Doulas and Midwives: What's the Difference?


 

Doulas and midwives, what's the difference between doulas and midwives? Doula holding expectant mother's belly

You know what’s a tough part of making a baby?

Childbirth.

In fact, it’s one of the most painful and remarkable feats of the human species. And certainly the most rewarding. After all, it’s a labor of love.

However, many women find that the birthing experience becomes a lot more bearable when you’ve got someone to support you through this exciting yet terrifying time.

There are two special individuals that are equipped to handle that task: doulas and midwives. Although the two roles perform on the same stage, midwives and doulas actually have very different training, education, and functions.

Let’s discuss some of the salient differences between these two maternity experts:

What is a doula?

Derived from the Greek word doulē, meaning a female attendant, a doula is your personal maternity caregiver. Her job is to provide emotional and physical support, and be your advocate. In just a few words, a doula is there for you.

Enlisting a doula has become an increasingly popular option for expectant mothers, and for good reason - while only 6% of moms hire a doula, over one in four wish they had. 

Doulas can reduce unnatural interventions in labor and delivery from epidural to episiotomy by a factor of 60%. In a study conducted in 2013, certified doulas helped improve birth outcomes for socially disadvantaged moms, cutting the risk of birth complications in half. 

The evidence is clear that having a doula support you during your transition from pregnancy to motherhood has many potential benefits. However, it’s important to distinguish between doulas. 

There are essentially two types of doulas: birth doulas and postpartum doulas.

Birth doulas

First is the birth doula. A birth doula is basically your personal trainer during labor. Except she’s more like a soothing yoga instructor, offering emotional support and reassurance every step of the way.

Your birth doula will walk you through relaxation techniques, therapeutic exercises for pain management, and other helpful methods to prepare you physically and psychologically for your birth. She will provide you with all the information you need to know in order to make informed decisions for yourself regarding your birthing options. She will assuage any fears you have in advance of your labor and birth. She has been there before and she will be there again to guide you through it all. 

Although they are not medical professionals, birth doulas can be tremendously beneficial as a calming and encouraging presence. Research supports that women are less likely to report a negative birth experience when they are coached by a birth doula.

Continuous labor support has proven to lead to higher satisfaction and has curbed the need for excessive medical intervention. However, that doesn’t mean no medical intervention.

Birth doulas simply don’t have the medical training that doctors and even midwives have. They also don’t have the authority to prescribe pain medication when you need it. While they don’t replace your medical professionals, they can certainly play a very important role on your birth team in caring for you. Recognizing that their role is limited by their lack of medical expertise, they will advocate for medical intervention where it is necessary.

Postpartum doulas

Maternal care doesn’t end at childbirth. 

Postpartum doulas are there to help you adapt to your motherhood once the baby is born. Recovering from birth can take some time, and postpartum doulas are there to hold your hand through that process. 

Whether it’s physiological or psychological, you’re going through lots of changes postpartum. Often when trying to juggle all these things while caring for yourself, your family, and especially for your new little one, something’s got to give. 

A postpartum doula will guide you through these exciting, new changes. She will show you how to swaddle, diaper, and care for your baby worry-free. Frequently, your postpartum doula will also be a certified lactation consultant. She can help you with latching techniques, and give you the skills and the confidence to nurture your baby on your own.

It is particularly helpful to have a postpartum doula when there are other siblings around, or when your partner can’t be there for you. Like your birth doula, postpartum doulas will give you the emotional support should you show signs of postpartum depression. 

Many birth doulas are also postpartum doulas. It’s a good idea to consider a doula that can fulfill both roles. For a whole host of reasons, it’s a lot easier to continue that relationship with the person who’s been by your side throughout your journey to motherhood, than to start with another person anew.

Antepartum doulas

There’s one last type of doula that specializes in high-risk pregnancies. For difficult and stressful pregnancies, an antepartum doula can provide the extra support that you need. 

Women on bedrest can use some emotional, physical, and informational support to feel more in control of their situation. An antepartum doula will take care of you, and often act as another maternal figure when you need a helping hand. 

midwife visiting expectant mother at home visit

What is a midwife?

In contrast, a midwife will aid in your birth and delivery as a trained medical professional. A midwife does many of the same things your doctor will do, as she is essentially a specialist in maternal health care.

While doulas focus on providing you with support in childbirth, certified nurse-midwives are traditionally more involved with delivering your baby. However, they can also be involved in prenatal care (for instance monitoring your baby using a fetal doppler), as well as postpartum care. 

Like an OB-GYN, your certified nurse-midwife is an expert in female reproductive health - she can perform gynecological exams, administer drugs to facilitate induced labour, and deliver your baby herself.

There are a couple distinct advantages in choosing to deliver with a midwife. First, a midwife tends to do a better job of offering personal, one-on-one guidance than an obstetrician. 

Generally, midwives also promote a natural, and holistic approach to pregnancy and childbirth that may be less prevalent in the (oft-perceived) industrialized world of obstetric delivery.

On the other hand, midwives are not as well-equipped to manage high risk births as obstetricians. They also can’t perform a C-section. But for normal pregnancies (as most are normal), midwives are perfectly functional and adept. They are just as safe and professional as obstetricians.

Midwives, unlike doulas, can replace your obstetrician in normal circumstances. Physicians and midwives can be found working in the same office.

Midwife certification

Midwives come with three different certifications and educational backgrounds. There is the certified midwife (CM), certified nurse-midwife (CNM), and certified professional midwife (CPM). 

In the US, certifications and licensing vary state-by-state. You can take a look here to find in which states these midwives are licensed.

Certified midwife (CM)

This distinction entails graduate level training in midwifery. Certified midwives are only licensed in five states, whereas certified nurse-midwives are licensed to practice in all of the United States. They can prescribe medication in just New York, Rhode Island, and Maine.

Certified nurse midwives (CNM)

Midwives typically go for their nurse-midwife certification, which implies a nursing degree plus a graduate degree in midwifery. In addition to licensure, certified nurse-midwives’ prescriptive authority covers all U.S. jurisdictions.

Certified professional midwives (CPM)

Here the title of professional simply indicates that the midwife has demonstrated competency in clinical training supervised by a midwife. These midwives have no formal college degree in midwifery, but they have the experience, which in many ways is even preferable. These are the classically trained out-of-hospital midwives that can facilitate births at home and in freestanding birth centres.

Doula certification

For doulas, certification is usually not required, however it does depend on your state. DONA International (Doulas of North America) offers a comprehensive doula training program for doulas seeking certification.

What do I look for?

When looking for a doula or a midwife, the most important quality to look for is selflessness. Especially for a doula, you’ll want a person who will consistently put their own needs second, and completely be present for whatever it is you need. 

Whether it’s physical support from a birth doula or relief and reassurance from a postpartum doula, you want someone who will be genuine and caring. The same is true of a midwife, especially as she is intimately involved with your delivery.

Of course, you’re going to look for relatability and honesty, too. You want to be best prepared for what’s going to happen regarding your birth, and what you need to do to make your baby’s entrance into the world as pleasant as possible for everyone involved.

Talk to your friends and family to see if they have any recommendations. The only thing better than knowing your doula or midwife is experienced is hearing about someone’s personal experience with them.

Mother holding beautiful newborn baby boy

Do I need a doula or midwife?

You know yourself. If you want to have a natural birth, doulas and midwives will advocate for that choice and help you through it. If you’d feel more comfortable not having someone watching over you and rooting for you, maybe don’t hire a doula.

If you’ve got a great relationship with your OB-GYN, or natural childbirth just isn’t a top priority for you, you’re probably fine without the help of a midwife. Many expectant mothers who would prefer a home birth will hire a midwife to take care of the delivery.

It really depends on what kind of support you feel you need, and where and how you want to give birth. You don’t need a midwife, but you should at the very least have a professional obstetrician to facilitate your labor and delivery to ensure that you and your baby experience a safe and healthy birth.

One final word on prenatal care. 

Tragically, over 800 women die every day due to pregnancy-related causes. One in five births worldwide occur without a doctor or midwife present. 

Especially in low income countries, lack of access to maternal health care translates to way too many preventable deaths. Making skilled prenatal care accessible can save the precious lives of hundreds of thousands of pregnant women and newborns.

Midwives and doulas have worked together to reduce maternal mortality globally by 38% over the past two decades. Whether you decide to go with a doula or a midwife, both, or neither, we all must appreciate the impact and importance of these maternal health experts, and the work they do keeping moms and babies healthy and loved. ♥️