Midwives and Doulas: the Past, Present, and Future of Maternal Medicine

According to Blue Cross Blue Shield, pregnancy and childbirth complications have increased by 31% as of 2018. Let’s state the facts. Modern-day medicine is progressing day-by-day. One minute there’s 3-D ultrasounds and the next day there’s a pump made to recycle blood. With these developments in mind, women still suffer from pregnancy and childbirth complications. With the statistics rising, more women are looking for support from midwifery and doula care.

Midwives are healthcare providers who handle pregnancy, childbirth, newborn and postpartum care. Contrary to popular belief, midwives are trained medical providers equipped to handle low risk, out-of-hospital births, including medication to stop hemorrhaging. Unfortunately, if you are not informed of what a modern-day midwife looks like, you are probably picturing someone who still writes with a feather and ink.

Today, Anja Akhile is a resident midwife student in California leading prenatal, birth, and post-partum care with the oversight of a licensed midwife. Akhile came to the decision to become a midwife after experiencing her first birth as a doula.

“During that birth, it was very clear to me, being a doula isn’t enough because, at that point, your clients have already gone through their whole pregnancy,” Akhile says. “So, they’ve already gotten all this prenatal care or lack thereof and there’s not that much that you can do to solve a lot of the problems at the end.”

Akhile wanted her patients to have the proper information during their pregnancy. To ensure that, she needed to be in charge of the entire process from start to finish. Enter midwifery.

The differences between midwives and OBGYNs are misinterpreted far too often in the 21st century. Akhile emphasizes that midwives practice a relationship with their clients known as “informed consent” while OBGYNs practice “blanket consent.”

“So informed consent means I’m informing you of all of your options,” Akhile says. “In midwifery care, you are an active participant in your care. All the information is presented to you, and you are given the option to either consent or decline. There’s always an option to decline something even if it is the standard of care.”

In the case of using an OBGYN, Akhile explains, blanket consent is handled in a manner that does not lay all your options flat on the table. Luckily, doulas such as Chéna Davis are observing the room at all times to protect their clients.

Chéna Davis, better known as Chey The Doula, is a full-spectrum doula in New Jersey and some parts of New York. Davis has been a working doula for six years now and offers services through her company, Butta’s Holistic Services. To Davis’ surprise, she became a doula before she even decided.

“I didn’t attend any births at that time. I would just tell them what’s normal and what’s abnormal, look at cute pictures and ultrasounds.”

According to Dona International, a doula is a trained professional who aides in physical, emotional, and informational support. Unlike midwives and OBGYNs, doulas do not have the medical status to provide physical care. They provide families with emotional and mental support that are not typically extended from doctors.

“It’s more so about connecting with them and being there on an emotional level,” Davis says. “Sometimes it means they just survived. As a doula, I am bridging that gap of ‘oh we’re just surviving’ to we are enjoying this experience however we can.”

Coincidentally, Akhile and Davis were one of the first in their separate circles of friends to have a baby. With the birth of their firstborns came along the responsibility of holding the desired answers for their friends. Both Akhile and Davis took their first-hand experiences and decided to implement their resources where needed. Unfortunately, few mothers know the benefits of midwives and doulas according to Akhile and Davis.

For starters, Akhile clarifies that midwives are trained in physiological births while OBGYNs receive their training in surgery. This explains the difference in the relationships midwives have with their clients compared to OBGYNs. Traditionally OBGYNs see their patients the day after birth and once again at six weeks. For midwives, the length of care is much more extensive.

“We actually see you 24 hours at your home. We see you 1 week postpartum, 3 weeks postpartum, and then again 6 weeks postpartum,” Akhile states. “Another thing about midwives that OB’s don’t have, [is] it’s in our scope of practice, medically, to actually care for a newborn for up to 6 weeks postpartum.”

Contrary to what the public may believe, midwives practice medicine. If you don’t know a lot about midwives, you may assume otherwise. What you don’t know is that midwives are trained to use the proper tools and medication to assist.

“When we go to a home birth or a birthing center we have all of the same medication to stop a hemorrhage that a hospital would. We carry oxygen if the birthing person needs oxygen. We are skilled in maneuvers to get babies out of there when they are stuck," Akhile states. "We know how to suture your vagina if you have a tear. We go through intense training to keep our clients and the baby safe and we are licensed by the same medical board that actually licenses gynecologist.”

When you are carrying a child, you should feel protected, enlightened, and powerful. Unfortunately, as a doula, Davis has heard too many stories from her clients about appointments that should simply be routine check-ups that went sideways. These situations are preventable if the notion that doulas are not necessary or a luxury were erased.

“To say ‘I didn't want to get one because I didn’t want to seem bouji or I can just do it on my own,’—Of course you can do it on your own. Of course, you can. Will you enjoy it?” Davis questions. “Will you feel heard on your own? Will you get through it at peace on your own without feeling like you have to fight for your life or just fight for your person?”

While Davis is not delivering the baby, her attention is focused on making sure the birthing person is feeling present and heard in the room whether it be in a birth center, home, or hospital.

“I am kind of the mouthpiece in the sense that I am the narrator of the room. If I see the doctor reaching for the amnio hook to break your water: ‘hey mama, the doctor’s getting the hook now. He’s going to want to break your water. Is this something that you still consent to?’”

Davis and Akhile hold different roles in the birthing room, but they are present throughout all of the same steps. They both see their patients through prenatal, birth and postpartum. Akhile lives her life on call as soon as her clients reach 37 weeks. Because she lives in California, the legal ‘due window’ is 37 to 40 weeks.

Business hours are no match for Davis because she wakes up every two hours between 11:00 p.m. and 6:00 a.m. Once Davis’ clients reach active labor, it can be difficult for them to concentrate and feel comfortable in themselves. When this occurs, it’s up to Davis to assist them through this process and help them reach a point where they can focus on breathing.

Unfortunately, statistics have shown that black mothers are not receiving the proper treatment for a smooth and successful birthing process similar to their white peers. Based on a study run by Kaiser Family Foundation, Black, American Indian, and Alaska Native women have a higher rate of pregnancy related deaths compared to white women. This dangerously high rate is based on the clear racial biases in the hospital.

When Davis and Akhile were asked how they reinforce trust in their relationships with their black clients, neither of them hesitated in emphasizing that transparency is key.

“I am transparent with my clients,” Davis states. “I do not sugarcoat things at all in the sense that I’m going to tell you the truth about the experiences that may or may not happen.”

Picture this. Davis is observing hospital visits by the side of one of her clients and notices she's worked with the doctor a couple weeks ago. She was not impressed. She takes it upon herself to be honest with her client and express her honest opinion on that doctor. Whether the clients takes her words with a grain or pint of salt is up to them and them alone, but she will not hesitate to recommend doctors of color.

“I snatch the clients from the doctors who are not doing right by them because prevention is better than cure,” Davis states. “If I can lead you away from that concern and fear safely and smoothly, let’s just make that change if you are open to it. So I always let my clients know any decision is their decision. I’m going to support it.”

Akhile lays it all out on the table. She refrains from sugarcoating any details for her clients. She recognizes the importance of building a foundation of trust. In order to help protect and provide for her clients. The midwife offers as much of her two cents as she can.

“I share a lot of personal experiences. I’m very vulnerable, so I feel in turn my clients are vulnerable with me,” Akhile states. “But I feel like the best type of way to protect clients is to give as much information as possible so that they can make the decisions for themselves.”

If Akhile advises her patients to go towards one direction of care, they might go the other way. When that’s the case, she must remind herself to not get too attached to the client and their experience. At the end of the day, that is what informed consent is all about.

“While I want to keep all black women safe and make sure that they’re not dying or having these crazy complications, ultimately, it’s their care. It’s their body. It’s their birth and they’ve gotta make the decisions that they think is right for them.”

Black women have been victims of unfair treatment in the hospital for far too long, but women like Akhile and Davis are dedicating their lives to bettering the space for pregnant women. Whether your birthing plan is set in a hospital, birthing center, or the comfort of your home, you should feel heard, seen, and protected if you are performing a miracle as transcendent as giving birth.

The reality is, midwives and doulas are not luxuries nor fallacies, so they should not be treated as such. They are professionally trained to meet your personal needs. If you’d like to seek the services of Chena Davis or Anja Akhile you can find them on Instagram at @buttatheholisticdoula and @ anja_akhile.