Difference between a doula and midwife

[vickin]

I am new to this website and my dh and I are TTC our first child. We are interested in natural birth. However, I am not sure I understand the difference between a doula and a midwife. What are the differences?

[loveslabor]

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[Maggi315]

Well, generally a doula doesn't do "medical things" like blood pressure, vaginal checks, listen to heart rate, etc. A midwife does all these things plus delivers the baby, placenta, etc. Do a google search, there is tons out there on both of them, most people list on their websites what they do and don't do.

[Yaliina]

Simply put, a doula is NOT a medical person. She is more like a counselor- she supports the mother and gives non-medical advice during l&d (like "try this position to releive back labor"). A doula can be your birth partner or she can support your birth partner. She can also intervene on your behalf- with nurses, doctors, or pesky mothers-in-law. A midwife is basically one step down from a doctor (or one step up- depending on how you look at it). A midwife IS a medical person- prescribing medications, performing exams, ordering tests, etc.

You can think of it like: a doula generally doesn't do anything that requires latex gloves, while a midwife does. ;)

Hope that helps. (BTW- my mother is a DONA certified doula & I have always used midwives- that's my expertise).
Happy Birthing!

[NavelgazingMidwife]

A doula most certainly should NOT intervene between client and doctor or nurse. The doula who does this risks not only getting herself tossed out on her ear, but also making things very difficult for other doulas in the community. (And any DONA doula knows this.)

A doula CAN remind mom of her wishes if she sees things about to happen that she'd said she didn't want. For example, the doula sees the doctor getting the amniohook out and telling the mom she needs to do an exam - the doula can lean down and say, "did you want your water broken?" and that is the cue for the mom or dad (or partner) to say, "whoa, Nellie!" and discussion ensues. It has born out over time that if the doula says, "mom said she doesn't want her water broken," the doctor/nurse gets incredibly angry and defensive because you are not a family member, but a hired hand (in their eyes).

Not all midwives are "medical" people, either. Certified Nurse-Midwives are nurses first and then midwives and can prescribe some medications (birth control, antibiotics, etc.). I'm a (Licensed) midwifery people (said: mid-whiff-er-ee). I cannot prescribe medications, but can administer emergency meds such as pitocin for hemorrhage or use lidocaine for suturing. These are, in the eyes of the law, *not* medical skills, but midwifery skills.

I've done doula work for 23 years (in January) and done midwifery since 1993 and I can promise, doulas do indeed need gloves on more occasions than one might think. Holding a woman's legs who's had an epidural, holding the barf bowl, helping her in the shower to pee, helping her clean herself after the birth, and more are all reasons a doula might wear gloves.

I have many explanations for the difference, but the main ones include:

- Doulas are a walking childbirth class so partners don't have to remember everything taught in classes.
- Doulas are a bubble surrounding the laboring couple/family so they can concentrate on the birth itself and the doula is the fetcher and lighter turner downer, etc.
- Doulas "hold" the birth plan in their minds and "pull it out" when things are confusing or happening quickly.

- Midwives are trained in normal birth including prenatal care, drawing labs, sending women for ultrasounds, etc. The difference is the average length of time of a prenatal with a doctor is 6 min. whereas with a homebirth midwife, it is 60 min.
- Depending on the type of midwife you choose, you can nearly guarantee she will be the one attending your birth. Not possible in most circumstances in hospital practices, luck of the draw in birth center practices, but most homebirth practices are a you-hire-her-she-is-yours type.
- Midwives see you as a person - emotional, spiritual, as well as physical and mentally brilliant! - and know you are part of a marriage/relationship (usually), family, community, etc. The medical standard of care is to see women as the numbers they can produce (blood pressure, dates on a calendar, units of blood lost, weight gained, fetal heart tones on a monitor strip, amniotic fluid amount, etc.) -mostly forgetting the woman has a heart and mind.

Those are the most common. It was a great suggestion to poke around the Net... you will read until your eyes bug out because there is so much information!

Much good luck,

Barbara E. Herrera, LM, CPM

[vermontana]

I agree with Navelgazingmidwife's response, and I just want to reiterate that 1)a midwife is not a "medical" person, generally (there are, of course those out there who are more "medwife" than "midwife", but that's a whole other topic),
and 2)there sure are plenty of times a doula needs gloves! And many doulas are know how to perform vaginal exams, check FHT, do BP checks, etc.
ALSO, I know many wonderful, warm, skilled and popular doulas who have never had any *official* training. Being a doula really means that you are giving the mother your complete compassion, your heart and your hands, to support and encourage her through her birthjourney. Most women are born with this gift of compassion and heart-feeling, and make great doulas, with or without training.

[Charmie981]

Rather than seeing a midwife as "medical personnel," I prefer to say that a midwife is your "health care provider" through the course of your pregnancy. In a normal pregnancy, your midwife will fill the role that OBs have in other pregnancies.

A doula...well...I just am NOT a doula and I don't like the work a whole lot, so I'll just say that everyone else has given an okay explanation. The doula takes care of you mentally and emotionally while a nurse, doctor or midwife takes care of you physically.

[NavelgazingMidwife]

Ah, but I spend a *great* deal of time with women's emotions during pregnancy, labor, and postpartum. Doulas do not have a monopoly on the spiritual or emotional aspects of a woman's life during the childbearing year. Doulas are, however, wonderful support in a world where most women do not have a compassionate (medical) caregiver.

In fact, I spend *so* much time (best guess is about 80% of each prenatal) working with women and their issues and concerns - including past birth traumas (with doctors, hospitals, nurses, CNMs, and homebirth midwives alike) - I've gone back to school and am working towards a Master's in Psychology with a focus in birth trauma. As a writer, I know I will be "heard" much more clearly with the amplification of MFT or PhD behind my name as I discuss birthrape, birth abuse, and birth trauma.

Hmm... getting off topic.

Anyway, I agree that most care providers don't or won't offer their hearts and sit with their clients and cry with them as they recount being sliced open while screaming for them to stop or to hold them as they share the pain of marital relations because of the memory of the vacuum extractor in their vaginas. But, some of us do.

Just wanted to say.

And Charlotte, I'm curious (and not in a snotty way at all... seriously curious), you say you are NOT a doula and that you don't like the work. Is it the hospital aspects? I hesitate putting words in your mouth, but think this is a great discussion topic. I hear it a lot from student midwives and doulas alike and would love to hear more if you are game.

Barbara E. Herrera, LM, CPM

[MrsMoe]

Think of a Doula as a birthing coach. Our Doula will assist us in natural pain relief methods such as counter-pressure, hot/cold techniques, back massage, breathing, position changes to aid labor, assisting husband in coaching, and so on.

A midwife however is like an OBGYN with a nursing degree vs. PhD. She delivers the baby and takes care of your prenatal visits so long as you do not fall into a high risk category. Midwives are less prone to medical interventions (such as inductions and episiotomies) than medical doctors are.


Here is an example of what a Doula is and does:
http://www.youreverydaymiracle.com/

[vermontana]

..a midwife is like an obgyn w/ a nursing degree vs a phd...?
I think it's interesting that so many of the explanations of a midwife are relying on analogies to the medical world, where, generally, there is just no comparison. The main reason being that most midwives who truly trust birth and women's ways of knowing, don't see birth as, or make it, a medical event.
It seems like even in more "alternative" circles, the labor-as-a-medical-event mentality is still present.

[Charmie981]

Ah, but I spend a *great* deal of time with women's emotions during pregnancy, labor, and postpartum. Doulas do not have a monopoly on the spiritual or emotional aspects of a woman's life during the childbearing year. Doulas are, however, wonderful support in a world where most women do not have a compassionate (medical) caregiver.


Anyway, I agree that most care providers don't or won't offer their hearts and sit with their clients and cry with them as they recount being sliced open while screaming for them to stop or to hold them as they share the pain of marital relations because of the memory of the vacuum extractor in their vaginas. But, some of us do.

Just wanted to say.

And Charlotte, I'm curious (and not in a snotty way at all... seriously curious), you say you are NOT a doula and that you don't like the work. Is it the hospital aspects? I hesitate putting words in your mouth, but think this is a great discussion topic. I hear it a lot from student midwives and doulas alike and would love to hear more if you are game.

Barbara E. Herrera, LM, CPM

See, I spend a lot of time with emotional, psychological and mental aspects also. IMO, a doula is not a necessity at a birth that I attend, because I function as doula also. If someone desires "extra" support, I'm GREAT with it, but a doula at a homebirth with me wouldn't be doing the same thing hospital doulas do becuse I connect with the mother during prenatal care and know what her dreams and desires are for her birth at home.

I really hate doula work because I'm a midwife. I'm qualified to provide prenatal care and to catch babies. I know as much (or more) about normal pregnancy, labor and birth as an OB. But when a client wants me to doula, she is saying "I want to have a labor assistant, but I don't trust you to do it all." All of my doula clients have had normal pregnancies and could have had their babies in my (or another midwife's) care at home, but chose not to. I find that with doula clients, I tend to enable the OBs to be neglectful. When a mom has a question that's not "worthy" of the OB's time, she calls me. And of course, I answer it. When she needs her back rubbed in labor, I do it, and the OB just shows up at the end. I feel like as a doula, I was simply hired to fill the gap between the level of care that the mother wants and the level of care that the OB is willing to provide. And I HATED that. She's trusting herself and her baby to him, but she feels the need to hire someone else because he doesn't provide enough one-on-one attention to her. I don't like that by filling that gap, I'm allowing the OBs to continue with the sub-standard level of care that they have learned to provide. I do think that moms who for whatever reason choose to have a hospital birth should have the option to have support, and I do feel that doulas ARE necessary because many OBs and some midwives don't provide the level of care that mothers desire, but *I* don't like being the one to fill in the gap. I feel much more love and joy with a client who trusts me to provide for her physical care during pregnancy, as well as her emotional and mental care. I don't feel the sting of being trusted with only *part* of her care, and I feel like I am able to provide BETTER care when I can provide care for the WHOLE mother, baby, and pregnancy rather than just a section of it. So that's why I HATE doula work. To me, it's based on mistrust...mistrust of the OB to provide for all of her needs, and mistrust of the ability of a midwife to meet her physical needs w/o a medical degree. It pains me to pour myself and my knowledge and love into a client, only to have her turn to the doctor and his "expertise" during the labor and delivery.

It's important for me to say that this is my experience in my area of the country. There are other women in this same area who love doula work, although they do it exactly as I have just described, and there are other women in the country for whom doula work is an entirely different scenario than what I just described. And they are ALL doing a wonderful thing. It's just not something *I* can do and be happy about.

[Noelia430]

So are you saying that you don't like doula work in general or for you to provide doula work? And if you hate it so much then why do you do it?

[Charmie981]

I hate doing doula work. I did it enough to know that I hated it. I don't do it anymore. Others love it, and that's great because there's a need for it. But I'm not the one to fill that need ;).

[Apricot]

I think I've got what you're saying - you don't want to be someone's doula for their hospital birth, but you don't mind giving as much doula care as possible while being a midwife?

From my observation, sometimes the midwife has to do things that are contrary to providing support to the laboring woman. Taking hearttones, blood pressure, catching the baby, suturing, etc. all take the attention off mom's emotional and physical support needs. A doula doesn't have that split in her duties. Her attention is not divided. A midwife is responsible for the physical safety of the mother and baby and that primary responsibility sometimes takes away from providing continuous support.

My quickest explanation is that the Ob is for the bottom half of the woman and the doula is for the top half. With a midwife, that analogy doesn't work as well, but I'll throw it out there.

Doulas also provide more hours of support than most midwives (exceptions noted!). If you go into labor at 2 am, you may talk to your midwife every couple of hours until she arrives at 8 am, but your doula will usually come over before that.
For a hospital birth, the doula will usually meet you at home and go with you to the hospital if you need her then.

[Noelia430]

I hate doing doula work. I did it enough to know that I hated it. I don't do it anymore. Others love it, and that's great because there's a need for it. But I'm not the one to fill that need ;).
Gotcha!

[Charmie981]

I think I've got what you're saying - you don't want to be someone's doula for their hospital birth, but you don't mind giving as much doula care as possible while being a midwife?

We've totally hijacked this thread.

But, yes, that's basically it. I always felt like I was midwifing my doula clients, but I guess you could also say that I doula my midwife clients. Same basic concept, I guess.

I do agree that midwives do have to attend to clinical tasks at homebirths, but it seems like at a homebirth, the father is more likely to be up to the task of emotional support, and to do it effectively, than a father in the hospital is. At the births I've attended, the midwife assistant also fills the doula role at times...assisting with position while midwife is ready to catch, or helping mom nurse or relax while midwife is suturing. There *are* certainly clients that I would recommend they have a doula at their birth as well, and I would never suggest that a client NOT have a doula, but I'm much more comfortable with a homebirth w/o a doula than I am with a hospital birth w/o a doula.