• Paula Schnebelt

Doulas VS. Midwife-- what's the difference anyhow?

I have had so many people try to use these terms interchangeably, so I’m going to do my best to explain the differences between the two because the distinction is important, especially to women seeking more information regarding their birthing options. A doula, for starters, is not a medical professional. Doulas offer informational, emotional, and physical support to a mother and her family throughout a pregnancy, during labor and delivery, and in some cases, postpartum. Doulas are great for both hospital and out-of-hospital settings; however, I think that any woman that desires a hospital birth should hire themselves a doula to help educate them, support them, and be their advocate. It is common for laboring women to get taken advantage of in hospitals through coercion by the medical staff, and a doula can help guide parents through any challenges that present themselves.

Doulas also offer continuity of care that is not usually possible in hospitals. The nurses work in shifts, so they may leave during your labor, and your doctor is usually whoever is on-call at the time and might not necessarily be the doctor you are familiar with. By having a doula who has gotten to know both you and your partner/family throughout your pregnancy, you have someone present with you that knows your fears, limits, hopes, expectations, desires, etc. and can do the best they can to help you have a positive birth experience in the hospital.

A midwife, on the other hand, is a trained medical professional that works with her clients throughout pregnancy, labor and delivery, and postpartum. There are various kinds of midwives, and the laws for what they can do vary state by state. In a hospital birth setting, you will most likely encounter a Certified Nurse Midwife (CNM), who is a medical professional trained in both nursing and midwifery. In a home birth setting or birth center here in California, you will likely receive care from a Licensed Midwife (LM), who is a medical professional trained solely in midwifery, but licensed by the same board (the Medical Board of California) that licenses physicians. A CPM, rather than a physician/OBGYN, may deliver your baby in the hospital. One of the great things about hiring an LM, though, is the same reason mentioned above; continuity of care. Your LM will basically be your primary care provider throughout the entire pregnancy, labor/delivery and postpartum process and in many ways, shares some of the same roles of a doula, minus their ability to perform certain medical procedures.

Licensed midwives do not have hospital privileges and in California, only operate in out-of-hospital birth settings whereas doulas, because they are not medical professionals, can practice in any setting, which is why they are a great resource for women seeking a hospital birth. It is also common for Licensed Midwives, particularly those who attend home births, to have a birth team that may include a doula or two. This is beneficial to the laboring mother because it provides her with some extra emotional/physical care during her labor if the midwife is focusing on other responsibilities, or in the case of an emergency, there are properly trained individuals in the room to assist.

Overall, if you are considering an out-of-hospital maternity care provider in California, a Licensed Midwife is most likely your best option for someone trained in the midwifery model of care. And if on the other hand, you are seeking a hospital birth setting, research your options and consider hiring a doula to be present with you during your pregnancy and labor/delivery process. Research has shown that having a doula can positively impact your birthing process in many ways, including lowering the cesarean rate, intervention rate, use of pharmacological pain management, etc.


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