.
A New York City resident, Elise sought out a midwife while pregnant with her first child 19 years ago. She didn’t trust traditional medicine to follow her wishes.
“I felt like the doctor was always making recommendations they weren’t giving me a choice about,” she says. “I didn’t want a C-section. I didn’t want them pumping me full of drugs. I felt like a midwife would give me more of an organic experience.”
Pre-Google searches, she found her team on a list posted at the Park-Slope Food Co-Op in Brooklyn. Her midwives (there were two) were invaluable, she says. They helped Elise, then uninsured, apply for Medicaid; directed her to a Lamaze class; and gave her pointers for dealing with discomfort. They were just the advocates she needed, especially when an obstetrician tried to steer Elise and her husband toward an abortion after an ultrasound found something problematic.
“I told the midwives and they were livid,” she says. “They called the doctor and were, like, ‘How dare you tell this to her.’ They were gangsta, and they were super supportive.”
That kind of support was key for Charlotte, North Carolina, resident Diyasha Smith, who had a similar empowered birth experience. Giving birth in a hospital was a non-starter for the 23-year-old, so she started looking for a midwife as soon as she found out she was pregnant.
“We had a protocol in case something went wrong,” Diyasha says, “but nothing about the experience felt like it was going to take a left turn. I trusted my midwife. Her motto was if there’s something going on, we’ll figure it out. We’ll walk it off, we’ll squat it off—whatever we have to do.”
Six months after giving birth to her son last September beside a wading pool in her home, she wouldn’t change a thing.
“It was a lot of bliss. Everything turned out how it was supposed to. It was everything I wanted and more—a healthy baby, a happy experience, having someone support me,” Diyasha says.
She offers this advice to other moms: “Make sure someone is around you, and they can stay strong and true to your plan. If you’re at a hospital and the hospital tries to push something on you that’s not absolutely necessary, that person has to be able to say you don’t want this and stick with your plan.”
Though it may seem like Elise and Diyasha are crunchy Bohemians, they aren’t. They followed the long history of midwifery in the Black community that has become less popular since the end of the Jim Crow era, when medical professionals started steering women to deliver in hospitals. Given the more positive birth outcomes that go hand-in-hand with using a midwife or doula, choosing one sounds like it should be a no-brainer.
Unfortunately, too many of us don’t go this route because we believe birth is something that should be medically managed or that midwives aren’t as well-prepared to handle a delivery. But women who want to have empowered birth experiences should keep the following tips in mind:
1. Build a support system.
“[Doulas and midwives] are not really promoted within the Black community,” says Barbara Verneus, a doula and midwife-in-training in Austin, Texas.
Diyasha experienced some of this. “I got a lot of flak,” she says. “People said, ‘What if you bleed? What if the baby doesn’t come out?’ I had that moment of deciding, ‘Do I want to let their experience guide me or do I want to go through my own?’”
Create a network of people who support your decision, and who will not bring any negativity or doubt around your decision to work with a midwife and/or doula.
2. Learn about the positives associated with births attended by midwives and doulas.
Black women have poorer birth outcomes across all racial, educational, and economic spectrums—from an increased risk of preterm and low-birthweight babies to a higher incidence of infant mortality and maternal deaths.
These facts could be improved through the use of midwives and doulas, both of which have been shown to help moms have healthy, happy birth experiences, while also benefiting babies. Studies show doulas, trained to assist moms through labor and delivery, decrease birth complications and low-birthweight babies and increase the likelihood of moms breastfeeding. Midwives, who are medical personnel, have been found to reduce cesarean sections, shorten labor, and lessen the need for pain medication.
How do they do this?
“We don’t look at birth as a disease,” Barbara says. “We prepare for all possibilities, but we don’t go in looking at it as something we have to solve. We look at it as a natural process and the less intervention the better.”
Education is also crucial, and it’s the cornerstone of any midwifery practice, says Kelley Robinson, a certified nurse midwife in Baltimore.
“During the prenatal period, there’s a lot of conversation around what to expect during the pregnancy and labor,” Kelley says. “We talk about pain management. We explain what that pain means, and in this case that pain is positive process.
“We take the time to process things that can hold up a labor,” she continues. “We’re a little less quick to go to induction, episiotomies, all those things that potentially bring about adverse outcomes.”
Midwives also consider other psycho-social factors and how those play a part in how women handle their labor.
“If there are concerns regarding delivery because of a history of intimate partner violence or trauma,” Kelley says, “we are able to address that in a safe way before labor. Whatever can be done to empower women to not be afraid of what’s happening to their body, we do it.”
3. Do your homework.
Barbara advises pregnant women to start interviewing midwives and doulas as soon as possible, and know what questions to ask.
“If they work at a hospital, find out the hospital’s protocol. Is there a rotation or will one midwife or doula be with you throughout the pregnancy?” she says. “Ask the midwife her protocol. There might be a protocol for the hospital, but her personal ideology might differ.”
Find out how many births your midwife has done and where she was certified. Ask “if this happened, what would you do?” Make sure she or your doula will help you speak for yourself.
Also note that the laws governing midwives vary from state to state. New mom Diyasha found out early in her search that North Carolina doesn’t allow midwives in hospitals.
4. Use your voice.
Within a hospital setting, some policies can’t be changed. “But you can have a midwife who advocates that you get up and ambulate or are able to get in the shower or that doctors hold off on medication,” Kelley, the certified nurse midwife, says.
5. Turn a complication positive.
You can have an empowered experience even if you have a complication. If a C-section becomes necessary, for instance, your midwife should explain the situation and inform you of your options. “[She should] keep a calm spirit, inform, [and] stay connected,” Kelley says. “If you’re in the operating room, she should use terms that are more positive—‘Your baby is going to be lifted into the world’ instead of ‘It’s time to take the baby.’
“In an emergency situation where you don’t have the opportunity to discuss,” she continues, “midwives take time on the back half to talk about what happened and why it happened, giving mothers time to process.”
In the end, this is your experience and you get to own that.
“I wanted to feel like I was a part of my pregnancy process and have someone answer my questions,” Elise says. “My midwives did all of that.”
And more—she continued seeing them through her second pregnancy and for all of her well-woman care for years after that.
“It was a really good experience,” she says.
By day, Kendra Lee is a public information officer specializing in domestic and sexual violence for Fairfax County, Virginia. She’s also a longtime freelance health writer and editor.