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  • Writer's pictureSusan Martin

What's the Difference Between A Doula and a Midwife?

As soon as you see those two pink lines on your pregnancy test, you have entered a whole new world. As you scroll through Google and Instagram, you may realize, “Wow. There is so much to know. And so many opinions out there. And what do some of these things even mean?!”

Well, first, welcome to this new realm called pregnancy and motherhood! You have started a wonderful journey where you can grow and learn. In this place you can come into a deeper sense of self-knowing and empowerment.

If you’ve been doing online research or reading books about pregnancy, it’s very likely that some of the words you've come across include “doula” and “midwife” and if these are new terms to you, you may be wondering: Who are these people? What do they do and what is the difference between them? Are they the same thing?

Doula support and midwifery care can be strategic choices to have have a good and supported birth experience, but they each have different roles and different skill sets. Let’s unpack what they do. Let's start with doulas - this birth professional is getting a lot more traction in the media these day, but what role does she play and what does she do?

When you are in labor and experiencing a lot of intense contractions, you are going to be completely occupied by the task at hand which will take your full attention - you won’t be able to do anything else or function like you do in everyday life (this is normal, doable and super cool - so don’t be scared!). This absolutely requires having others around you who will help take care of your needs and provide moment-to-moment support as you go through this event. There are different ways to get the support you’ll need. Your partner or another significant person in your life can often be one source of support.

A doula can be another important support person. Doulas are birth professionals who can be hired to provide essential and practical physical, emotional and educational support. Most often they are women who have given birth themselves (although not always) and many have received special training to know how to support pregnant and laboring women (meaning they have gone through a certification process, but this is not required to be doula). The important thing to note is that a doula is not a medical care provider; doulas do not check fetal heart tones, give vaginal exams, diagnose conditions, or give medical advice. That is the domain of your chosen health care provider.

You might be thinking, “Well, won’t my doctor or the nurse offer this type of support?” In a word, no. Doctors most often are not on the floor at all or with you for extended periods time while you labor. Their knowledge and tool set is also different from a doula. Health care providers are concerned with clinical aspects of care. Nurses are also busy with clinical aspects of care (especially as the doctor is not on the floor for a large part of the labor process) and most are trained to support medicalized birth, not natural birth. Who your nurse will end up being on your big day will also be a roll of the dice, so you have absolutely no idea about what they think or the type of care they feel most comfortable with. Additionally, nurses usually spend only about 30% of the time you are in the hospital in your room. While a nurse can be a wonderful part of the support structure around you, they are not going to be there moment-to-moment for every need you have.

Not providing medical care does not mean doulas are not important. A doula is like a sherpa or guide on an arduous mountain trek. She can’t do it for you (it’s still your journey), but she can guide you along and be by your side on this path. She can make sure that you have the support you need and help you stay motivated. Doulas are especially helpful in hospital births where there is a lack of continuity of care; she is someone with whom you develop a relationship and who will be with you during the whole labor and birth process. Doulas provide the support that other village women used to in times past, but since this knowledge and type of support has been eroded in modern times, a professional doula can step in to fill that important role.

Doulas are not just for support of the mama and baby, but also for the partner (or other family member or important person in your life). Having doula support allows partners to have a team member that is also there for them during a very intense experience in which they will have normal concerns and worries. Being the sole support person can be overwhelming and too much for some partners - especially if they haven’t been properly prepared and trained to handle the realities of bringing a baby into the world. (Side note: The only type of childbirth preparation that prepares partners in this regard is a 12-week Bradley Method series of classes)

A doula can be hired at any point in your pregnancy, although it's a good idea to not wait until the very end of your pregnancy to hire one. Some doulas book up pretty fast, so options may be more limited if you wait until the last month of your pregnancy, but it’s never too late to get a doula. A doula will meet with you several times during pregnancy so you can get to know each other and she can know more about you and how you envision your birth. She is someone you can reach out to during your pregnancy. She will be on call for your labor and usually be with you during the majority of that process until an hour or two after your little one is born. Doulas have referrals and connections with other perinatal providers.

As I noted before, doulas have an important role, but they are not medical care providers. This is an essential difference between a doula and a midwife, because a midwife is a licensed health care provider. Doulas may (or may not) be certified by an organization. Midwives have completed specialized education and training to become midwives - it takes years of intensive learning. Midwives are licensed by the state. Midwives are autonomous health care providers who specialize in normal pregnancy and birth. “Autonomous” means they are health care providers in their own right with their own specialty. Midwives have a different toolbox than obstetricians (doctors trained as surgeons who specialize in the pathology of pregnancy and birth) and have most often a different outlook on the process of labor and birth.

There are different types of midwives:

  • Certified nurse midwives (CNM) often work in hospital settings, but sometimes also work in the community setting (meaning out-of-hospital).

  • Licensed midwives (LM) and certified professional midwives (CPM + there can be other titles depending on the licensure of the state) work solely in the community birth setting, which could be a free-standing birth center or even your own home.

A midwife is a health care provider with whom you can work with pre-conception and after you give birth. A midwife monitors you and your baby’s health and well-being throughout your pregnancy. She provides the same urine screening, fetal heart tone monitoring and blood pressure checks as at the offices of obstetricians plus accessibility and referrals to other screenings and tests. Midwives generally spend more time on nutrition and checking in on many other important aspects of your well-being both mentally and emotionally. Visits are usually longer than typical doctor visits so that you build a relationship with your midwife. She knows this is essential for a healthy and safe outcome. She also wants to make sure that you are taking actions to stay healthy and low-risk so that your birth plans are more likely to go the way you want. In a free-standing birth center or at home you are more likely to get continuity of care with a midwife, but it depends on the type of midwifery system you are using. Generally, midwifery care is more holistic - taking in the whole person and the circumstances in their life.

Midwifery care has plenty of evidence that supports it as the medical care with the best outcomes for low-risk mothers and babies. Midwifery care is a great alternative to obstetrical care if you are in this group. So, you can feel confident if you choose to hire a midwife or midwife group as your health care provider to support you and your baby’s well-being along this journey.

So, now you know the difference between a doula and a midwife. They offer different types of support and function in different, but complimentary ways. A midwife can be your primary health care provider during your pregnancy and support you during your labor and birth; depending on what’s available where you live - you may be able to have a midwife in a hospital setting, a free-standing birth center or at home. A doula can provide essential practical physical, emotional and educational support to you and your partner whether you work with a doctor or a midwife, and whether you give birth in the hospital setting or outside of it. You can have a midwife and a doula. Or one of them. Or none. It’s up to you. It’s your journey.

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