What’s the difference between a Midwife and a Doula?

Like most doulas, I’m a member of several private groups for birth professionals. One of the topics that comes up frequently is the “does this sound like she thinks I’m a midwife?” post. Usually it starts with a mother contacting a doula, and having the usual “I’m interested in doula care” conversation, when suddenly it takes a different turn. “What can you give me for my morning sickness?” “How many babies have you caught?” “Do you know how to flip a breech baby?”. These questions leave us in an awkward spot. We certainly don’t want to overstate the obvious, but we also don’t want to disappoint a client under the assumption that we’re practically midwives, nor do we want to shoulder the legal and ethical quagmire that is stepping out of scope (unless, of course, we are midwives as well. Or monitrices.). It can be confusing, understanding the differences. Which also contributes to another phenomenon, the classic “I don’t need a doula, I have a midwife.” speech. I once gave that speech myself. I couldn’t understand what a doula could do that my midwife wasn’t already available to do herself.

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The truth is, midwives and doulas are extremely complementary. We’re two sides of the same coin, and often work very well together. But there are several key differences. Areas where our scopes of practice just don’t match. For clarity’s sake, in this post the scope of a Midwife is defined by local standards (Ontario) and the scope of a doula is defined by that of doulas certified by most leading organizations.

The level of education obtained by midwives and doulas could not be more different. A certified nurse midwife is a medical practitioner, with the level of education one would expect. They go through the entire process of becoming a registered nurse practitioner, go on to take graduate studies in midwifery, and follow that up with apprenticeship. They’re licensed professionals who are held to a very high standard. In essentially all matters but surgical, your midwife can provide the same quality of care as an Obstetrician.

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The education of a doula is a very controversial topic. Those who claim we’re an unnecessary addition to the delivery room love to point out “anyone can just walk in off the street and call themselves a doula!”. This is technically true. We have no standardization. Does this make us unprofessional? Absolutely not. Historically, “women’s work” professions have a long way to go to be considered valid. The “any one can just walk in off the street!” comment also applied to midwives not long ago, and is still uttered by detractors in areas where direct entry midwives are legal. Doulas are fighting a battle to be considered true birth professionals as we speak.

If education and training are important to you, ask your doula what kind of training she’s had. Right now, abiding by strict training guidelines is voluntary. Your doula may not be trained at all. She may have trained organically, by self study and apprenticeship. Or she may have chosen formal education. As a doula who chose formal education, I can tell you I absolutely did not walk in off the street and call myself a doula. I signed up to cross certify, with one international birth professional organization and one internationally recognized collegiate level education center. Together adding up to three years worth of training materials. I read a long list of required reading, performed and submitted two assessments of local resources, sat through hours and hours of lectures and assignments, took two exams with a pass threshold of 85+%, and attended a minimum of 12 prenatals, 12 postpartums, and six births while collecting evaluations on my performance from the entire birth team. This doesn’t even touch on continuing education, the constant research, and three other sub certifications I hold. Certified doulas are highly trained professionals, but we are not standardized. Nor are we trained medical professionals like midwives.

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Our scopes cross over at many points, but differ in the level of personal involvement and medical support. If you’re feeling anxious at 3 am, you’d call your doula. You can invite your doula to your home for a back rub and a chat. You can chit chat with her about baby names and your sex life. You can get non clinical advice from her.

What she won’t do is catch your baby. The only circumstance in which I would ever catch a baby is in an emergency where I am the most highly trained person in the room. In practice, this would mean I arrive to a home birth before the midwife, I call 911 and they do not arrive in time, AND both parents are unable to catch for emotional or medical reasons. That’s a long list of qualifiers! I have yet to catch a baby and I hope I never do. A doula delivering your baby implies things are certainly not going according to plan.

Your midwife, however, is a pro baby catcher. She can prescribe medications, perform procedures, check fetal heart tones. She addresses a whole world of maternal fetal health for which I am unqualified. She has incredibly important tasks to perform. Which is exactly why we mesh together so well. Your midwife cares tremendously about your wellbeing. So does your doula. But your midwife is responsible for the health of you and your baby. She can’t possibly attend to a medical emergency while also holding your hand and talking out options. That’s where your doula comes in.

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What does that look like in practice? In an uncomplicated labour, where both Midwife and doula are available to support their client/patient, we help each other. I’ve been asked to tie scrubs, hold lamps, each take a side and lift a patient up to change positions or use the washroom. I’ve helped change bedding, fill bathtubs, and I’ve given amazing three person massages with the midwife and patient’s partner. We help each other, because we have a common goal.

When the Midwife is preoccupied with an emergency or delivery, the doula cares for her client’s comfort and confidence. When an emergency intervention becomes necessary, and there’s no time for the Midwife to discuss it in depth, your doula will be there to explain the details and hold your hand. When the Midwife is busy catching your baby, your doula will be there supporting your weight, squeezing your hips, telling you about all the great work you’ve done. And when you’re meeting your child and your Midwife has placentas to catch and tears to suture, your doula will be there to cry and laugh with you, take pictures, and facilitate your first feeding.

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Midwives and Doulas exist in a strange space. We could not possibly be both more different or more similar. It may get confusing, and that’s okay. You’re allowed to check in and ask “Is this in your scope or hers?”. We’re two sides of one coin. Medical care on one side, emotional and comfort care on the other. Each side focused entirely on your wellbeing.

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