What is the Difference between a Midwife & a Doula?

What is the difference between midwives and doulas? This is the second most common question I get asked (the first being “You are a what?? What is that??). The simple answer is: medical - a midwife does the medical side of birth, a doula does not. 

A midwife is a medical professional. Most midwives have extensive medical training. A certified nurse midwife (CNM), for example, has a nursing degree (and passed all those nursing exams) and then went on to midwifery school – more training, more testing/exams, more learning and best of all: catching babies! You can have a midwife as your healthcare provider instead of an OB/GYN. A midwife has a model of care that is different than an OB/GYN (that is another blog post!), which focuses on the mama and baby and has a more holistic approach. It generally means less medical interventions and more time spent with each laboring woman. 

Midwives are on-call for your birth. They are also who you can see for all your prenatal appointments. There are birth center, home and hospital midwives. Midwives come once you are in active labor (for the most part) and work to stay with you until an hour or two after your baby is born (sometimes more, sometimes less). Hospital midwives might have multiple laboring mamas and have to spread their time between them (that sometimes happens to birth center and home birth midwives as well). A midwife is usually with you before they “catch” your baby, and they spend time coaching and supporting laboring women. They also help with breastfeeding and postpartum care. Midwives are wonderful people and health care providers. I highly recommend them!

A doula does not do any medical care or support. A doula provides emotional, physical and informational support. A doula is on-call 24/7. A doula discusses your fears, hopes, dreams, concerns, questions with you at length. A doula is with you from the beginning. A doula is there holding your leg during labor, doing hip squeezes, helping you stay cool by fanning you for hours on end, massaging your legs, your neck, your arms or back. A doula is there supporting your partner with food, emotional support and giving ideas/tips so your partner can support you better. A doula holds the partner when he is crying in the corner because his wife lost a lot of blood, and now everyone is okay and he can’t be strong any longer. A doula spends hours on her knees supporting you while you labor in the tub. A doula gives massages to your family who has been with you for the last 30 hours. A doula helps you write a cohesive and clear birth map. A doula empowers you. A doula encourages you. A doula holds your hand. A doula holds space for you. A doula watches as you find your inner strength and beauty and roar your baby out. A doula cries with you while you hold your baby in your arms for the first time. A doula takes pictures of the emerging baby, the new family, the support team. A doula is there, present, the whole time. A doula doesn’t have other laboring women that she has to spread her time between (normally – that is what back-ups Doulas are for!). A doula is there to focus on you as long as you need her, in whatever way you need her.

A doula works with the partner. A doula works with a midwife. A doula works with nurses. A doula works with an OB/GYN. A doula works with the family of the laboring woman –the mother who is a retired L&D nurse, or the mother-in-law who has only had c-section births, the dad who is so strong and silent in his support, the sister who laughs and supports, the cousins who just want to see the baby. A doula also protects the laboring woman and her birth space. A doula turns the lights low, shuts the door to keep the noise down, whispers, murmurs words of affirmation, silently holds a hand, rubs a shoulder or moans with the laboring woman as she moves her baby down. A doula does not tower over the laboring woman, instead a doula is always down on her level or lower.
    
A doula (usually) has also had extensive training and if they are a certified Doula (like I am), they have also met the extensive qualifications and passed the certification process through a trusted organization. Doulas aren’t usually nurses (although some eventually go that route). Doulas can be a doula anywhere - hospital, home or birth center. There are doulas that work only in one place or the other, and their are hospital-based doula programs. Most doulas, however, are independent and work with clients in all situations and from all walks of life. Doulas support you through whatever labor/birth choices you make and experience.  A doula can support a woman under going a c-section, having a vaginal birth, requesting medication or going for an un-medicated birth. A doula supports all woman and all birth experiences. 

Doulas provide benefits for all families. According to a 2013 Cochrane Database Systematic Review, “continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth.” (read full article here).

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As one of my clients said to me “my husband is my right hand and my doula is my left”

More on Doulas from the web:

DONA – What is a Doula? https://www.dona.org/what-is-a-doula
DONA – Benefits of a Doula: https://www.dona.org/what-is-a-doula/benefits-of-a-doula
Why Pregnant Women Love Doulas: https://www.bellybelly.com.au/pregnancy/doulas-what-is-a-doula
Nursing School - Difference between Midwives and Doulas:  http://www.allnursingschools.com/articles/doula