I get this question a lot – which is really unfortunate because the roles of a doula and a midwife are REALLY different. Honestly, I think people misunderstand midwives for the most part, but let’s talk about midwives vs. doulas and what the difference is. While we’re at it — let’s throw in labor nurses, how do they function in the middle of all this?
Oh, and how do I know so much about it? Hi — I’m Hilary, many people know me as The Pregnancy Nurse. I have been a nurse since 1997 and have 20 years of labor and delivery experience — including with midwives and doulas. Well, I’m a great resource for that!
Real quick, doula or no doula I recommend EVERYONE take a birth class. I recommend this. Thousands of couples agree (seriously, these reviews 🤩).
What is a Doula?
A doula is someone who helps you through a difficult process. This article is specifically talking about LABOR doulas, but there are:
- Hospice/Death doulas
- Postpartum doula
Honestly, if you google there are doulas for all occasions.
Funny since I was actually a hospice nurse before becoming a work nurse…. maybe it’s in my blood too?
Doulas do not need to be licensed, certified or anything else. Anyone can say they are a doula for any reason. Which makes it really difficult.
So — when it comes to a birth doula, they help support you in a few different ways:
- Answer basic questions
- It helps you better communicate with your healthcare team
- Pain management
- Baby placement management
The only thing they are NOT allowed to do is anything medical. This means they cannot do anything medical or give you any medical advice.
This means they should NOT check your cervix, give you IV fluids, talk about the medical choice you need to make (although they can talk about options they have seen). This is the BIG difference between doulas and the other people in this article.
Doulas can practice in homes, hospitals, birthing centers…. (he’s basically just the patient’s visitor).
🚩🚩🚩 It’s a real red flag if you see a doula talking about medical advice. It’s not their place and it can be extremely problematic. When looking for a doula, you want to be sure they stay away from this area.
Want to learn more about doulas, check out these posts:
What is a Midwife?
Midwives deliver babies. They perform (or order) interventions during pregnancy, labor and delivery.
Here is the real problem. There are three main types of midwives (names vary by state, but these are the main categories):
- Lay Midwives — those people who have just seen/assisted in many births but have no license or formal training. Most of the time they are delivered to homes.
- Professional Midwives — these people have gone through a training program and may be licensed (depending on your state). Most often they are delivered to homes or birthing centers.
- Nurse Midwives (more formally called Certified Nurse Midwives, or CNM) — these are nurses who have gone on to master’s, sometimes doctoral, training to become midwives. They are licensed and deliver at birthing centers or hospitals, most of the time. They are actually trained to assess babies as well.
We sort of refer to all three of these departments as “midwives” – which, frankly, is really unfair because nurse midwives have a TON of training and basically a “residence” where they deliver hundreds of babies under a coach.
In the hospital, most of the time you wouldn’t be able to tell the difference between a Nurse Midwife or an OB for the most part. However, I am a HUGE fan of nurse midwives because….
- They are often born in a more natural pattern
- They often help out more during labor and tend to stay in the hospital longer while patients are in labor (think of it as extra hands in the delivery room)
- They tend to take a more holistic view of you and your birth (they often spend more time with you and at your appointments).
That’s not to say I’m not a big fan of OBs, but My favorite is a practice where the midwives take the low-risk patients, and then if that patient needs a higher level of care, they can see an OB or transfer their care to them (in the same practice) if necessary.
I talked about this on my podcast with one of my favorite midwives:
I think midwives often allow us to do more of the interventions that doulas often help in the delivery room. You’ll see them help more with physical pain management, educate more, and help with positioning more — similar to a doula.
I find that many people (especially mums/grandmothers) think that midwives only deliver at home, so when someone chooses a ‘midwife’ for their care, they get angry. Feel free to send them this podcast for more information on this!
What does a work nurse do?
Well, while we’re here — what does the nurse do then?
In general, your birth nurse is your birth advocate, she also carries out doctor’s or midwife’s orders and takes care of your hospital stay.
They can’t order medical interventions, but they can request and perform them (think IVs or giving medicine).
They can position you, they can help you manage the pain. However, often labor nurses have more than one patient and may assist in other rooms if problems arise. They help when they’re there, but they’re not always there — if that makes sense.
So, what is the difference between a doula, a nurse, and a midwife?
A lot of this has to do with scope of practice. We use this term a lot in medical settings — it just means what we’re “allowed” to do.
A midwife can only support, she must not do anything medical.
A nurse can assess, carry out and request orders, but must not make orders herself.
A midwife can make orders, support and assess.
Personally, we never had the money for a quality doula during my childbearing years. We needed to save that cash to survive after the baby was born.
However, I think they can be so useful. However, good things usually come with a big price.
What I tell friends:
Join a great midwife practice (bonus if the practice also includes OBs who can help if you’re at higher risk) and use it.
Your insurance should cover the midwife’s care. Your midwife will help you with many of the interventions a doula can do during labor, educate you more at your prenatal appointments, and hopefully during labor as well.
Of course, this is no reason NOT to take a birth class, I recommend this one.
I also have to say that I have seen a lot of really bad doulas. I have no idea how much experience they had (if any) but they were not helpful to their customer and in some cases made everything worse. As I said above, anyone can call themselves a doula — so as hospital staff we never know what we’re getting when someone says they’re a doula.
Versus a nurse practitioner or a CNM — we know these people have at least a basic level of training. The same cannot be said for doulas.
There are bad midwives just like there are bad RNs or birth nurses (or doulas)… so be sure to shop around and find the one that “fits” well. Some are just as medical as an OB, so they differ quite a bit.
Briefly
Midwives deliver babies.
Nurses assist in the duties of a doctor or midwife.
A doula is a support for labor but should not do anything medical.
Hope this helped. I would love to see the midwives be a bit more separated, because they really are very different, but for now that’s what we have.
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