Which is Better to Have at Your Birth: a Midwife, a Doctor, an OB, or a Doula?
Midwives or Doula?
If you aren’t sure about the difference between midwives and doulas, check out my other article Midwife vs Doula: What are They.
Both midwives and doulas have a more natural approach to birth than a doctor or obstetrician. But midwives and doulas have very different jobs in the labor setting, so you can have both at your upcoming birth, or just choose the one that suits you best.
It is hard to answer if you should have a midwife or a doula without also talking about the rest of your options… So let’s talk about Midwives, Doctors, OB’s, and Doulas!
Midwives, Doctors, OBs, and Doulas
Which is best?
Since midwives are care providers, the first choice you need to make is do I want to have a midwife, doctor, or OB? The honest answer, it depends.
It depends on your values and priorities in birth.
If you believe in low intervention medicine and want a more natural approach, a midwife is likely a great option.
If you are high-risk, you can choose to have a midwife/OB tag-team. The OB would monitor your high risk issues while the midwife brings the more natural approach to your birth. You would switch between them for visits, but if your high risk issues aren’t becoming problems, you will likely see more of your midwife.
This also means if you become high risk during your pregnancy and you have a midwife, you don’t have to transfer your care. You can choose shared care, bring it up with your midwife if they are suggesting you transfer care.
A doula on the other hand is always a great addition to your support team.
A doula will take the time to get to know you and what you value. This is often done by creating a birth plan.
This means that a doula is a great option if you are wanting a natural birth OR are planning to get an epidural right away. A doula can help by relieving contraction pain and educating you on your options.
To learn more about what a doula does see here.
Price
In Alberta, midwives are covered under Alberta Health just like a regular doctor or OB, so there’s no cost! Isn’t that great!
Doula’s on the other hand often cost between $800-$1600.
Read this article to see if doula services are covered under your health insurance.
If they aren’t covered under your insurance, be sure to check out my article about how to pay for doula services.
Birth Place
Choosing a midwife over an OB or family doctor or choosing shared care, gives you full options for place of birth.
A midwife is able to attend home births, birth at the birth center (see here for more information on Calgary’s Birth Center), and hospital births.
If you have shared care between a midwife and OB, you will still have the option of birth place. There are some risk factors that might contraindicate an out-of-hospital birth.
Do your research, ask all the questions, and remember that it is your decision and your responsibility to make the best decision for you and your family😉
A doula is allowed to attend births at home, the birth center, and the hospital.
One thing to know though, is that in the hospital, a doula counts towards your designated support people. Many hospitals in Alberta right now have a limit of 2 support people during labor and 1 in the OR for c-sections. So you will need to prioritize who you are bringing with you.
Relationships
Midwives and OB’s generally work in pairs, this makes it easy to build a relationship with them and feel comfortable with who will be at your birth.
However, many Low-Risk Clinics rotate between 5-6 doctors. Many people find that they like one or two of the doctors, but not all of them. This also means you don’t know who will be attending your birth which can be stressful.
Having a doula at your birth can help mitigate this worry, since doulas work alone or sometimes in pairs. They are guaranteed to be a familiar face during your labor.
You have also spent considerable time talking with your doula about your wants and wishes for the birth which is comforting to have them support you when you start voicing your desires.
Appointment Times
Midwives, Doctors, and OB’s all have office hours for when they take appointments and do prenatal visits.
Doulas have flexible schedules and are happy to meet with you during the day, in the evening, or on weekends if that is most convenient for you.
Many midwives have an emergency phone to call in case you are in labor or worried about something outside of their office hours.
Family doctors, OB’s, and low-risk clinics typically tell you to go to the hospital for any worries outside of office hours and have no emergency phone you can call.
Doulas are on-call 24/7 between 38 weeks-birth. So if you are experiencing any weird symptoms or are headed to the hospital please call your doula.
Doulas are just a phone call away if you need some expertise to know if something is normal or not. Just keep in mind that they are not medical providers and cannot do an assessment.
When in doubt, it’s best to go with your intuition and get checked out.
Wait Times
Wait times vary from provider to provider and office to office. However, here is some general information on typical wait times for each type of provider.
Low-Risk Clinics typically have the longest wait times. These can range anywhere from 40 minutes to 1.5 hours.
Obstetricians wait times are not as bad, with typical wait times being 20-30 min.
Midwives generally have the shortest wait times, anywhere from 10-20 min.
Doulas come to you, and are rarely more than 5 minutes late. If they are going to be later they will send you a text or email.
These wait times are for regular appointments only. If you are having symptoms and come in unexpectedly you will get seen right away no matter which provider you have.
Appointment Length
Just like wait times, your appointment may be longer or shorter than what is listed below.
Low-Risk Clinics and Obstetricians typically have 10-15 minute appointments.
This is long enough to measure your belly, check your blood pressure, listen to baby’s heartbeat, and sometimes pee in a cup to check for protein in the urine.
Unfortunately, many people feel rushed and end up leaving without feeling like they had a chance to ask any questions.
Midwives have longer appointments, with each appointment being 15-30 long. This gives enough time for the same checks as the Low-Risk Clinics and OB’s.
It also gives ample time to get to know each other and build that relationship.
There is enough time to go over risks and benefits for any suggested tests, ensuring that you are fully informed before agreeing to anything, including the routine tests.
You will also have time to ask any questions you may have.
Doulas have the longest appointments. There is plenty of time to ask your questions and go in depth about anything you are worried about.
These will often cover similar topics to what you learn about in prenatal classes, though I still recommend taking a prenatal class. To learn more about prenatal appointments with a doula see here.
Immediately Postpartum
If it’s a home birth or birth centre birth, a midwife will stay with you until the placenta is out, the bleeding is at a normal amount, baby is doing well etc.
This typically takes about 3-4 hours.
A midwife will continue to check your fundus (the top part of your uterus) every half hour until they feel confident that it is shrinking as it should and there is no retained placenta.
If everything is looking normal, the midwife will give you a list of things to watch out for and tell you to call if you are worried about anything.
If it’s a hospital birth, a midwife will also stay with you until the placenta is out, the bleeding is at a normal amount, and baby is doing well.
The midwife is in charge the whole time and does all the fundal checks and any necessary stitching postpartum.
The midwife can discharge you if everything is normal and you can often go home within 3-4 hours after delivery.
Doctor’s and OB’s also stay until the placenta is delivered, bleeding is in the normal range and the baby is stable.
This is often as quick as 30 min to 1 hour. Since the doctor is not leaving the hospital and can be paged back if there is any complication, they often move on to their next patient fairly quickly.
Nurses are then left in charge to finish monitoring mother and baby for the remainder of the immediate postpartum.
Discharge can happen later that day, or they may keep you overnight since hospitals have certain times of the day that discharges happen. Unless they need the beds, they tend to stick to their discharge times.
A doula will stay until all the excitement has calmed down and the couple is starting to feel relaxed.
If the mother is planning to breastfeed, the doula will be there to assist with that.
If everything is normal, shortly after the birth there will be a hormonal shift and the birthing mother will often feel quite drained and tired, especially if she was up all night.
This typically happens around 2 hours postpartum and the doula will take her cues from the new family of when they feel comfortable with her leaving.
Postpartum Appointments
A midwife will visit your house 24 hours after baby is born, if the baby is born at home, or 24 hours after leaving the hospital.
They will visit to check up on you and baby on day 3 and 5 as well. You then go to the midwife office for postpartum visits at 2 weeks, 4 weeks, and 6 weeks.
If you are having trouble breastfeeding, the midwife can help, or she may refer you to a lactation consultant.
If you have a doctor or OB, a public health nurse will be sent to your house 24 hours after you go home from the hospital.
If you are having trouble with breastfeeding this nurse may be able to help, however a visit to the well-fed clinics or an appointment with a lactation consultant will be your best support in this area.
You will have frequent check-ups for your baby with your family doctor after this point, however you will not have another check-up with your OB until your 6 week check-up.
This can lead to postpartum mental health issues developing without a care provider noticing.
Most care providers: midwives, doctors and OBs focus on your method of birth control at the 6 week postpartum visit.
They may ask a few basic questions about your mental health, but unfortunately this is not the focus of the visit.
If you are dealing with postpartum mental health difficulties, getting help sooner will help you feel better sooner.
Check out Julia at the Family Nurse, for a great postpartum resource in the Calgary area (currently offering virtual services).
A birth doula will typically have 1-2 postpartum appointments included in her birth rate.
The in-person appointments are typically done in the first week or two after the birth. However many doulas stay in contact throughout the first 6 weeks for any questions a growing family may have.
Having a doula often leads to a more positive birth experience as well as more positive postpartum mental health outcomes. Most doulas also screen frequently for mental health problems in the first 6 weeks.
A doula is happy to help with cleaning, talking about the birth, helping with breastfeeding, helping with infant care, etc. during their postpartum visits.
If you hired a postpartum doula, your doula can generally start as soon as you need after the birth.
Maybe Not A Midwife...
Although I love midwives, here are some reasons you might choose an OB, Family Doctor, or Low-Risk Clinic.
You might not be able to find a midwife
Midwives are in high demand in Alberta. They get booked up very quickly and often if you haven’t found one in your first trimester, it is unlikely you will get one.
Try anyway because they may have spots become available if someone transfers care mid-pregnancy. People transfer care if they risk-out and prefer not to have shared care, if they move away, or they don’t get along with their provider.
Luckily, there are always available birth doulas. The longer you wait to hire a doula, the less options you will have to choose from.
You are high risk and feel more comfortable with medical professionals
Some of you likely have a history of miscarriage, early loss, or have a current condition such as high blood pressure, that makes you worry more.
While it is safe to choose a midwife in these situations, some people feel more comfortable with a doctor.
A doula is an amazing support for these situations!
A doula will talk through your worries and fears with you. They can tell you statistics, give you your options, and are easy to contact if you ever have questions about what is normal vs when you should get checked out right away.
Location, Location, Location
This can be a big deciding factor when choosing a care provider.
Many OB’s offices are right at the hospital. If you are planning a hospital birth, it can feel reassuring to drive the route many times before the big day. However, parking at a hospital can be expensive and difficult.
Family Doctors and Midwives often don’t have a problem with parking.
Take into account drive time. Will you be driving from your home? Would you prefer someplace closer to work?
Remember, you will be driving there every two weeks in your third trimester and every week for the last month!
Doula’s on the other hand will gladly meet you in your home!
In Conclusion
Who you invite to your birth is a big choice and that decision should always be taken with care. And yes, when you choose a midwife, doctor, or OB, you are inviting them to your birth.
These are the people who will be supporting you during your birth and with you in a very vulnerable moment.
If you have already chosen a provider and it no longer seems like the right fit, it is never too late to change your mind, not even at 38 weeks!
No one has the right to be at your birth without your express permission.
If you can afford a doula, always hire a doula! Check out my article about how to find the perfect doula.
A doula will strive to get to know you and help you have a birth experience that feels positive and empowering to you.
Plus those who hire a doula reduce the risk of interventions including inductions, c-sections, epidurals and more. Click here to see more benefits of hiring a doula.
One of the best things about having a doula for me was the longer meetings and that they were done in my home. It really gave me time to get comfortable and think through my birth options. I feel like this just can’t be done in 15-30 mins -1-2x before birth.
Brielle talked me through my thoughts and gave me information and applications where needed. I felt so much more prepared and confident than I would have been when the time came to give birth.
The birth clinic i went to has rotating doctors and so I didn’t know which one I’d get as it really just depends on when I went in to the hospital so it was really good to have one consistent person to touch base with. I feel like her coaching helped me have a shorter pushing time and to tare less. So many thanks to Doula Brielle!
Such great information in here! I loved my experience with a midwife. I felt cared about and a personal relationship with them.
My brief experience with O/B’s did not give me the same feeling.
I think a doula would be a great addition to anyone’s birth team, but I think it would be extra helpful in the care of an O/B!
I had midwife/OB shared care as well as a doula and it was the dream. I had some higher-risk complications in pregnancy that my OB could keep tabs on if needed, with comfortable, personable care from my midwife and doula visits. I was able to have a completely natural labour and delivery with my midwife, with backup care if needed. I didn’t have my doula present for delivery, but I’m completely confident that her support in birth prep and labouring helped me relax enough to encourage that natural, relatively quick labour and delivery!
Doulas are totally more than worth the cost no matter your provider, imo. Great article!