From client consults to parties to explaining what we do to our own friends and family, we answer this question at least once a week:
"What's the difference between a doula and a midwife?"
Since doulas and midwives are both a bit out of the mainstream in most of the US, it's totally understandable that so many people are wondering about difference between the two. If you find yourself a bit confused, keep reading!
Here are some other questions we've gotten:
Aren't midwives a thing of the past?
Don't midwives only exist in rural areas or in other countries?
How do you even say "doula"? (The answer to this one is "doo-luh")
If these are questions for you too, rest assured... you aren't alone. The history of midwifery in the US is complicated. Financial and political motives played a role in moving birth from the hands of women in homes into the hands of male physicians in hospitals in the early 20th century, where it has largely remained. And that's to say nothing of the way African-American midwives in the south were systematically barred from continuing to provide care for generations of families.
Since we've become so far removed from midwifery as a culture, it's no wonder some people think of colonial settlements or pioneers when they think of midwives. (In a consult once, a dad told us that when his wife suggested finding a midwife to care for her during their first pregnancy, all he could picture was scenes from Little House on the Prairie!)
The main difference between doulas and midwives is that midwives are medical care providers and doulas aren't.
Midwives are responsible for the health and safety of their patients. They can provide well-woman care in addition to caring for women during the childbearing year - through pregnancy, birth, and the postpartum period. Midwifery training and licensing requirements vary by state, and there are different types of midwives (certified, professional midwives, certified nurse midwives, and traditional midwives to name a few). Depending on state regulations, midwives can care for families birthing in hospitals, birth centers, or at home.
Midwives are trained in physiological birth and are the preferred care provider for low-risk pregnancies according to the World Health Organization. They are trained in recognizing risk factors and complications that may require more specialized medical attention. They do not perform surgery, so if a cesarean birth is required for any reason, they transfer care to an obstetrician (OB) who specializes in high-risk pregnancy and birth.
In many parts of the world, care from a midwife is normal for most people who are expecting a baby. The US is a huge exception. (This is probably one reason why our maternal and infant birth outcomes among the worst of any developed country.)
While midwives are primarily concerned with the physical health and safety of their clients, doulas focus on emotional support.
Doulas are here as a comforting, encouraging, and knowledgeable presence to support parents during pregnancy, birth, and the weeks and months following birth.
While we can provide some general medical information regarding options for families in birth and early parenthood, we do not provide medical advice or opinions. We support families in their right to informed decision-making, respecting and supporting you in whatever choices you make regarding your birth and the care of your baby. All that said, doulas don't have medical training. We do not take vitals sign measurements, perform exams, or deliver babies.
There are different types of doulas. You may have heard of birth doulas (who support families during labor and birth) and postpartum doulas (who provide at-home baby care education and support for the whole family after birth), but there are also:
bereavement or loss doulas: support families enduring the loss of a baby
full-spectrum doulas: support people through all of the fertility cycle (from fertility treatments to ending a pregnancy to adoption and beyond), and
antenatal doulas: provide support during pregnancy only
In contrast to midwives, doulas don't have any licensing requirements. There are organizations that train and certify doulas, but there is no governing body that oversees these certification processes or sets forth expectations of certain levels of training or experience in order to practice as a doula. Doula certification requirements can range from a weekend workshop plus reading a couple books, to a years-long process with one-on-one mentoring. There is a LOT of variation here!
This is one HUGE reason to interview doulas! When you meet with a doula you're considering working with, ask them about what their training has involved and why they chose the training programs or workshops they did. If you're curious, find out whether they have chosen to certify (remember... certification isn't a measure of quality in a doula). But most of all, find out about their approach when working with parents. (If you're curious about our approach, head on over here.)
Myth: If you are working with a midwife, there is no need to hire a doula.
False! Since midwives are responsible for keeping everyone safe, they are not always able to provide hands-on emotional support. Some midwives aren't even interested in that type of doula role at all! Other midwives have come to midwifery from a doula background and enjoy providing that kind of support in their midwifery practice. But if something is concerning during birth, midwives will always need to put safety before emotional support. Having a doula present in a situation like that means you'll have someone focused on helping you stay present in the moment, connected to your partner, and able to handle whatever comes your way. (Read more about how doulas support partners.)
Another thing many people don't realize is that midwives' role in birth usually comes in toward the end of active labor and the pushing phase. That means that your midwife likely won't be present for your whole labor, or even for most of it. Of course, there are exceptions to this. It's always a great idea to ask any midwives you're considering working with at what point in labor they usually join parents. If you've hired a doula, they can join you when you're ready for more support, offering coping techniques, positioning changes, and comfort measures as you labor.
Doulas fill the role of emotional support before a midwife arrives and during any situations where a midwife needs to be laser focused. We work together with midwives to make sure parents feel informed, supported, and truly cared for during their birth experience. Doulas and midwives make a great team!