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July 2008

What Do They Really Do?
Services for New and Expecting Parents

By Jessica Stockton Clancy

Brigette Polmar, a mother from McLean, knows firsthand the misconceptions about some of the specialists who serve new parents. Last February, when her daughter was a newborn, Polmar enlisted the help of local lactation consultant, Pat Shelly, director of the Breastfeeding Center for Greater Washington, whom she credits with rescuing her from having to abandon breastfeeding. Says Polmar, “When I told people I was working with a lactation consultant, half didn't know what that was, and half thought I was sitting around topless with a group of women eating organic food!” Though Polmar laughs, she couldn’t be more serious about how important a specialist was to her ability to breastfeed.

New and expecting parents may be confused and mislead by stereotypes and misinformation regarding the professional services available to them to support their needs prior to, during and in the months following birth. The following explanations will demystify some of these services.

MIDWIVES

The term midwife most often refers to a certified nurse-midwife (C.N.M.) or a certified midwife (C.M.). Both have completed midwifery programs and are certified by the American Midwifery Certification Board. A certified nurse-midwife is also a registered nurse (R.N.) Midwives provide prenatal and postnatal care and deliver babies in hospitals, birth centers or at home. Midwives also offer complete well-woman gynecological care.

According to the American College of Nurse-Midwives (ACNM), births attended by midwives have lower rates of cesarean sections, episiotomies and use of epidurals. Additionally, they have a higher rate of successful vaginal births after a woman has previously delivered via C-section. According to ACNM, the number of births attended by nurse-midwives has doubled since 1990.

“Midwives listen to women, and we are experts in normal childbirth,” says Leslie Ludka, a C.N.M. and senior technical advisor for ACNM. She adds that “normal” does not mean opting out of pain control measures, if that is what you choose.

Midwives are highly trained at recognizing the signs that make a woman high risk, and they work in collaboration with physicians. They order the same testing as obstetricians, and their prenatal care is virtually identical.

“The value of going to a midwife from the start is that we are constantly teaching,” says Judith Krones, C.N.M., who practices at The Family Health and Birth Center in the District. “So a woman can ask valuable questions and be an educated consumer,” she says.

According to the ACNM, 97 percent of births attended by a midwife are in hospitals.
Jody Melto is the mother of 2-year-old Felix and a District resident. She opted for a drug-free birth at a nearby birth center and credits her midwife for pulling her through when things became difficult. “She held my hand and made me believe I could do it,” says Melto. “I felt like Wonder Woman.”

Unyong Kim Waide decided to deliver all of her daughters, ages 10, 7 and 2, with a midwife at her home in Arlington. After touring hospitals, Waide was uncomfortable with some of their standard procedures. She believes more women would consider natural childbirth if they weren’t discouraged from trying it. “It’s like climbing a mountain,” she says. “Women can be quick to take a suggestion to stop before it gets hard, but they don’t know about the view from the top.”

Wondering about cost? “The 'apples to apples' cost of prenatal care and birth are the same whether a midwife or an M.D. is providing the care,” says Ludka. Often costs are lower as a result of fewer interventions. Most insurance policies cover the services of a midwife, but be sure to check with your insurance company in advance; some do not cover home births.
To find a midwifery practice or birth center in your area and to learn more about midwives, go to www.midwife.org.

LACTATION CONSULTANTS

Many new mothers feel disappointment and stress when breastfeeding presents challenges. A lactation consultant is a board-certified specialist, trained to assess and resolve breastfeeding problems. Women who have pain, whose babies won’t gain weight or who just have the instinct that something isn’t right should pursue a board-certified lactation consultant. Early help can dramatically affect a mother’s potential to breastfeed.

Anita Visser is the mother of 2-year-old Owen and a resident of Northwest, D.C. After her son’s birth, she was committed to breastfeeding but had some challenges in the early weeks. “I didn’t know where to turn,” she says. “I was looking for answers in books.” Visser was referred to Shelly and credits their two home appointments with making the difference. “Had there not been that service, I fear I would have quit within a couple of weeks.”

Frequently nurses (in the hospital or your pediatrician’s office) will refer to themselves as lactation consultants because they provide advice about breastfeeding. Though their intentions may be good, unless they are certified by the International Board of Certified Lactation Consultants (IBCLC), they do not have the advanced training of someone who is, and they may miss important cues when assessing a mother and baby. A certified consultant will have the letters “IBCLC” after her name on a badge or business card.

Shelly says, “More and more, women want to breastfeed, and they are seeking out solutions.” She emphasizes that women shouldn’t hesitate to pursue qualified help. “If you couldn’t walk, you would see a specialist,” says Shelly. “This is the same thing.”

Office consultations and home visits vary by provider. The average cost is $80 per hour for an office consult and usually twice that for a home visit, which includes the consultant’s travel time.

Check with your insurance company for details about your coverage. Many policies cover the services of a lactation consultant, but some will not cover home visits. You may be able to use a Health Savings Account (HSA) to cover the cost.

Local resources:

DOULAS

A doula assists women (and their families) both during and after childbirth. Their services are broken down into two categories:

Birth Doulas:

Birth doulas offer continuous labor support from the onset of labor through one to two hours after birth. They offer educational, physical and emotional support, typically starting at home and then transferring with the mother to the hospital or birth center.

Birth doulas help mothers stay comfortable and informed and do everything possible to support the family’s wishes for the birth. This may include avoiding interventions. She educates parents before and during the birth, comforts the mother with massage and recommends helpful positions to facilitate birth. “A doula is trained in nonjudgmental support,” says Natashia Fuksman. “She believes the parents are going to make the best decisions for themselves.” Fuksman is the Northeastern regional director of DONA International (Doulas of North America), the largest doula organization in the world, with more than 6,000 members.

Nurses and doctors may have shift changes, making the consistent presence of a doula desirable for a laboring mother. “It’s like an on-site birth consultant and a guarantee of continuous care,” says Tammy McKinley, a certified doula (and midwife) from Arlington. According to a study published by the Cochrane Database of Systematic Reviews, women receiving continuous support during childbirth are less likely to have cesarean sections or require anesthesia, forceps or vacuum extraction.

Christie Lavigne lives in the Foxhall neighborhood and is the mother to Jack, 2 years old, and Madeleine, 7 months. The doula she hired had been present at more than 300 births. “I wanted a natural birth,” says Lavigne. “She helped me stay focused and calm, and together we got through it.”

The birth doula typically pays the family a postpartum visit both to see the baby and to review the birth story with the parents.

Post-Partum Doulas:

Post-partum doulas support the family at home in the transitional weeks after birth. They typically work in three- to six-hour shifts. Their role stems from the tradition of new mothers having knowledgeable companions during the challenging early weeks.

Lavigne was reassured by her post-partum doula. “She made sure I knew how to care for the umbilical cord and that I was napping and eating,” she says, adding that the doula was also supportive of her husband. “Little things like that made a huge difference,” she says.

“It’s a very different role than that of a baby nurse,” says Fuksman. “It’s not a role that is specific to any one person in the family.” Post-partum doulas offer emotional support and newborn advice, help with laundry and meals and offer referrals to specialists, like lactation consultants, if necessary.

DONA, Birthworks and ALACE, are some of the organizations that certify doulas. When choosing a doula, understand the standards of practice she abides by (ask for a copy) and weigh both her experience and your comfort level.

A doula’s level of experience will affect the price:

For birth doulas in the D.C. area, prices range from volunteer to $1,200 for a complete package.
Post-partum doulas charge an hourly fee ranging from volunteer to $35 per hour.

Some insurance companies cover doula services under “professional labor support.” If not, parents may be able to use their medical savings account or other pre-tax accounts.

You can find doulas in the D.C. area by contacting Holy Cross Hospital Doula Program at 301-754-7780 or go to www.dona.org, www.birthworks.org, www.alace.org, or www.dcurbanmom.com.


Jessica Stockton Clancy is a freelance writer and mother. Born and raised in New York City, she now lives in Washington, D.C.