You’re a doula - that’s like a midwife, right?

The frank answer is No. A Certified Nurse Midwife (CPM) or a Certified Professional Midwife (CPM) is a board certified medical professional. For example, a Certified Nurse Midwife (CNM) is a Registered Nurse with an additional minimum of a two-year Masters Degree in Midwifery. A midwife can oversee the healthcare of a woman in the areas of general women’s health including low-risk pregnancy and birth (including some VBACs). Most may attend births at free-standing birth centers, home births and hospital settings. Many developed countries in the world utilize a midwifery model of care for women’s health and childbirth and reserve Obstetrics for high-risk circumstances. Below is a comparison of number of midwives and obstetricians, respectively, in the US vs the UK.

US: 4,470 vs. 29,633
UK: 31,186 vs. 1,600

A Certified Birth Doula is a person trained for labor support. They provide continuous emotional, physical and informational support as well as reassurance and communication facilitating between their clients and healthcare providers. They do not perform clinical tasks, give medical advice, diagnose conditions or “catch” babies. A doula works to support birthing mothers in the type of birth they want and help meet those goals however that may be desired by the expectant parents. Depending on the certifying organization, most doulas fulfill a required amount of training through a mix of in-person and self-paced curriculum in order to receive certification.

One reason a Midwife and a Doula may be mistakenly interchangeable is the model of care and birth philosophies that each commonly practice and believe. Both typically regard birth as a normal event and support the physiological process of birth rather than the point of view that birth is something to be managed. They reserve interventions on an as-needed basis and work to find resolutions that work with the woman’s body before introducing more invasive solutions.

Aren’t doulas only for home births?

No. Doulas are a great resource for navigating the unfamiliarities of a hospital setting. The majority of births I have attended are hospital births.

Are doulas only for unmedicated births?

No. Though doulas may be very beneficial for those desiring a low-intervention birth, there are also many aspects of introducing interventions such as pain medication or induction methods in which doulas are VERY helpful. In a number of ways and in some circumstances, it may be argued that a doula is even more valuable in helping families navigate the unfamiliarities of a more medicalized birth - providing suggestions of new comfort techniques custom to the intervention, progress techniques, position changes, coping with side-effects, giving partners a respite, providing suggestions, normalizing what is taking place, aiding in decision-making and communicating with hospital staff.

Will a doula replace my partner?

No, a doula should not. A doula should discuss the level of involvement the mother and her support people each desire. Then a doula works to help partners support the mother to the degree that they wish and are comfortable. The support of those relationally close to the mother is of utmost importance. Interestingly, in one study conducted of women and male partners who were randomly assigned a doula or routine care, the presence of a doula was rated Very Positive by 93% and Positive by 7%. A doula’s focus is on the partner’s needs close second after the mother’s. A doula values the well-being and experience of the support people and seeks to alleviate any stressors they may have leading up to and during the birth.

What about Labor and Delivery nurses?

Labor and Delivery nurses are a vital role to the birth team for the care of both the birthing mother and baby as well as the experience of the support people. No doubt. Research has shown, however, that the amount of direct support expected from birthing mothers from their nurses differs from the actual direct support a nurse may be able to give. Where surveyed women expected approximately 50% of the nurse’s time to be spent giving direct support (45% clinical tasks and 5% other paperwork), actual times were between 6-12% of direct supportive care and 50-75% of the time they were not with the patient. Another study in the U.S. indicated that only 31% of the nurse’s time was in the patient’s room. This can be due to a number of barriers perhaps outside of the nurse’s control, but under most circumstances, labor and delivery nurses might not be able to provide or might not be trained in continuous labor support.

What about hospitals that are currently only allowing one visitor? Are doula’s “allowed” to attend?

As we know, COVID-19 has changed the daily operations and dynamics of many healthcare facilities. Also, as we know, policies can change quickly and, seemingly, without exception. As of Spring 2022 many hospitals that have a “one visitor” policy have a clause for mothers who also have a Certified Birth Doula as part of their team. For those hospitals that do not honor the presence of a Certified Birth Doula, I would recommend a correspondence with the Hospital’s patient advocacy department to voice concern for long-term maternal experiences/familial well-being and birth outcomes for families desiring the specific continuous support of a Birth Doula.

When in my pregnancy is the best time to hire a doula?

As soon as you have the idea that you would want one. 1) Doulas are in demand and their calendar can fill up quickly, 2) you will benefit from her resources and insights throughout your pregnancy 3) yet, it’s never too late to inquire even if you are ready to have that baby any day. Depending on how many births a month a doula takes on, they’re on-call schedules don’t want to overlap too aggressively, so it’s good to get one before they book up. Also, a doula plans her personal life around her on-call schedule (family vacations and other life events), so it can be timely to book a doula before they make their plans. I have had repeat clients call me the day after they discover they are pregnant. The honor of being a doula is that you might know about a pregnancy literally before anyone else.