Aren’t doulas and midwives the same? And other misconceptions.

Every time I tell someone I am in school to become a midwife, I get something like “My friend is a doula too!” Well, I’m here to share a little secret – midwives are not doulas. Although some midwives are also trained as doulas, they are distinct professions.

Both are an important part of the birth team, but midwives and doulas have very different roles during pregnancy and births. One is a trained medical professional and the other is a trained labor support professional. For the purpose of this post, I will be focusing exclusively on birth doulas, but folks also train to be postpartum doulas, abortion doulas, and bereavement/end-of-life doulas.

Doulas

Photo of doula, Efe Osaren. Photo credit Janet Upadhye.

First of all, let’s get this straight, I am not a doula. I’ve had the pleasure of working with many doulas in the hospital setting, so I’ve witnessed firsthand some of their tremendous impact in the birthing person’s world. This is a list of my observations about the work of a birth doula:

  • Offers professional birth support, and often continuous care during labor.
  • Does NOT catch babies or medically assess the client in any way.
  • Does not give medical advice or speak on behalf of the client to medical personnel.
  • Offers resources and information during pregnancy to help prepare the birthing person and their support team for labor, birth, and the postpartum period.
  • Helps the birthing person identify preferences and priorities for their birth experience.
  • Helps the birthing person cope with the pain of unmedicated labor.
  • Helps the birthing person cope with positioning while getting an epidural.
  • Ensures that the family is involved in the birthing person’s care.
  • Educates the birthing family on comfort measures during labor.
  • Encourages everyone in the family to get adequate rest and nutrition during labor.
  • Works with clients regardless of their preferred birth setting (e.g., home, hospital, birth center, etc.).
  • Generally stays for a couple of hours after the birth of the baby, or until family is settled and nursing.
  • Usually follows up with the birthing family after birth. Follow-ups occur once or twice in the birthing person’s home or by phone.

Midwives

Midwife, Asasiya Muhammad, LM, CPM.

Midwives are the medical caregivers during the childbearing process. There are different types of midwives (I’ll post more on this later). Midwives can be community-based midwives, certified professional midwives, certified midwives, and certified nurse-midwives. For the record, I will mention that the scope of practice for midwives varies based on the type of midwife you are (and the state you practice in). For example, Certified Nurse-Midwives (CNMs) care for clients from the onset of menses through the menopausal years. This is one of the huge differences between CNMs and Certified Professional Midwives (CPMs), as CPMs care for clients during the childbearing year only. For the purpose of this post, I will highlight some of the ways in which CNMs care for people.

  • CNMs are licensed medical professionals trained to focus on the wellness and safety of the birthing person and the baby (in utero and newborn)..
  • They can catch babies at home, in the hospital, or at a birth center. They also perform medical assessments during pregnancy, labor, and the postpartum period.
  • They may have multiple clients in labor depending on the birth setting, so often are not available to provide continuous labor support.
  • Can do all prenatal, birth, and postpartum care for normal, healthy pregnancies (meaning you will not have to see an Ob/Gyn unless you have certain risk factors or complications).
  • Can give medical advice.
  • Can prescribe medications.
  • Can do yearly well-person check ups.
  • Can do pap smears and other types of gynecological care.
  • Can insert IUDs, place Nexplanons, and prescribe birth control.

As you can see, the roles of doulas and midwives are distinct. However, their ways of supporting the birthing person can sometimes overlap and they commonly work together at some point in order to give their mutual client the best birth experience possible. People often ask me, “should I get a doula?” and my response is always a resounding “YES!” Doulas are an integral part of any the birth team alongside a midwife or Ob/Gyn.

This post was cowritten by Crystal Hawkins, RN, SNM (Jamii Midwife) and Mari-Carmen Farmer, CNM. The list is not meant to be exhaustive, but rather to show some of the major differences between doulas and midwives.

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