I am often asked, “Is a doula the same as a midwife?” I can understand the confusion; midwifery is not as common in the US as it is in other countries– most of us grow up assuming a doctor is the only one who can deliver a baby–and doulas are a relatively new phenomenon.
But these professions are significantly different.
A midwife is a trained medical professional who assists the birth. A midwife is an alternative to an obstetrician. In other words, you choose between a doctor or a midwife for primary care.
A midwife will do all your prenatal visits and be there when you deliver the baby. A midwife can write prescriptions, request testing and call for medications during pregnancy and labor, including epidurals.
The midwifery model of care is different from the medical model of care — midwives tends to be more hands-off when it comes to medical interventions (such as continuous fetal monitoring and pitocin) than obstetricians, though there are exceptions to every rule. Midwives are not trained to perform surgery so if you have a midwife and need a C-section, you’ll be referred to an OB.
There are various training levels for midwives. A certified nurse midwife has been through nursing school and midwifery school. A certified professional midwife has been through a direct-entry midwifery program. A lay midwife is self-taught. The legal requirements for midwife certification and where a midwife can deliver varies by state. Some midwives do home births, some work in birthing centers and some in hospitals.
These are things people are often surprised to learn: Midwives can be covered by insurance, deliver in hospitals, and get you an epidural if you want one.
Now, the doula.
A labor support doula is someone who helps out during the birth. A doula has no medical authority and really is there to help mom with comfort measures more than anything else. So a woman would have a doctor or a midwife and then on top of that she could hire a labor doula. (There are also postpartum doulas who help families in the weeks after birth.)
I think the rise of doulas coincided with the drop in nursing staff in hospitals. These days many hospitals have a nurse on staff for several laboring women at once — she checks in with you but she’s not really with you throughout, helping and explaining what’s going on.
If you hire a doula, you pay out of pocket for what some consider to be basic, essential support. The prices can range from several hundred to several thousand (for the super experienced doulas). Studies have shown that having continuous labor support from a doula, or someone very much like a doula, can reduce the length of labor, reduce the likelihood of a C-section and other medical interventions.
Doulas are often brought on to help a woman have a more “natural” childbirth, but they can be tremendously helpful to women hoping for epidurals or otherwise requiring medication.
Doula comes from the Greek word meaning female slave. Since she gets paid, that’s not an entirely accurate description. But a good doula will serve a mom during labor in a very giving and committed way. She will probably also meet with you before labor to go over coping strategies, logistics and offer some education about how birth works.
I hope that clears up any confusion. I have to confess I had no clue what a doula was when I got pregnant for the first time. And I didn’t know that midwives were a real option for women in the US. Both doulas and midwives can be great options if you are hoping to give birth with as few medical interventions as possible.
If you’ve had either a midwife or doula, chime in on your experiences or any tips you have for picking a good one.
To read more about the history of midwives and the unique benefits of the “midwifery model of care” check out, In Labor: Women and Power in the Birthplace by Barbara Katz Rothman, PhD or Birth Matters: A Midwife’s Manifesta by America’s most famous midwife, Ina May Gaskin.
One of my favorite birth books is A Midwife’s Story by Penny Armstrong & Sheryl Feldman. Armstrong trained as a midwife in hospitals and then became a midwife to the Amish, who all plan to give birth at home. Her statistics are amazing and her stories provide a perfect counterpoint to the birth-is-a-screaming-emergency narrative that dominates today.