Midwives and doulas have become slightly more mainstream in the U.S. over the past few decades, but there is still much confusion as to what exactly their roles are. Women often ask why they need a doula if they are planning to have a midwife. Another common question is why they would need a doula if their romantic partner is planning to be the birth companion during labor. The truth is that each of these people have a specific and important role to inhabit during the birthing process and these roles are very different.
A midwife is a medical professional, much like an OB/GYN solely in terms of her ROLE in pregnancy and labor. A midwife is trained through years of schooling to provide any necessary medical care during pregnancy and her license authorizes her to catch the baby when it comes time for labor. (Not to be weird, but I don’t like using the expression “deliver the baby” because the mother is the one delivering the baby … not the doctor or midwife. Even through the language we use, I think the power should stay where it belongs, with the mom.) Certified nurse-midwives can do many of the same things as doctors, meaning they can perform gynecological exams, provide prenatal care, administer pain medications, give labor-inducing drugs, monitor the fetus using electronic equipment and perform an episiotomy and stitch tears. Here is where the similarities with modern obstetrics end, however. Midwifery, in contrast to the medicalized model of birth, is woman-centered. It produces birth professionals with expertise and skills in supporting women to maintain healthy pregnancies, have optimal births and have the most favorable recoveries during the postpartum period. Here is a statement from the Midwives Alliance North America:
“The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:
- monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
- providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
- minimizing technological interventions and
- identifying and referring women who require obstetrical attention.
The application of this model has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”
In contrast to a midwife, a doula is not a medical professional, but her role is just as important. A birth doula is basically a birth coach, trained in all sorts of non-medical techniques to help a laboring mom feel safe and empowered throughout the experience. Doulas provide continual, uninterrupted support during the length of the labor, responding to mom’s physical, mental and emotional needs as they arise. A doula is always asking herself “What is going on for mom at this stage of her labor and how can I best support her?” This can come in the form of physical support: providing comfort measures for pain management, such as massage, hot packs, ice packs, or breathing exercises, and even reminding mom that she might need to eat, use the bathroom or simply rest. One of the most important ways in which a doula can provide physical support is by suggesting position changes based on where the baby is in the pelvis or if a position is not producing any progress. The majority of unplanned cesareans are performed due to “failure to progress,” which means the baby essentially gets temporarily stuck in the pelvis, and the doctor either doesn’t have the time or doesn’t know how to help mom and baby get into a more favorable position for descent. If mom is encouraged to move, squat, perform a lunge, allow an “abdominal lift” or a side-lying release for a few contractions, it often provides just that extra little bit of space so baby can wiggle his or her way down further in the pelvis. This provides a feeling of accomplishment for mom and less birth trauma for baby.
Mental support from a doula might involve coaching mom through visualization exercises, or explaining what could be happening at any given time so mom or her partner can better advocate for themselves. Preserving the memory of the birth is another way in which a doula provides mental support, as she can often fill in fuzzy details for the new parents later during the postpartum visit. Finally, a doula provides emotional support through constant reassurance and encouragement. She takes charge when mom loses her rhythm until mom can get it back. If mom loses faith in herself for a moment, a doula is there to remind her that she is strong enough to deliver her baby. Often what is needed is some sort of change, whether it be positional or environmental, and a doula can provide knowledgeable guidance. After birth, postpartum doulas help a new mother as she recovers from the birthing process. This includes caring for the infant and guiding a mother through the breast-feeding process.
Benefits of having a doula:
A birth partner (husband, wife, partner, etc) has a large supportive role during labor, but unlike a doula, lacks the specific training to help mom with position changes and pain management techniques. A doula will often coach the partner in how to better support the laboring mom, so rather than the doula being the focus, the focus can be on the bond between mom and her partner. As the partner has a very personal investment in the birth process, s/he might get anxious or overwhelmed and be unable to help mom effectively. A doula has the professionalism and experience to handle emotional situations with a sense of calm, and can often step in to provide the necessary support until the partner can once again participate. A doula can be helpful for the partner as well as for the birthing mom.
The childbirth year is a time of a woman’s life during which she should have an abundance of support. A doula, in addition to a midwife and labor partner, can play an integral part in helping a laboring mom to feel as empowered as possible and to have a more positive birth experience.