I didn't do this, but understand the need for it. As a nurse, I feel like sometimes it's all I can do to keep up with just making sure that both baby and mom are doing ok physically. Most of the time I can offer labor support and do that also, but sometimes I can't. There are times when I need to be on my toes and can only work on making sure that mom and baby are safe. It's at those times that I love the moms who have doula's. I feel great knowing I can do what I need to do for their well being, but not have to worry about not being able to work with mom through her labor emotionally. A doula can always be there for you emotionally, while sometimes a nurse(and a midwife would be the same I'm assuming) have other things that need to be attended to.
The short answer is: If you are giving birth in a hospital with a CNM she will not be there for labor support like a a midwife would at a home birth or sometimes a birth center. The doula is not medical, she's there for your emotional and physical support. Something most CNM's can't give in a hospital setting usually because they attend multiple births at once.
I haven't done this because I had so many women friends around me at my home birth, I felt a doula would be unnecessary. But, if I were to deliver in a hospital without my friends around me, just my husband, my midwife and hospital staff, I would want some one who was biased toward what I wanted but wasn't emotionally invested in my baby. A midwife in a hospital still has to follow the rules of the hospital, and my husband would be attuned not only to what I want in my labor, but also could be swayed (like myself) by what could go wrong with our baby. So having a doula is like having a person there that can keep a clear head no matter what. She would be like my rational brain when my rational brain has been sucked down into my cervix!
I attended a birth yesterday in a hospital and the baby was delivered by a midwife. I was there all 13 hrs, the midwife was there for 30 min of pushing and 30 min of "clean-up". Don't get me wrong, she was wonderful, but when it was time to help mom understand what she needed to do, I was the one with the relationship established that had gone through all of it with her. It was like I was in her head with her, so she had a link to the world outside of herself. Pretty amazing.
You are right about hiring someone who has an emotional disconnection to you, your husband, and your baby. I have extreme empathy for my clients, but we have still have a professional relationship. I can't let how I'm feeling get in the way of how I do my job.
But a doula isn't there to give medical advice. We can suggest what you may want to speak to your doctor about, we can keep you calm, but many times yesterday I found myself encouraging my clients towards what the nurse or midwife was saying, I would NEVER step in between the two to intervene.
Often what happens is the client is so set on having what she wants, and her husband is right there wanting his wife to be happy, they can't see that a compromise needs to made for the sake of all involved. In that situation, I will wait until the care provider leaves the room, and gently suggest that they may want to consider what is being said.
It's not always the case that the attending care physician has everyone's best health interests at heart, but I expect my clients to do their provider homework. If they choose to use that particular one, then I am going to encourage them to listen.
Of course every circumstance is different, but as a doula, I think that should be my place.
Well I didn't do both. But I understand the concept b/c my husband was my 100% present birth partner and it is very different to have someone waiting on your every need, completely tuned in to you at all times, versus someone there to manage the birth or deliver your baby.
I also think that unless you have certain preferences such as wanting to be alone (a very valid feeling that some women have) the more hands, the better. For helping to move you to different positions, for warming the tub, for grabbing a cup of water or getting a blanket, etc etc.
Your doula is not meant to replace your birth partner. This is a point I hope your doula has clarified with you. She is there for both of you, and she can provide things for you your birth partner, being emotionally and physically connected to you, cannot. ESPECIALLY if this is your first child, transition and second stage can be difficult for the birth partner, because you are in a very different state of mind, and it looks very chaotic sometimes. (This isn't always true, but usually is) Your doula, not being connected to you in that way, can remain detached and calm, knowing that the situation is under control. This allows your birth partner to give support, while still being able to care for his/her own needs.
Likewise, your doula will know when to step back and let your birth partner coach and support. Sometimes the best thing to do is back him/her and re enforce his efforts.