Doulas, Midwives and other Birth practitioners

Picking who will be on your birth team can be a daunting task. There are many non-medical birth professionals such as birth doulas, postpartum doulas and childbirth educators. Certified Professional Midwives, Certified Nurse Midwives, and Ob-Gyns are your medical professional options. Below I will dig into the differences of each and how they may fit into the birth of a surrogate baby. 

Birth Doulas have been around as long as women have been birthing, but they didn’t always have a formal name. In the past this role was typically filled by a female family member or community elder. When a woman went into labor their village of women worked together to offer the support the birthing person and their family needed. Now the formal role of a birth doula does just that. She is a non-medical professional who is trained in offering emotional and physical support to both the birthing person and their family. In a surrogacy birth this can be extended to include the parents of the baby. Her scope of practice includes helping the surrogate and intended parents review birth options, provide basic educational resources including newborn procedures, provide preliminary practice of labor positions and natural pain relief techniques, and open discussion for what birth will look like as a team. During the actual birth, the doula is the constant source of support throughout what may be multiple shift changes in medical staff. She will be the motivational coach, voice of reassurance, and continuous reminder of self-advocating. She will also provide physical massage of various forms and other physical support desired by the birth person. She is there to answer questions as they arise and humanize medical options presented to the surrogate and intended parents. Immediately following the birth, depending on the pre-arranged preferences of all parties, she can stay with the surrogate and offer support during the immediate postpartum period or can follow the intended parents to their private room and provide initial feeding assistant and support during newborn procedures. This should be discussed beforehand so everyone is clear on expectations. Often it is desirable to hire doulas who partner together to support both sides continuously. 

Postpartum doulas offer support after the baby has arrived. For the surrogate, she will offer tips and support on nurturing of herself and family while she heals from birth. This includes helping in routine care such as helping with showering following a cesarean birth, herbal baths to reduce inflammation after a vaginal birth and even caring for the surrogate’s own children while she gets much deserved rest. For her family, she can take care of basic cleaning of the home, meal preparation and running errands. For the new parents, a postpartum doula can offer the same cleaning and meal prep but is also able to provide help in teaching newborn care and offering care to the baby while the parents get some sleep. There is something truly magical about going to lay down and waking up to find not only is your baby contently sleeping, but your home is clean and the sink full of bottles is now empty. 

There are childbirth educators who specialize in the unique dance of surrogacy. They are able to provide information on birthing choices and augmentation and intervention, as well as newborn procedures and newborn care. But most importantly they are able to offer direction as to which decisions are to be made by whom. Obviously, as a birthing person a surrogate maintains autonomy. This means she is in charge of what happens to her body. But with surrogacy some decisions can impact the baby she is carrying. A childbirth educator specialized in surrogacy is able to walk both parties through what those scenarios may look like and can help facilitate a road map to endure less stress during the birth. You will have the facts needed to make confident decisions as a team.

Moving into our medical providers we will start with a Certified Professional Midwife.  A CPM is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives. A CPM typically only attends births in the home setting but can also be found in some birthing centers. These midwives do not have a background in nursing or medicine. But have gone through a formal apprenticeship to gain their skills. For gestational surrogates who birthed their own children with a CPM, this may be a desirable option. Matching with like-minded intended parents would be key. As many intended parents have had a very long journey, often filled with loss, the comfort of a more medical approach is often preferred. 

Certified Nurse Midwives are registered nurses who have gone on to earn their MSN in Midwifery. They are specialized in treating physiological birth and recognizing when medical intervention in necessary. They are most often found in the hospital or birth center setting but can also assist in home births. A CNM can be a perfect compromise for a gestational surrogate who desires a midwifery model of care and intended parents who prefer the hospital or birth center setting. These midwives can work independently or in partnership with and OB GYN practice.

Lastly, we have OBGYNs, these providers are often the first ones thought of in terms of pregnancy care. These doctors have attended medical school and gone on to specialize in the care of pregnant women. They deliver in the hospital setting and often treat birth as something to be managed. You will frequently find they follow more stringent policies and procedures. For some this may be unwelcome and for others this may be extremely comforting. These doctors are able to treat both a healthy pregnancy and handle and variations from normal as they occur. In the event of a cesarean birth being necessary they would also be able to perform the surgery while the before mentioned providers will have to transfer care.

Reading through this list you will find there isn’t a right or wrong answer to utilizing any of these professionals. The support team needed is as unique as the individuals on the journey. But by knowing what options are available to you, you will be able to find the perfect balance between the birth a gestational carrier is comfortable with and a delivery intended parents feel confident in.  

Do you have more questions surrounding surrogacy? Visit us here to learn more.