I already have a Midwife, so why do I need a Doula?
I hear this question a lot and I think it’s a great one! Some people don’t fully understand the difference between the roles of a midwife and a doula, while others realize they aren’t the same, but figure that their midwife will do all the “doula” stuff anyway, so they don’t see the need to have both.
First, let’s clarify the distinct roles of these two types of birth companions:
A midwife is a trained medical professional who can perform all the clinical tasks related to the safe delivery of a baby in a normal and low-risk pregnancy. This means that your midwife will monitor the health of you and your baby from the prenatal period to postpartum and everything in between. As your care provider, a midwife may work closely with nurses, doctors, and assistants, but is fully capable of handling whatever medical care you may need during your labor and vaginal birth.
A doula, however, is not a medical professional and is not trained to do clinical tasks, assess your health, give medical advice, or help with the delivery of your baby. Instead, a doula’s role is to help support you emotionally and physically during your labor and delivery. This can take many forms, but ultimately means that they will be with you for the duration of active labor, while also giving you encouragement, providing comfort measures such as counter-pressure or massage, recommending great positions, holding positive space, reminding you of your strength, guiding your breathing, suggesting food, drink, or bathroom breaks if needed, and helping you stick to your birth plan when you may not even remember what a birth plan is.
So, the question remains...can a midwife do all those things as well as their designated medical tasks? Maybe. But maybe not. Some midwives work in a birth clinic or hospital and may have multiple clients in labor at once or may need to see patients for prenatal or postpartum visits while you are in labor. In these cases, the midwife will not be able to stay with you for the duration of your labor. Even if her caseload is fairly low, she may be occupied with charting or office work. Most midwives will check on you periodically, but do not necessarily stay by your side during 100% of your labor.
If you are planning to be at a birth center or are having a home birth and you need to transport to the hospital, your midwife may not be able to accompany you or stay with you for the remaining portion of your labor, but your doula will. In a situation like this, you and your partner will appreciate having the familiar face of your birth companion at your side. It truly can make a big difference in your emotional well-being and will help make the transition easier.
Even if your midwife does intend to be nearby or in the room with you during your entire labor and birth, it does not mean that they will be planning to do all the “doula-y” things mentioned above. Many midwives do not consider those tasks to be part of their job description or may do some of those things, but not all. Furthermore, if a midwife is busy diagnosing or helping to manage any medical tasks or emergencies for you, then they by default would not be able to attend to your emotional needs or comfort measures, as their clinical tasks would take priority.
Please don’t get me wrong, most midwives are very caring and will often lend a tender hand to their laboring patients, even beyond their technical medical care. But midwives and doulas definitely make great teams and tend to work best when they are each able to give the support that they are specifically trained to do. In fact, most midwives appreciate when a doula is present, as they know that their patient is in great hands and getting the emotional encouragement they need, even when the midwife is busy elsewhere or is focusing on keeping you healthy!
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Waterbirth with Midwife and Doula