what does a doula doIf I had a dollar for every time I’ve heard this question, I could fund doula support a few times over! The short answer is no, doulas and midwives perform different roles. The midwife’s role is clinical while the doula’s role is not. Although it’s frustrating to be asked this repeatedly, I know it’s not the public’s fault. As a society, we have failed and are failing our pregnant and birthing people and their babies so miserably. I know that sounds overly dramatic. But I’m a big-picture thinker and I view this question as a symptom of an illness. In this case, the illness is miseducation regarding reproductive health. The issue is deep and wide and it starts with the lack of information given to young people about their bodies. For parents wondering how to start, I recommend this book. Today though, I’ll focus on my particular area of expertise–childbirth–and set the record straight regarding the roles and qualifications of childbirth professionals.

If it were up to me, I would banish the term midwife altogether. I will be the first to admit this is a blasphemous and problematic statement. I would never want to fail to give homage to the grandmother midwives who had their knowledge, traditions and very identities stolen from them, and whose care of rural women and their families brought the midwifery field to where it is today. But let’s face it: midwifery has a big public relations problem to solve. No one understands their role. And yet, I believe their philosophy of care is powerful and that it holds the solution to so much of the suffering that goes on in the birth realm today.

Part of the reason people don’t understand what midwives do is that they attended only 8.3% of all births in the U.S. in 2014, which is the last time data was collected. More than 90% of those births were attended by certified nurse midwives or certified midwives. Both CNMs and CMs have full legal and educational qualifications to practice medicine in hospital settings. They do everything OB-GYNs do, save for Cesareans and instrumental deliveries using a vacuum or forceps. There is an obstetrician on call 24/7 at any hospital with a labor & delivery unit to perform these functions. Midwives have extensive training in spotting problems and know when these measures are necessary, and they can be life-saving. CPMs (certified professional midwives) specialize in out-of-hospital birth and are licensed in 33 states to perform clinical birth care. They are not licensed to practice in a hospital, but they are able to work collaboratively with hospital-based care providers to provide safe, quick transfers when necessary.

So if it isn’t clear by this point why you would work with a midwife and a doula simultaneously, it’s that doulas do not perform any clinical tasks, such as cervical exams, administering medications, or helping you physically give birth to your baby, i.e. “delivering” or “catching.” Doulas do, however, help you through the process emotionally, more like a labor coach, providing support, helpful tips and resources during your pregnancy and early labor, and accompanying you continuously once you head into the hospital to give birth to your baby. We also provide up to a couple of hours of support in your birth setting after your baby is born, helping you get settled in as a new family and getting you off to a good start with feeding/latching. We visit you a few days after the birth as well to see how you’re adjusting, answer common newborn questions, and connect you with resources if needed. We are also able to provide the same level of care for home births but we do not ever replace the role of your midwife, regardless of the setting you choose for your birth. It’s helpful to have both of us as a part of your team because one of us focuses on the health and safety of you and your baby, while the other advocates to make sure your emotional and physical needs are met. Read more about the doula role here and here.

If you have more questions about the roles and how midwives and doulas work together, feel free to drop a comment or get in touch! I am happy to help you understand this topic more deeply.

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