Midwife vs Doula: What Are Their Roles?

As a doula, I get these questions all the time.

So, what is the difference between a midwife and a doula?

I'm having a midwife, so do I need a doula as well?

Can I just hire a doula instead of a midwife?

Can't my midwife be my doula?

These are great questions to ask, and so here is the deep dive today on what each of these roles entail to help you decide who you would like to be present at your birth.

Birth Team

Just like on any team, your birth team is comprised of various people who will play various roles. Some people you have the privilege of hand selecting, and others you may not since it is whoever is on call or working that day. Keep in mind while you do get to choose who your provider may be by choosing what practice you would like to see, whether it is OB or midwives, be aware that you may not be able to pick who will be present at your birth since a practice does typically have a call rotation schedule.

A typical birth team may consist of:

Husband

Doctor/Midwife

Nurse(s)/Birth Assistant

Doula

Photographer

Any family member/friends you would like present at the birth as well

Now keep in mind while some roles of each person may overlap, each person on your team has a specific role they are tasked with. In a hospital birth the nurses are tasked with keeping an eye on the mother and baby's vitals throughout the course of labor, while the doctor or midwife will only come in occasionally to check in and will mainly be present at the very end when it is time for the baby to be born. At a home birth, the midwife and her assistant will arrive later in labor when the mother is nearing time to push. In neither situation does the doctor/nurse/midwife stay the entirety of labor.

Your husband/friends/family can be present throughout the entire duration of labor, from the very beginning of early labor to the postpartum period and going home. Your doula will arrive at some point once labor has been established and will depart once you have been settled after giving birth. Do keep this in mind when deciding who will be a part of your team.

Midwifery Model of Care

The word midwife literally means "with woman" (I will go into more depth with a later post about what the midwifery model of care looks like verse your typical OB care). A midwife is your main provider for you throughout your pregnancy, birth, and postpartum period. A homebirth or birth center midwife is also your newborn's main provider for the first 6 weeks of their life as well. During the birth, her job is to make sure that both mother and baby are healthy and doing well during labor. While some midwifes will provide different labor positions to try, they will not remain with the mom throughout the entire course of labor. Her role is to watch and guide, not hands on support.

Once the midwife arrives, she will provide vital checks for mother and baby make sure the mother is well, and then step out to keep her charts and listen for when the mother has begun to feel/sound pushy. While she doesn't leave the house, she isn't always in the room, but a shout away if needed.

Midwives remain with the family through the birth and up to 4-6hours postpartum. They will clean up the room, make sure baby and mom are healthy and well, and help with the initial breastfeeding.

Doula

The word doula means "handmaid". A doula is a non-medical birth professional who is knowledgeable in birth positions, stages, and comfort measures. Her role is to care for the mother and her husband through physical comfort measures, providing emotional support, and being an additional resource to utilize throughout pregnancy and postpartum. Most doulas arrive once labor has been established and will typically arrive before the midwife does.

The doula can stay in the room the entire labor and will provide the husband with a much-needed break. She will fetch water and food when needed for the family as well as provide words of affirmation and encouragement to both the husband and wife.

Doulas remain with the family through the birth and up to 1-2 hours postpartum. They will make sure the mother has her food after birth, help do light clean up with the mother's items, take photos during/after the birth, and can help with the initial latch.

They are Different Roles

At the end of the day, midwives and doulas do have different roles, and for good reason. Midwives have to chart what is happening with the mother and make sure mother and baby are always sounding good. She can assess where baby may be positioned and from there make some suggestions of what positions for the mother to try to help encourage baby to move along. Her role does truly begin once baby has been born, checking mother and baby's vitals, checking on mother for her postpartum bleeds, taking care of the placenta, and performing the newborn exams. For this reason, a doula is there for the hands on and comfort of the mother. She has the ability to take photos throughout labor and the birth, apply much needed counter-pressure, and suggest different positions to try to help encourage baby to do what baby needs to do to come into mother's arms.

Midwives and doulas may have different roles, but they work together to help mother and her family to have the birth experience she desires.

Should I Have Both?

This is completely up to the mother, and there really is no right answer. At the end of the day, it is up to what the mother wants. It is good to know what the role of each person is before making the decision to be clear on what each person will and won't do, so there is no assumption. I have heard of mothers who only hired a midwife, assuming they would also play the role of a doula, which was not the case, and they were disappointed. I've also had women ask about just hiring a doula and not worrying about a midwife. Some doulas may be comfortable with that, but keep in mind they still don't do vitals or check baby's heartrate.

It's also good to check with your midwife as well. Some will have doulas they strongly recommend, but some also may require first time moms have a doula because they know how long a first-time labor can be.

Some moms may not be able to afford both. If that is the case but you still desire the added support, talk with local doulas to see if they can either provide a payment plan, can barter services, or see if you can set up a doula fund on your baby registry.