Since the beginning of humanity, women have given birth. We learned about birth through experience of both doing it and helping other women through it. Through the years, roles were defined. Midwives were the ones with the physiological knowledge of bodies and childbirth, they managed the safety of mother and baby. Doulas maintained a supportive role, doing whatever they could to comfort the mother in labor and help her through the experience. This is not new - it's as old as birth itself.
When people ask what we do and we answer "doula" we often get one of two responses - either "what's a doula?!" or "Is that like a midwife?". We then have the opportunity to enlighten people with this information, which is always a good thing. So, let's dig deeper into the differences between a doula and a midwife.
Knowledge/Expertise: Attends Home & Birth Center Births (CNM's @ Hospitals), Trained in the physiological aspects of pregnancy, childbirth & postpartum. Monitors Mother-Baby's health pre and postnatally as well as in birth.
First of all, let's talk about different kinds of midwives - a Certified Nurse-Midwife ("CNM") is an advance practice registered nurse who has specialized education and training in both nursing and midwifery. They deliver babies in hospitals, sometimes both home and hospital, though this is pretty rare. A CNM is someone who might be more laid back about birth, yet still has very medically minded training. S/he may have never seen a truly natural birth or a home birth.
A Home birth Midwife also comes in many varieties. "The CPM (Certified Professional Midwife) is a knowledgeable, skilled and independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM). CPM is the only international credential that requires knowledge about and experience in out-of-hospital birth."
A Licensed Midwife (LM) is sanctioned by her state after she passes a test administered by the state’s medical board licensing division. Lay midwives in eight states – Indiana, Iowa, Kentucky , Maryland, Missouri, North Carolina, Virginia, and Wyoming – and in the District of Columbia are not able to legally become licensed midwives. So, a lay midwife could risk being arrested by attending home births. However, some states - like our state of Michigan - simply do not require a licence.
Then, there are "Lay midwives" (also referred to as traditional midwives, empirical midwives, or direct-entry midwives). They are not nurses; rather, they're women who have had direct training in midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program that is separate from the field of nursing. Lay midwives are trained to provide the Midwifery Model of Care to healthy women and newborns throughout the childbearing cycle, primarily in non-hospital settings. Some lay midwives become certified professional midwives (CPMs) or licensed midwives (LMs).
In all of the differences of midwives, there are also difference in style. Some are very hands on, some very hands off, others will let you decide what is best for you. Some will repair your perineum if you tear, others you will need to transfer into the hospital for repair. Some will show up earlier in labor and sit with you, others prefer to be called in when you are close to delivery. The differences go on and on - so, this article is really written from a perspective of "is this her job or not". We know many midwives who will rub your back and spend more time with you - but, traditionally, this is not their role. The midwife, ultimately, is hired to keep you and your baby safe and healthy.
Knowledge/Expertise: Attends Home/Hospital/Birth Center Births, Educational/Informational Support (providing information, options and community resources to people prenatally as well as in labor and postpartum), Comfort measures for labor and birth (ie: breathing, meditation, rebozo, massage, acupressure, position changes, distraction, etc.), Assistance with breastfeeding and postpartum recovery/comfort.
Just like there are many different types of Midwives, there are also many different types of Doulas. There are Birth, Postpartum, Antepartum, Adoption, Loss (miscarriage/abortion) and even Death Doulas.
A Certified Doula (CD) is someone who has been certified through training and requirements by some kind of educational program. There are MANY of these. Juliea of Crowning Lotus is trained through DONA, so, her "letters" are Juliea Paige CD(DONA). There are many different triainings out there, Crowning Lotus itself now being one of them. When someone is interested in becoming a Certified Doula, they will have to reflect on their own beliefs, ethics, styles, etc. and find a process that works for them - IF being certified is important to them.
Because Doulas do not take an active roll in your actual health care, they are not at all liable for the outcome of your health or birth. They do not require any sort of certification to work as doulas. Much of what a doula does can easily be obtained through independent learning and experience. When hiring a doula, you will also need to reflect on what is important to you as far as the knowledge and training your doula will have and need.
Again, styles, personalities, knowledge, approach - these all differ in doulas as well. Overall, however, the doulas role is one of support. She is there to ensure you know what your options are, to encourage you to make healthy decisions for yourself and your baby and then will support you throughout your labor process knowing you and what your preferences are. She is the person who will walk with you as a companion, as a person who provides you and your partner with comfort and peace.
The difference between doulas and midwives
Doulas don't do anything medical. They will not monitor your baby, take blood pressure, temperature, do vaginal checks, etc. It is not their job to catch your baby or to make calls regarding the health of you or your baby....as a matter of fact, the doula doesn't make ANY calls. She holds space for the mother to speak for herself. She will walk with you every step of the way, but will allow you to lead always.
The midwife's job is not to make you comfortable or to help emotionally prepare you for birth and parenting. You are hiring her to keep you and your baby safe. She will monitor and make calls regarding the health of you or your baby, she will do vaginal checks and catch your baby (unless you decide you or your partner want to do that). She will also deliver your placenta and monitor your bleeding and physiological adjustment after the birth as well as the baby's.
The midwife harbors the safety of the mother-baby.
The Doula provides comfort and support through the process.
Both roles equal in importance,
both in support of and benefiting from the other.
As you can see from the chart we created above, Doulas bridge the gaps in care that are provided by your OB OR Midwife*. While one is certainly not the other, all respectively have an important role in birth.
*Obviously, some midwives go above and beyond what their job is, but, we made this chart with the thought "this is or is not their JOB to offer this?" so you, the reader, would have only true expectations of any midwife. Overall, you want your midwife to be focused on your care, hiring a doula ensures that every facet of your needs are covered without putting too much on any one person - including your partner!