1. Supporting Mothers:
Midwives, Doulas, Lactation Consultants,
and Nannies
Midwives
Midwives are primary care providers who specialize in pregnancy and birth. They provide healthcare to
women throughout the lifespan. They provide medical services such as physical exams, prescriptions,
prenatal care, gynecological care, and health education and counseling. Midwives view pregnancy and birth
as normal life events. They are huge advocates of vaginal births. They typically encourage medication-free
methods of pain management.
Two Types:
 Certified Nurse Midwives (CNMs) - registered nurses who have completed additional midwifery
education through a nurse-midwifery education program; pass a national certification exam; licensed
health care providers
 Certified Midwives (CMs) - those with a health field background other than nursing that complete a
midwifery education through a nurse-midwifery education program; and pass a national certification
exam
Homebirths with a midwife typically cost less than hospital or birthing center births attended by a midwife.
Thirty-three states require private health insurance to cover fess for the use of a CNM. Most health insurance
companies will cover the use of a midwife during a hospital birth. Sometimes they will cover the cost of using
a midwife at a birth center. Most insurance will not cover the cost of a homebirth. Medicaid reimbursement
for CNM/CM care is required in all states. Out of pocket costs can range from $1,500-$5,000.
Those experiencing high risk pregnancies may still be able to use a midwife. They can assist with finding
resources to support the mother goals for childbirth, provide emotional support, and work alongside
OBGYNs and other healthcare specialists to ensure better outcomes. Midwives cannot perform C-sections or
use forceps or vacuums to facilitate delivery. If you have had a C-section previously, midwives can help
assess if you will be able to have a vaginal birth after C-section (VBAC) with your next pregnancies.
Birthing centers and homebirths may be better options for families who have members with special needs.
These atmospheres are usually more family-oriented and most midwives encourage delivering mothers to
be surrounded by loved ones.
If your state licenses midwives, you may be able to find a public directory of midwives in your state. They
may also advertise in the Yellow Pages, health directories, and on midwifery websites. Local pregnancy and
birth groups may also have this information.
 http://www.midwife.org/find-a-midwife
 http://ourmomentoftruth.midwife.org/OMOT-FIND-A-MIDWIFE
 http://mothersnaturally.org/midwives/findAMidwife.php

2. Doulas
Doulas are advocates for you and your birth plan. They provide mental, physical, emotional, and relational
support before, during, and after pregnancy. They are able to provide the support, wisdom, care, and
knowledge that other female family members have given in the past. There is no common philosophy for
doulas, though they are typically women who have experienced childbirth who are passionate about
supporting mothers and families.
Types:
 Birth/Labor Doula – provide mental/emotional encouragement; teach about process of birth;
provide massage and physical support during birth
 Antepartum Doula – typically serve women on bed rest and those with high risk pregnancies; listen
and provide emotional support; find contacts and resources for mother; assist with housework and
preparation for baby
 Postpartum/Postnatal Doula – help mothers with basic tasks after giving birth, such as housework,
cooking, cleaning, providing support for breastfeeding, and assisting with the baby’s sleep schedule
 Adoption/Foster Doula – help family adopting, mother who is giving her child up for adoption, or
both; provide similar birth services to mother as well as additional emotional support; builds bridges
between adopting family and birth mother; help birth mother and family navigate the transition
 Miscarriage/Loss Doula – often these are women who have experienced this loss themselves; provide
emotional, physical, and informational support to mothers and families experiencing loss
No formal education or training is required. Many doulas do go through some type of training. The highest
standard for doulas is certification through DONA International. They provide two types of certification:
birth doula [CD(DONA)] and postpartum doula [PCD (DONA)]. Doulas can receive both types of certification
if they choose to do so.
Doulas charge between $300-$1500 for their services. Cost depends on length of service. Most health
insurance will not cover the cost.
Antepartum and Postpartum doulas can assist mothers with high risk pregnancies and children with special
needs. They can help by providing emotional support for mothers expecting children with special needs and
by caring for that child or other children in the family with special needs after birth.
You can find a doula through local birthing and pregnancy groups, birthing centers, and online directories.
 http://www.dona.org/mothers/find_a_doula.php
 doulamatch.net
Lactation Consultants
Lactation consultants and counselors teach mothers how to feed their infants through breastfeeding and
breastfeeding alternatives. They help solve breastfeeding problems, such as latching issues, painful nursing,
low milk production, etc. They can help with babies who aren’t gaining enough weight. They help mothers
create and reach breastfeeding goals. They know various methods and techniques to aid in breastfeeding,
such as infant positions. They are typically knowledgeable about breastfeeding equipment, such as breast
pumps. Many lactation consultants and counselors provide one-on-one consultations and group classes.

3. Types:
 Certified Lactation Counselors (CLCs) are individuals who have successfully completed the Healthy
Children Project’s Certified Lactation Counselor Training Program, an Accredited ANCC Nursing
Skills Competency Program™ and are also certified by the Academy of Lactation Policy and Practice
(ALPP).
 International Board Certified Lactation Consultants (IBCLCs) are health care professionals who
specialize in clinical management of breastfeeding.
CLCs and IBCLCs have the mentality that breast is best. They work to find the best method for mothers to
provide breast milk for their infants.
Costs are roughly $120-$300 per session. These may or may not be covered by insurance.
CLCs and IBCLCs can help mothers find the best feeding techniques for children with special needs. La Leche
League argues that breast milk is essential for babies with special needs to protect them from infection and
digestion issues. A CLC or IBCLC can help a mother learn different techniques to help her child (ex. Children
born with Down syndrome, cleft lip or cleft palate, cardiac problems, cystic fibrosis, or neurological
impairment). Technology such as breast pumping and using bottles, naso-gastic tubes, or an at-breast
nursing supplementer can help bridge the gap between baby and breast milk. These methods can also be
used for premature babies in the NICU.
Find a CLC or IBCLC by asking your local health care provider, local pregnancy and birth group, La Leche
League, midwife, doula, etc. Also consider searching through International Lactation Consultant Association.
 http://www.ilca.org/i4a/pages/index.cfm?pageid=3432
Nannies
Nannies provide child care to children in their family homes. Nannies either live in the home with the family
or arrive as needed.
Types
 Live-In – lives in the home with the family
 Full-time/Part-time – works a designated number of hours per week in the home with the children;
does not reside in the home
 Newborn Care Specialist – receive specialized training and typically provide 24 hour child care
during the first few weeks of life
 Sleep Trainer – receive specialized training to help babies and children develop healthy sleep
routines
 Temporary – short term employment (few hours to several months)
 Multiples Specialists – extensive experience working with multiples
 Governesses – educationally qualified nanny employed full or part time in the home; educates/tutors
children
No formal education or certification is required to be a nanny. Most nannies have previous experience with
children and an education/child development background. To increase pay and employment, many nannies
opt to receive additional certifications:
 CPR/First Aid
 Water-Safety Certification
 Certification in Infant Care
 International Nanny Association (INA) Nanny Credential

4.  Certified Professional Nanny (CPN)
 Kid’s Nutrition Specialist Certification
 Certified Children’s Fitness Specialist
 Foreign Language/Additional Language skills
The cost of a nanny depends greatly on age, experience, and quality. Most nannies are paid between $8-$17
per hour. If paid weekly, they cost roughly $350-$1000 per week.
Finding care for a child with special needs can be especially difficult. Hiring a nanny may be a successful
alternative to finding a child care center. There are nannies with extensive experience in caring for children
with special needs as well as medical experience. These nannies could provide more one-on-one care for
your child than child care providers in a center.
Finding a nanny requires time and effort. They can be found in help wanted ads, internet classifieds, and
through word-of-mouth. The INA recommends that families use a nanny placement agency or contact a
nanny training program.
 Nanny.org
 Care.com
Additional Resources
The Midwife Is In - themidwifeisin.tumblr.com
American Midwifery Certification Board (AMCB) - amcbmidwife.org
Midwifes Alliance North America - mana.org
American College of Nurse-Midwives – midwife.org
Our Moment of Truth – ourmomentortruth.org
Mothers Naturally – mothersnaturally.org
Bloomington Area Birth Services – bloomingtonbirth.org
National Association of Certified Professional Midwives – nacpm.org
Citizens for Midwifery – cfmidwifery.org
International Confederation of Midwives – internationalmidwives.org
International Center for Traditional Childbearing – blackmidwives.org
DONA International – dona.org
Radical Doula – radicaldoula.com
How to Become a Doula – howtobecomeadoula.com
Doula Match – doulamatch.net
International Lactation Consultant Association – ilca.org
International Board of Lactation Consultant Examiners – iblce.org
Healthy Children’s Center for Breastfeeding – healthychildren.cc
Academy of Lactation Policy and Practice, Inc. – talpp.org
Le Leche League International – llli.org
La Leche League of Indiana – lllofindiana.org
International Nanny Association – nanny.org
America’s Nannies – americasnannies.com
Care – care.com