What is the Difference Between a Midwife and a Doula?

I get asked this question about once a week. Many people don't know that there is a difference and often confuse the two. Here it is, plain and simple:

A midwife is a primary care provider. She provides clinical care for the healthy mother and baby. For many women, as long as their pregnancy progresses normally, they will have no need to ever see another primary care provider, say for example, an obstetrician. The midwife oversees the general health of mom and baby throughout pregnancy and manages the delivery and postpartum period as well. You could say that the midwife delivers the baby, but I think most midwives would disagree. It's the mother who delivers the baby! 

A doula is an extremely valuable person to have on your birth team, but she doesn't have a clinical role. A doula's job is to support the mom and her partner in labor. She provides physical support (massage, labor coping techniques, etc.) and emotional support. She can help the parents navigate the hospital system if they are delivering in a hospital by educating them on different procedures and holding space for them to make informed decisions. The doula does not take the mother's blood pressure, assess the baby's heart rate, or do anything else clinical. 

 
Doula Yien supports a mama having a natural delivery at home by keeping her calm, focused, and on top of her contractions. Yien provides continuous physical and emotional support until the baby is born, never leaving the mom's side.  Photo by Pam Ellis

Doula Yien supports a mama having a natural delivery at home by keeping her calm, focused, and on top of her contractions. Yien provides continuous physical and emotional support until the baby is born, never leaving the mom's side.
Photo by Pam Ellis

 

Midwives and doulas often work in tandem. It is common to see both a midwife and a doula supporting a birthing mom together, each bringing her own set of skills to the process. 

In her blog, A Wondered Life, Rebecca Coursey explains the difference from another angle:

"Midwives are not just trained, and medically-board certified, to deliver babies and provide well-woman care, they are also trained in care of the newborn. They make sure all is well, checking for any abnormalities that are not caught during prenatal testing, making sure that everything is working properly and that baby is thriving. Often people confuse midwives and doulas, thinking that midwives are just doulas who decide they want to start helping women birth their babies at home. It is quite the contrary. Doula training is typically just a certification process from a 3-4 day class. On the other hand, Midwives have 3-4 years of schooling that is not only academic, but clinical as well. They bring with them a "mini-hospital" to home births (or at their birth centers)-- and have advanced training in life-saving support skills. They must pass national medical boards (the NARM) and be licensed through the state where they practice in."

 
Midwife Amy assesses a healthy newborn. The midwife works to keep mom and baby safe and healthy throughout pregnancy, birth and postpartum. To do that she monitors vital signs, draws and interprets labs, educates clients on tests and interventions, and is trained in normal birth, as well as emergency techniques. She works within the medical community and refers clients to outside providers as needed.  Photo by Sandor Weisz

Midwife Amy assesses a healthy newborn. The midwife works to keep mom and baby safe and healthy throughout pregnancy, birth and postpartum. To do that she monitors vital signs, draws and interprets labs, educates clients on tests and interventions, and is trained in normal birth, as well as emergency techniques. She works within the medical community and refers clients to outside providers as needed.
Photo by Sandor Weisz

 

Midwives in the United States deliver babies in hospitals, in freestanding birth centers (not attached to a hospital) and in homes. There are a few different types of midwives, and although there is some crossover, you will generally find Certified Nurse-Midwives in hospitals and Certified Professional Midwives in freestanding birth centers and homes. Doulas work and provide a valuable service in all settings and for all different types of births, including Cesarean sections.

Pregnant? Get. A. Doula.

It’s that simple. And it’s something I can’t stress enough....

Having a natural home birth? Get a doula. 
Having your baby at the hospital with an epidural? Get a doula. 
Having a natural birth at the hospital? Definitely get a doula.
Having a C-section? Get a doula.

In the ten years I’ve been attending births, I have never seen a more effective way to increase your chances of having a positive birth experience. Doulas are unique among the birth team in that they are trained professionals that provide continuous support for the laboring mom. This means a doula will never leave your side. Your midwife, your OB, the nurses, everyone else - they have other tasks to attend to - charting, prepping, making sure everyone is safe, not to mention other patients/clients (if you’re in the hospital). But a doula, she is there with you from the moment you need her until well after your baby's born and you've done your first breastfeed. She will rub your back, breathe through contractions with you, help you stay calm and focused, help you talk with hospital staff, support you in breastfeeding, get you something to drink, get your partner something to eat, and the list goes on and on and on. 

One of the most important things a doula does is to help your partner support you. Let’s face it, sometimes partners get tired, or they get overwhelmed, or they plain just don’t know what to do because they’ve never been to a birth before! Have no fear. Doulas have often been to many births, and are experts in managing the interpersonal aspects of labor. They are very intuitive about knowing how to support partners and help them feel comfortable, as well as helping to manage relationships with other family, friends and birth team members, all according to the mother's wishes, of course. 

A few things a doula does not do: 

  • She doesn't do anything clinical - no vaginal exams, blood pressure checks, fetal heart tones, etc.
  • She does not replace your partner. 
  • She does not speak for you or represent you to birth team staff. She can help hold space for you, and help you to think through decisions, but you or your partner are still responsible for communicating directly with your birth team about your needs and desires.

I know a lot of you out there are numbers-oriented folks, so let’s look at what the statistics say about having a doula at your birth. A meta-analysis of 22 studies comprising over 15,000 births showed that overall, women who had a doula at their birth experienced a:

  • 31% decrease in the use of Pitocin
  • 28% decrease in the risk of C-section
  • 12% increase in the likelihood of a spontaneous vaginal birth
  • 9% decrease in the use of medications for pain relief
  • 14% decrease in the risk of newborn being admitted to the nursery
  • 34% decrease in the risk of being dissatisfied with the birth experience

I advise all of my clients to get a doula. They are worth their cost many times over. I have never heard a mom say she wished she’d saved the money she spent on a doula. In fact, I’ve often heard women say that they would have paid much more if they had known what a valuable service a doula provides.

In recognition of World Doula Week, I urge everyone reading this to learn about doulas and get out there and spread the word. Educate yourself and the women and families you know about the amazing benefits of having a doula. ALL mothers deserve a doula!

P.S. In this post I am specifically talking about birth doulas, but I also want to acknowledge postpartum doulas, who are equally as wonderful, and are often a godsend for families who are learning how to incorporate a newborn into their lives.