Midwives versus Birth Doulas
What is a birth doula? What is a midwife? What is the difference? Should you use one, the other, or both?
Doulas and Midwives work together just like any birth team would. Doulas often work with all types of providers in a hospital setting. These can include: Obstetricians, Residents, Anesthesiologists, Midwives, Hospitalists, Nurse Providers, etc. The list is endless.
Just like with any of the providers mentioned above, Doulas and Midwives work closely to ensure a healthy mom and healthy baby, but also view birth holistically. Besides safety, they keep the birthing person’s emotional and physical comfort ate the forefront of their minds. Most midwives view birth similarly to how doulas are taught: Birth is a natural phenomenon that is safe and normal, a physiological response that does not need to be medicalized. The key word here is need.
Many folks want to use medicine as it can reduce pain and is comforting. Midwives are great because they understand the want for a holistic approach, but also, can harness the power of medicine in birth spaces when wanted or necessary.
What is a Midwife and Birth Doula?
Doulas are professional birth assistances who provide physical, emotional, and informational support to birthing families. They can be certified through many different organizations and care for women towards the end of their pregnancies, continuous care during labor and birth, and some are also trained as postpartum doulas.
Midwives are trained medical professionals who care for women’s health and specific to this post, pregnant women throughout their pregnancies. They attend to births, but are not always continuous support. Midwives have multiple credentialing bodies and can be certified nurse midwives, certified professional midwives, or lay midwives. Some midwives are trained as a doula as well.
Key Similarities and Differences between Midwives and Birth Doulas
Similarities:
continuous labor support (not always the case for midwives, but home-birth settings yes)
individualized and personalized approach
limits and reduces the use of medical interventions
Value the Mind-Body connection
Support the physiological birth viewpoint
Can work in hospitals, birth centers, and home-births
Differences:
Midwives perform medical exams, Birth Doulas do not
Midwives can administer and monitor medications, Birth Doulas do not
Midwives work in midwifery practices, sometimes combined in an Obstetrics group
Midwives follow you throughout your entire pregnancy, from confirming a pregnancy to delivery
Doulas work with your around your 2nd trimester to birth, some work as postpartum doulas as well
Personalized Care From a midwife and birth doula
Midwifery and doula services are incredible for folks who want more than just their vitals checked. Midwives and doulas want to know your health history, but also want to get to know you as a person. Midwives and doulas are great listeners. They want to know your strengths, your insecurities. They want to get to know your partners. They want to get to know your motivations and psychology. Working with a midwife combines obstetrics and emotional care. Midwives connect with you in a way that is meaningful.
Midwives give personalized care in a medical format. They will work with how you feel to determine if a cervical check is necessary. Midwives are more flexible with their approach to medical interventions as tools. They offer a tool, give you all the education, and won’t sway you either way in your decision. Midwives are patient, understanding of your preferences, and work in a holistic manner for your labor and birth.
Doulas offer personalized care in a supportive fashion. Birth Doulas get to know you in their own version of pre-natals. They do discuss any of your medical history, but leave the monitoring and attending to the medical professionals. Birth doulas find out how you would like to labor. They offer practice positions, movements, and massage. Birth doulas help set the mood and gather resources for you so that you are emotionally care for during the entire process. Based on your preferences, they may use touch, create positive affirmations with you, practice breathing patterns, or help coach your partner to do these things too.
Midwives and birth doulas dedicate their time to YOU. Both groups focus on the whole person, not just from your waist down.
Support in a hospital setting from a midwife and doula
In a hospital environment, midwives work in groups similar to Obstetricians. They have multiple patients that they are caring for and would not be providing continuous labor support. Midwives in a hospital setting also work in shifts and on-call schedules similar to nurses. So, if you are being care for by a midwifery group, you may have your midwife for some of your labor, all of your labor, or you may have a different midwife present the whole time. That being said, most groups schedule pre-natal visits so that you meet and get to know each provider before your due date arrives.
Doulas, conversely have you as their prime client. They are hired most of the time outside of hospitals and will be there to support your throughout your entire labor. Because they are not trained medically, a medical provider is still necessary. Doulas will stay with you over the course of your labor and work alongside your medical provider, whether it be a midwife or not, to ensure your needs are always met.
Outside of a hospital setting from a midwife and doula
Midwives are the care providers behind many birth centers and home-births. They support laboring women wherever they choose to birth and are key promoters of making sure you feel safe in whatever setting you choose to birth in.
At birth centers, similar to hospitals, Midwives will have certain shifts they are working and on-call for. You may be lucky to have one midwife throughout your labor and birth, whereas others may have several midwives who attend to them throughout the course of their labor. It is different for every pregnancy and every labor.
In a home-birth setting, midwives are often present for longer portions of your labor and birth. Midwives will be available to you throughout early labor via phone support and give you resources, options for comfort, and talk with you about your progression. Your midwife most likely arrives around the start of active labor, this is when she will begin to monitor you and the baby, as well as, prepping for your birth. They stay for the remainder of your birth and will monitor you for several hours after birth, this helps ensure your bleeding is normal and that everyone is happy and healthy. Midwives will continue to check in and schedule postpartum visits that aid in recovery and assist with breastfeeding.
Doulas will support you in both settings as well. Birth Centers will sometimes have doulas on staff, but regularly respect the use of outside private doulas coming in. In both birth centers and home-births, a birth doula can be there to support you the minute you go into labor. Every person feels differently about when they may need support, so your birth doula will work with you to ensure you feel supported 100% of the time. Whether it be phone support or coming to you in early labor, Doulas want to make you feel confident, comforted, and educated.
Medical Interventions
As stated above, Doulas do not handle any medical interventions or give medical advice. Midwives, on the other hand, are medical providers. They can help make decisions on when to use certain interventions such as Pitocin (synthetic drug that promotes contractions and labor progression) or other medications. Midwives will perform vaginal or cervical exams to measure dilation, effacement, and baby’s station. Doulas are educated and knowledgable regarding these measurements and can help you get into different movements and positions that continue to progress labor.
Midwives vs. Doulas
At the end of the day, Midwives and doulas are there to support you through the birth of your baby. I don’t believe there is a competition or versus between the two groups. In fact, Midwives and doulas compliment each other very well and offer full-coverage support to you. Midwives offer the gentle guidance over you medically, while remaining steadfast with your wishes, desires, and mindset for your birth. Birth Doulas support you emotionally, physically, and informationally to help you feel confident and make sure your non-medical needs are met. In my mind, although biased because I am a Birth Doula, having support from both groups is critical in having a holistic, natural, and empowered birth.