Do you recommend a doula for birth center birth?

I'm planning to give birth with midwives at a birth center (Pacifica), and my husband and I are trying to decide whether we want a doula as part of our team. We're a little worried that a doula might have too much overlap with the midwives, and we want to keep our birth team as streamlined as possible. Has anyone out there given birth at a birth center and...

  • ... wished they had a doula?
  • ... loved having their doula?
  • ... wished they hadn't had a doula there?

Would love to hear your perspectives!

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I had my first child at Pacifica and we are very happy we had our doula there. The doula helps comfort and get through much of active labor before you arrive, and then the doula can help not just you but your husband as well during labor and post-partum. A very long story short but our doula helped after I had some complications after delivery, and she was able to hold my little one when my husband slept, she stroked my hair when they did all the after stuff, and she came around to support after we went home. If you can afford it, do it. Feel free to message me directly if you would like more information.   

I did not deliver at a birth center, but I did *plan* to deliver at a birth center and risk out.  At 36+6 I went in for a routine appointment and got diagnosed with gestational hypertension (not a complete surprise since it requires two readings and I'd been monitoring my blood pressure.) So I went right to triage, got induced two days later, and instead of delivering at a birth center where I'd met all the midwives, I delivered in a hospital with a new person on duty every 12 hours from a large pool, none of whom I'd ever met. 

I was so happy to have a doula lined up.  The doula is the only person who promises to be there with *you* regardless of how your birth goes.  My doula stayed with me throughout active labor (midwife and nurse had to pop in and out), helped contextualize what was going on, coordinated with my partner when I was kind of out of my gourd - it was great.  

Hi there and congratulations! 

I worked with Pacifica for my first birth (2 years ago) and am preparing to deliver there again with my second this summer. 

I did not use a doula and found the support of the midwives (as well as my husband) to be very present, hands on, and exactly what I needed during active labor. 

I would ask yourself what kind of additional support you are hoping a doula could provide for you to determine if it might be useful —

for example, would you like someone to be with you at home during early labor? Is your partner not super into hands- on support and having a doula to offer a little more care in his stead useful? Do you want extra postpartum support once you are home?

Please feel free to message me if you would like to jam further.

Wishing you a beautiful birth that may be exactly what you need! 

We faced this exact dilemma, interviewed a bunch of doulas/the midwives (at SFBC), and ended up going with no doula. Our rationale was, one of the major benefits cited was that the doula would provide support to my partner/be an extra pair of hands. But my mother was also visiting, so we didn't need that. 

Well, in the end I was in labor mostly at home--got to the birth center just 40 minutes before the baby came out. And if I could do it again I think having an extra person would have been useful, especially since my labor was overnight, and everyone involved was very tired & needed sleep. I did not feel it was important to have a doula once we got to the birth center, though ymmv depending on how long you end up being in the facility.

That being said, having no doula was definitely totally OK because we had read the book The Birth Partner and so were relatively prepared, plus also had my mom around--if we hadn't had both of those things I think it would have been a much worse experience. Also, the few contractions that a midwife helped me with were noticeably smoother and more pleasant than the ones my husband helped me with, which were also better than the ones my mom helped me with--so experience+strength can definitely make a difference to your comfort.

I gave birth at Pacifica (love them!) with a Doula and I'm really glad I did. The biggest thing is that she came to our house while I was laboring *before* we went to the birth center and helped me (and the midwives on the phone) decide when we needed to go. And she was a wonderful grounding supportive presence at the birth. She didn't need to be an advocate the way I read about doulas in a hospital, but she did actually have some moments of helping guide the midwives help me even better. And she was just a nice person to talk to leading up to the birth as well, she was helpful for preparing in a different way than the midwives. So yes! :) 

I have given birth at a hospital with no doula, given birth at a birth center (not Pacifica) with a doula, at Pacifica without a doula and at the hospital with a Pacifica midwife as my second support person (Thanks, gestational hypertension.)

For my hospital birth I definitely wished I had a doula, especially since it was my first. I needed more coaching and help than my medical team could provide. Thankfully my husband is a really good birth partner but we could have both used some more support.

With our second it looked possible we'd have an early delivery and be in the hospital again and so hired a doula. She was excellent but our birth center birth we had her, a birth assistant and three midwives. It was too many people in the room. I wouldn't say I wished we hadn't had her but she was definitely extra. (It was also my easiest labor.) The midwives at a birth center are just there for you and aren't juggling a ton of cases at once. They can coach and present as much as your want them to be. 

So with our Pacifica births we didn't even consider it. The midwives were great and very present. When with our last pregnancy we risked out of Pacifica and ended up at Alta Bates, one of the midwives came to support us and did many doula type things. It was great and made the hospital birth much less anxiety producing.

Hi! I gave birth at Pacifica without a doula. I felt unsure about it too, but I was happy with my choice in the end. I didn't feel like I was missing anything. But my early labor was pretty short, so we didn't spend much time laboring at home. I think a doula would've been helpful if we had a lot of time to get through before getting to the birth center. Happy to chat more if you'd like!

Whether to include a doula along with the midwives should  be decided based on two factors:

1. The expected scope of responsibility of the midwives at the birth center; and

2. Your personal rapport with any of the individuals involved.

Let me explain.

Back in the 1980s, when the medical industry relented from its prior stance that all births were to be overseen only by (predominately white male) obstetricians, the title "Certified Nurse Midwife" was created.  This was partly in reaction to the hippie mothers of my generation who eschewed the medical industry and gave birth at home with lay midwives.  Someone with the title CNM is highly educated and skilled.professional.

But midwifery is a challenging career path. Babies do not decide to be born on a reasonable schedule, and they often come in the middle of the might. Midwifes need career-life balance just like any other working woman.

Anecdote: Our son was born at home in Oakland, at 4 a.m. on UC Berkeley Big Game Day. Our midwife, Peggy, was scheduled to drive to Monterey that day for her SCUBA diving certification. She did the delivery, and got the SCUBA certificate, but she was very tired afterward!

So you can see how over the years midwifery practices have evolved to be more like doctors' practices.  You may discover that your preferred doctor or midwife is not scheduled to be working at the time your baby comes. That's where having a doula with whom you have a rapport would be a good thing.

My advice:  check with the birth center about their policies, and try to plan so that your preferred birth attendant will be present, whether it is a staff midwife or a doula you have selected.

I have had 2 children. The first began w midwife care at Pacifica without a doula, and ended w a hospital c section. The second was a hospital birth w doula that resulted in successful vbac. I loved the care I received from the Pacifica midwives for kid 1 and also from the doula for kid 2. Knowing what my wonderful doula provided for me in the hospital setting, I don't think I would have needed it/was redundant with the midwives. Good luck!

I had my first baby at Pacifica without a doula. On the one hand, it didn't feel like we needed an extra person as we had a senior midwife + a student midwife with us at all times. But on the other hand, my husband couldn't rest at all during my 24 hour labor as he was my immediate support person. For my second (which was not at Pacifica), we had a doula and it was great - allowed my husband to sleep overnight while I labored, and I think it helped contribute to a successful vbac for various reasons.

In short, I do think it is worth it.

Hi and congrats on your pregnancy. 

I had a doula for both of my births- which were both with midwives- one in a birth center, and one at a hospital. I had similar questions to those you are mentioning. I'm was so glad I had a doula at both births. For me the huge positives were: 

- doula will come to your home, so if you would like to labor at home for a while, it can be really nice to have that extra support for both you and a partner (so they don't feel alone in supporting you). doula really helped us remove the stress around the decision making part of labor (when to go to the hospital, what was normal, what to try next) 

- depends on the doula and the midwives, but in best case scenario, it can be a super collaborative team; both my labors were long, especially in the pushing phase; for my 2nd labor especially, our doula had a lot of good ideas about different positions to try, and ultimately, made the suggestion that I think was most helpful to ultimately having a vaginal birth 

- doula usually stays with you throughout labor, while midwives may need to come and go, depending on how many folks they are supporting; we found it super helpful to have someone who was 100% in it with us

- most doulas do some amount of pre and post visits, and I really appreciated these as a way to prepare, and also process after the fact 

Good luck with it all! 

My wife gave birth with a midwife and we had a doula. It was easily one of the better decisions we made. The midwife focused on the actual birth but the doula was with us for most of the time during the ‘build-up’.  She was a great help providing support (for both of us), giving advice and showing me useful massages, pressure points etc. She also alternated with me and allowed me to do other tasks for my wife. 

Hi I did not have a doula at my first birth and did at my second and it was a big difference, great support. The doula works for only your family and can support you and your partner in the ways you want suooorting the role of your partner not taking over their role which was important to us. It’s like having a supportive friend that is knowledgeable in birth and can advocate for you. Really important! 

My doula was awesome so I always try and recommend her when I can: