Midwife, Doula, Childbirth Educator & the Obstetrician: Working Collaboratively, Not Substitution.
Denise Bolds MSW, CD(DONA)
December 10, 2015
As a certified birth doula, I get this a lot: “Denise do I
get a midwife or a doula? Should I take childbirth education classes? I have a
doula, I don’t need childbirth education!”
So many women don’t understand the roles and functions of
the midwife, labor doula, childbirth educator and obstetrician. These four services are not interchangeable; in fact they are a collaborative.
A midwife provides clinical support to the woman during her
pregnancy and childbirth. A midwife can provide this service in a hospital, birthing
center or home. Health insurances coverage require authorization. Many midwives note that there are huge obstacles in obtaining reimbursement
from health insurance plans. A midwife fees are several thousand dollars. At a
birth, a midwife is present as the birth is immanent. Midwives possess licensure/certification, has
liability insurance according to the laws of the state she is allowed to
practice in. There are some states in the United States that do not allow
midwives to practice. Midwives work with doulas and obstetricians, supporting
the teaching of the childbirth educator. A midwife is on call, depending on the
size of her practice.
A childbirth educator (CBE) is also a certified professional
providing education in reproductive health and the stages of pregnancy and childbirth.
A CBE provides fortification of confidence
of childbirth knowledge to the prospective parents through education. Being
exposed to terms, definitions and scenarios opens the mind to familiarity,
reducing uncertainty. The CBE aligns with the actions and knowledge of the
midwife, doula and obstetrician. A CBE is not present at the labor or birth.
The cost of a CBE ranges from free to several hundred dollars. They can provide
education in a community, hospital or private setting. The CBE supports the
midwife, doula and obstetrician educating in the scope of reproductive health
and childbirth and is an enhancement to empowerment. A CBE is not on call.
A labor doula, also a certified professional, is insured
against liability and certified in CPR. A labor doula provides emotional,
physical and spiritual support along with education and advocacy to the mother,
her partner and family. A doula is present throughout the pregnancy (depending
on when contracted by client) offering support from the onset of labor, through
the birth and post partum. A labor doula practices the education of a CBE in
the paradigm of midwifery and obstetrics. The cost of a labor doula ranges from
volunteer to several thousand dollars and is not covered by health insurance.
The labor doula contributes as part of a team with the midwife and obstetrician
on education that is introduced by the childbirth educator. A labor doula is on
call for her clients.
An obstetrician is a medical school trained professional in
medical and surgical treatment of pregnancy, labor, childbirth and
complications therein. An obstetrician treats in paradigm of diagnosis. There
is clinical support that is structured in education that often the mother and
her partner are not aware of; or can go beyond the education provided in
childbirth education. An obstetrician treats within a time constraint that is
allowable by health insurance coverage and malpractice insurance guidelines.
Obstetricians provide services at birthing centers and hospitals, not home
births. The fees of an obstetrician are much higher than a midwife and birth doula
combined. If a cesarean section occurs, costs increases up to four times as
well as the risks associated with this intervention. Services are covered by
health insurance coverage. The obstetrician
contributes in the team of doula, childbirth educator. An OB is on scheduled
When a client asks if it is possible to substitute a midwife,
doula, childbirth educator or obstetrician, inform her that collaboration is
key to teamwork. A mother can obtain the
birth she wants if her pregnancy is healthy, her providers and support are all
on board with her wishes and the facility she chooses to give birth at is as
Denise Bolds MSW, CD(DONA)
November 15, 2015
“There’s a place, a space of
joining, a scared time, you and me become we.” Denise Bolds.
Holding space – many take it
for granted, others cherish it. As a black birth doula, holding space is one of
the supports I make sure my families have. The moment of love is a space of
sacred accord; where two people agree to love one another. The moment of
conception is also a sacred space, when the sperm penetrates the egg; a bond formed and energy shared.
I support many births; black,
white, Asian, Latino, same-sex, single, married, couples; all instinctively
engage in the same act, bonding with the newborn and with each other as new
parents. It doesn’t matter how many times a woman has given birth; she bonds
with her baby. A special connection occurs within that moment of skin-to-skin
and meeting of the eyes.
As a birth doula it is my
responsibility to advocate, to hold space for the newborn and parent(s). Many
couples have cultures and traditions that are done at the birth of a child that
may include singing, prayers, silence, reading a passage, whatever it is I am
holding space for them and their new baby in this moment.
As a black woman with
southern and Native American roots, I deeply understand the value of holding
space: many of my slave ancestors gave birth to their babies only to have them
snatched away and sold. My African roots are built on traditions; many African
tribes have ceremonies heralding the birth of a baby. These traditions were
abolished when the Africans was brought to America as slaves.
Holding space is politely
done with gentle reminders to the L&D staff and is kept within professional
boundaries. This can be requested as part of a client’s birth preference
developed before the birth.
Why hold space? It is so
vital in the validation of the mother-baby union. It is affirming the bond of
the parents as supporter of one another as well as commitment. This builds
self-esteem and strengthens the family bond. It is a once in a lifetime event
that cannot be replicated until death. Holding space is just a poignant as the
baby crowning or cutting the cord.
In this scared space the
newborn claims his/her mother’s breasts; the life source that is found through
smell, sight, touch and instinct. This act is a wonder and miracle all in one.
Hold that space, it doesn’t
matter what race, ethnicity or relationship status; holding space for the
inevitable, instinctual human tradition is a blessing to witness and a wondrous,
unforgettable reminder of just how sacred and amazing birth is. Bold Doula is honored to hold space for you and your birth.
***These two amazing photos
were taken by myself with the permission of my clients.***
A Ticket To Ride
Denise Bolds, MSW, CD(DONA) October 13, 2015.
“She’s got a ticket to ride!
She’s got a ticket to ride!
She’s got a ticket to ride and she don’t care! The
My name is Denise Bolds; I am
a black 51-year-old Leo. According to DISC, I am a ‘D’ personality. Remember
that. I am a certified birth doula and placenta encapsulation specialist.
This year alone, I have spent
over $3,500 in doula related trainings; I am building my new business of 16
months. Being in the birth profession is
not for the faint or the broke at heart for sure!
ProDoula is hosting their
first conference in Kansas October 15, 2015. It was discussed enthusiastically
at the first placenta encapsulation training I attended in Kansas in April
2015. I got my conference ticket at a discount, I had a dear friend Abbey offer
to share her hotel room with me – I was almost there! Life got in the way, I
got busy with births and trainings – I also attended an Advanced Business
Training with ProDoula as well.
Along this journey, I have
had signs of spiritual direction; I may be a dominate in personality, but I am
certain in my spirituality. I am also
listening constantly. This year, not only has my business grown, I have as a Black
woman, mother and daughter grown spiritually.
By the time I was to get my
plane ticket, I had been spiritually shown many things in the doula world. My budget did not look like it could support
another long distance trip/training. I contacted both Randy & Abbey to let
them know I wouldn’t make it – I cried. I’m a risk taker; surely I could pull
this off… I could sell a ring or two!
Randy called me personally
and gave me some tough love as well as validation that I deserved to be at this
conference. I really wanted to meet the guest speaker Cupcake Brown; she is my
hero for decades. Randy also gave me the sales pitch about having the
distinction of being able to say I attended the FIRST ProDoula conference.
Randy knew how to reach the ‘D’ in me – I told her I would come up with the
money for my flight – fuck everything else.
Ticket money now in my
business account, I proceeded to book my flight online. I ended up staying on
my Mac for over TWO HOURS going round in circles selecting flight times - it got so convoluted, I called the travel
agent TWICE, only to have my calls drop BOTH TIMES. Finally, I got the flights
and went to pay with my credit card, the card would not go through, I try
several more times, I call the bank, I use my personal card, all to no avail, I
could not book the friggin flight!
I sat in turmoil; I wanted
this to happen, I MAKE things happen right? Suddenly, I went still. In that
stillness clarity came to me. When I stopped trying to dominate and go against
the flow, I understood what was before me.
I accepted that I am simply not supposed to attend this event. It’s just
not my time. I have witnessed actions in this group that are not conducive to
who I am or where I am at this time – I need to sit this one out.
At first, I thought to sell
the conference ticket, I could not get a refund. I contacted both Abbey &
Randy again that I definitely could not make it and how could I get rid of this
ticket. It wasn’t a matter of getting rid of it – it was a matter of
surrendering. What? I’m a ‘D’
personality. I don’t surrender anything!
At that point an epiphany hit
me: How did I get here? How did I get to this amazing year being a birth doula?
How did I get to this very breath I am taking right now? A few years ago, I was
given a free plane ticket to India – all I needed was to come up with the money
for hotel and food ($2,000) I sold my life insurance policy (If I was alive
upon my return I would get another) and my 30 year old solid gold high school
ring, a gift from my parents and I got a visa. My ass was on that plane without
My trip to India was a
life-changing event all-possible by the kindness of a stranger and the
synchronicity of fate – I was able to get what I needed to go to India in SIX
DAYS!!!. This year spent busting my ass had come down to me surrendering to
karma and giving this opportunity to another the same way I received an
opportunity a few years ago that changed my life. I had to continue the wave of
karma. Giving up the ticket to ProDoula’s first conference was spiritually necessary.
Once I began the process to
give up the ticket, things became lighter. I held a raffle and there was a
winner; a complete stranger whom I’ve never spoken with before. She told me she
desperately wanted to go but could not afford to and gave up. She won my ticket and she also got a free
plane ticket to travel with hotel stay.
Did I mention I’m a dominate? When I do karma, it is BIG!
It is my sincere hope that
this opportunity will change this woman’s life as my own life was changed a few
years ago. She now has a ticket to ride.
I appreciate Randy’s approach to me – it was the perfect sales pitch to incite
me to try my very best to be there – to be one of the first.
Do you remember my
description of myself? Yes, I am a Leo and a dominate in personality, my last
name also happens to be BOLD. I have learned that while its great to be
first, its BOLD to be best. This all
turned out BOLD in the very best way.
Will my business fail because I didn’t attend? No – it just isn’t my time. This BOLD
Leo ‘D’ is back on her grind! My
business is Bold Doula. Remember that.