The use of independent midwives and professional lay birth supporters, known as doulas, is growing. This may be because National Health Service support for home birth, although technically available, is currently uncertain. Women who want to be sure of having someone that they know with them at the birth, who believes in and has experience of home birth and who knows how to help a laboring women, may want to employ a professional birth attendant.
A doula cannot deliver a baby except in an emergency. An independent midwife is able to manage your antenatal care, help you have the baby and look after both of you postnatally. She may work on her own or with one or two other midwives. She is likely to see you in your home for antenatal visits, and she and/or one of her colleagues will be with you at the birth. Postnatal care may last up to six weeks. Independent midwives work as truly independent practitioners and have more freedom to exercise their professional judgement and are often able to take on ‘high-risk’ women. Although more midwives are choosing to work in this way, the numbers are relatively small and early booking is strongly recommended. Payment is by arrangement and there may be some flexibility about it.
Doutas (a Greek word meaning woman servant) may or may not be trained or registered. They may have been doing the job, unpaid, for many years. They provide emotional, physical, informational and practical support for the expectant, laboring or postpartum mother. A doula should be well-informed about current policies, best practice and local conditions. Some doulas provide day-today care for mothers and babies after the birth.
In employing an independent midwife or doula, you need to be certain that you are comfortable with each other. Ask around about her (NCT, Home Birth Support Group) and if possible take the opportunity to meet several.
You may want to discuss some of the following topics. Getting a sense of the way the person will be able to help you through birth, and feeling free to discuss your hopes and fears are the most vital aspects of meeting. In this, as in labor, it is important to trust your instinct.
— What service she provides — before, during and after birth. What are her fees and how does she want them paid?
— How long she has been doing it, how much experience she has of home birth, information about previous transfers. What does she enjoy about the job?
— Does she have any additional skills, e.g. reflexology, massage, acupuncture, herbs?
— Availability and contactability. Is the job shared with anyone else?
— What ifs? Talking through possible scenarios — both parties need to know the other persons position in various hypothetical situations. It is important that they will support your decisions, but they will want to be sure that you are aware of the possible risks and benefits of a particular choice. They will want to be sure that you realise that giving birth is hard work and that a given outcome cannot be guaranteed.
— Contact details of other mothers that have employed her.
— What happens next if you want to book her?
With luck you will take her on with a sense of excitement and anticipation, in the knowledge that she is willing and able to help you give birth in a way that you can look back on with pride.